HL7 IPS - User contributions [en]

IPS implementationguide 1

2023-07-19T15:36:05Z

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<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
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This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''International Patient Summary''' (will be incorrect/inconsistent at times).<p/>
See the [http://www.hl7.org/implement/standards/product_brief.cfm?product_id=483 Directory of the published standard].
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{{Infobox_Document
|Title = HL7 CDA® R2 Implementation Guide<br/>International Patient Summary<br/>STU Release 1 (Universal Realm)
|Short = International Patient Summary
|Namespace = cdaips
|Type = Standard for Trial Use
|Version = 1.86
|Sponsored = 
|Date = October 25, 2018
|Status = Final
|Period = STU
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = © 2018 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_INTLPATSUMMARY_STU_R1_2018OCT
}}

{{:HL7_Important_Note}}

{{:IPS_Authors_and_Contributors}}

__TOC__

{{:IPS_Introduction_1}}

{{:IPS_Technical_Background_1}}

{{:IPS_Functional_requirements_1}}

{{:IPS_Design_conventions_and_principles_1}}

=Conformance clause=

This section references the requirements, criteria, or conditions to be satisfied in order that a product (tangible) or a service may claim conformance to this guide, and how other artifacts may claim compliance with it. (Note: The concept of conformance and compliance are used coherently with the HL7 Service-Aware Interoperability Framework: Canonical Definition Specification, Release 2<ref>HL7 Service-Aware Interoperability Framework: Canonical Definition Specification, Release 2 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=3</ref>. The fulfilment of these clauses indirectly assures that a product that is the subject of a “conformity assessment” satisfies the business or the design requirements this specification complies to. It should, however, be clear that compliance with the specified business or design requirements, for example in the future with the CEN prEN 17269 IPS, does not imply that the compliant implementations are technically interoperable. A “conformity assessment” is a process that assesses that any proposition that is true in a given specification is also true in the service or product that implements it. In most real-world cases conformance testing objects are used to technically validate the products. These objects provide a great help in the validation of the instances, even if they are most often not sufficient to guarantee the functional/ semantic conformity: many real-life examples can be made about instances that are technically valid, but not clinically meaningful or correct.

<ref group="Figure" name="ipsworld"></ref> below depicts how this concept applies to the business requirements, the current and hopefully future IPS projects standards (CEN/TC 251 and HL7) and other related artifacts involved in this assessment chain. (see section [[#Relationships with other projects and guidelines | Relationships with other projects and guidelines]] for a description of the standards developed by the CEN/TC 251 IPS project )

{{IncludeImage|IPS_world.png|700px|80%}}

<ref group="Figure" name="ipsworld">The IPS World</ref> The IPS World

The "rules" and processes for refining the standard through constraint and extension, including which standard artifacts are subject to constraint or extension; the definition of constraint and localization profiles; the criteria for establishing a conformance statement; and the principles guiding who may define extensions to the standards and under what circumstances they apply to the CDA standards are defined in §1.3 CDA Conformance of the CDA and detailed in the HL7 V3 Refinement, Constraint and Localization section (see the CDA R2 Standard<ref>CDA R2 Standard http://www.hl7.org/implement/standards/product_brief.cfm?product_id=7</ref>).

This guide does not provide additional requirements regarding the Recipient and the Originator Responsibilities.

The formal representation used in this implementation guide for expressing the conformance statement is described in chapter "How to read the table view for templates" of this guide and makes use of a tabular representation that may include also computable or textual constraints. The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

The HL7 Templates Standard: "Specification and Use of Reusable Information Constraint Templates, Release 1" defines also how derived templates may relate to the templates defined in this guide for example:
*Specialization: “A specialized template is a narrower, more explicit, more constrained template based on a “parent” template.
* Adaptation: “The adapted template is “based on” the original template which means it can be an extension or a specialization (restriction) of the original template design.”
* Equivalency: “two templates have the same purpose and the same design; however, their governance and/or metadata and/or details of their design may be different.”

Based on this the following way to use this guide may be considered :
* IPS as a document: the conformance is asserted at the document level. All the rules defined by this guide, or by a specialized IPS document level template, are fulfilled. Implementers may take advantage of the template openness to better support specific cases - “extended” parts, however, may not be interoperable among them.
* IPS as a library: the conformance is asserted at the section or the entry level. The templates are used as a library to build, for example, new cross-border documents. For example the immunization section may be used to build an electronic implementation of the WHO yellow card for vaccinations; or the IPS section templates are used to communicate to the country of affiliation minimal and non-exhaustive information about the encounter in which the Patient Summary has been used (cross-border encounter report ). Implementers may take advantage of the template openness to better support specific cases - "extended” parts, however, may not be interoperable among them.
* IPS as a reference: the implementation is conformant with templates that are an adaptation of or equivalent to those defined by this guide. In this case some of the rules defined by this guide are not fulfilled and the conformance cannot be asserted. However, differences may be limited and the effort required to achieve the harmonization may not be not large. Typical examples are templates in which alternatives vocabularies are used.

Jurisdictions may also decide to impose the closure of the template in order to limit the implementation optionality. This should be carefully evaluated in terms of the flexibility of the solution.

{{:IPS_Alltemplates}}

{{:IPS_Appendix_1}}

=List of all artifacts used in this guide=
==CDA Templates==
*[[2.16.840.1.113883.10.22.1.1]] International Patient Summary
*[[2.16.840.1.113883.10.22.2.1]] IPS CDA recordTarget
*[[2.16.840.1.113883.10.22.2.2]] IPS CDA author
*[[2.16.840.1.113883.10.22.2.3]] IPS CDA custodian
*[[2.16.840.1.113883.10.22.2.4]] IPS CDA legalAuthenticator
*[[2.16.840.1.113883.10.22.2.5]] IPS Patient Contacts
*[[2.16.840.1.113883.10.22.2.6]] IPS CDA documentationOf
*[[2.16.840.1.113883.10.22.2.7]] IPS CDA relatedDocument
*[[2.16.840.1.113883.10.22.3.1]] IPS Medication Summary Section
*[[2.16.840.1.113883.10.22.3.2]] IPS Allergies and Intolerances Section
*[[2.16.840.1.113883.10.22.3.3]] IPS Problems Section
*[[2.16.840.1.113883.10.22.3.4]] IPS History of Procedures Section
*[[2.16.840.1.113883.10.22.3.5]] IPS Immunizations Section
*[[2.16.840.1.113883.10.22.3.6]] IPS Medical Devices Section
*[[2.16.840.1.113883.10.22.3.7]] IPS History of Past Illness Section
*[[2.16.840.1.113883.10.22.3.8]] IPS Functional Status Section
*[[2.16.840.1.113883.10.22.3.9]] IPS Plan of Care Section
*[[2.16.840.1.113883.10.22.3.10]] IPS Social History Section
*[[2.16.840.1.113883.10.22.3.11]] IPS History of Pregnancy Section
*[[2.16.840.1.113883.10.22.3.12]] IPS Advance Directives Section
*[[2.16.840.1.113883.10.22.3.14]] IPS Results Section
*[[2.16.840.1.113883.10.22.3.15]] IPS Translation Section
*[[2.16.840.1.113883.10.22.4.1]] IPS Allergy or Intolerance
*[[2.16.840.1.113883.10.22.4.2]] IPS ManufacturedProduct
*[[2.16.840.1.113883.10.22.4.3]] IPS Manufactured Material
*[[2.16.840.1.113883.10.22.4.4]] IPS Medication Entry
*[[2.16.840.1.113883.10.22.4.5]] IPS Allergy and Intolerance Concern
*[[2.16.840.1.113883.10.22.4.6]] IPS Reaction Manifestation
*[[2.16.840.1.113883.10.22.4.7]] IPS Problem Concern Entry
*[[2.16.840.1.113883.10.22.4.8]] IPS Problem Entry
*[[2.16.840.1.113883.10.22.4.9]] IPS Result Organizer
*[[2.16.840.1.113883.10.22.4.10]] IPS Result Observation
*[[2.16.840.1.113883.10.22.4.11]] IPS Pathology Result Observation
*[[2.16.840.1.113883.10.22.4.12]] IPS Radiology Result Observation
*[[2.16.840.1.113883.10.22.4.13]] IPS Laboratory Result Observation
*[[2.16.840.1.113883.10.22.4.14]] IPS Body Author
*[[2.16.840.1.113883.10.22.4.15]] IPS Immunization
*[[2.16.840.1.113883.10.22.4.16]] IPS Immunization Medication Information
*[[2.16.840.1.113883.10.22.4.17]] IPS Procedure Entry
*[[2.16.840.1.113883.10.22.4.18]] IPS Criticality Observation
*[[2.16.840.1.113883.10.22.4.19]] IPS Certainty Observation
*[[2.16.840.1.113883.10.22.4.20]] IPS Problem Status Observation
*[[2.16.840.1.113883.10.22.4.21]] IPS Allergy Status Observation
*[[2.16.840.1.113883.10.22.4.22]] IPS Comment Activity
*[[2.16.840.1.113883.10.22.4.23]] IPS ObservationMedia
*[[2.16.840.1.113883.10.22.4.25]] IPS Severity Observation
*[[2.16.840.1.113883.10.22.4.26]] IPS Medical Device
*[[2.16.840.1.113883.10.22.4.27]] IPS Pregnancy Status Observation
*[[2.16.840.1.113883.10.22.4.28]] IPS Pregnancy Outcome Observation
*[[2.16.840.1.113883.10.22.4.29]] IPS Pregnancy Expected Delivery Date Observation
*[[2.16.840.1.113883.10.22.4.30]] IPS Specimen Collection
*[[2.16.840.1.113883.10.22.4.31]] IPS Internal Reference
*[[2.16.840.1.113883.10.22.4.33]] IPS Subordinate SubstanceAdministration
*[[2.16.840.1.113883.10.22.4.34]] IPS Social History Tobacco Use
*[[2.16.840.1.113883.10.22.4.35]] IPS Social History Alcohol Use
*[[2.16.840.1.113883.10.22.9.1]] IPS CDA Organization
*[[2.16.840.1.113883.10.22.9.2]] IPS CDA Device
*[[2.16.840.1.113883.10.22.9.3]] IPS CDA Person
*[[2.16.840.1.113883.10.22.11]] IPS Address

==CDA Template References ==
* [[2.16.840.1.113883.10.21.9.1]] UV Use Period

==Unconstrained Templates from the original CDA specification ==
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity

==Value Sets ==
*[[2.16.840.1.113883.11.22.2]] Allergy or Intolerance Type
*[[2.16.840.1.113883.11.22.3]] Allergy Reaction
*[[2.16.840.1.113883.11.22.5]] CORE Problem List Disorders
*[[2.16.840.1.113883.11.22.8]] IPS Condition Verification Status
*[[2.16.840.1.113883.11.22.9]] Absent or Unknown Allergies
*[[2.16.840.1.113883.11.22.10]] Allergies to substances
*[[2.16.840.1.113883.11.22.11]] Adverse Reaction Agents
*[[2.16.840.1.113883.11.22.12]] ActStatusActiveCompletedAbortedSuspended
*[[2.16.840.1.113883.11.22.13]] Time units (UCUM)
*[[2.16.840.1.113883.11.22.14]] DRUGActCode
*[[2.16.840.1.113883.11.22.15]] Absent or Unknown Medication
*[[2.16.840.1.113883.11.22.16]] Problem Type
*[[2.16.840.1.113883.11.22.17]] Absent or Unknown Problems
*[[2.16.840.1.113883.11.22.18]] Problem Severity
*[[2.16.840.1.113883.11.22.19]] Language Code
*[[2.16.840.1.113883.11.22.20]] IPS Expected Delivery Date Method
*[[2.16.840.1.113883.11.22.21]] IPS Pregnancies Summary
*[[2.16.840.1.113883.11.22.22]] ActStatusActiveCompletedAbortedCancelled
*[[2.16.840.1.113883.11.22.23]] IPS Medical Devices
*[[2.16.840.1.113883.11.22.24]] IPS Condition Status Code
*[[2.16.840.1.113883.11.22.25]] Medicine Doseform
*[[2.16.840.1.113883.11.22.27]] Medicine Package
*[[2.16.840.1.113883.11.22.28]] Quantity Units
*[[2.16.840.1.113883.11.22.29]] WHO ATC
*[[2.16.840.1.113883.11.22.30]] Medicine Strength Numerator
*[[2.16.840.1.113883.11.22.31]] Medicine Strength Denominator
*[[2.16.840.1.113883.11.22.32]] Medicine Active Substances
*[[2.16.840.1.113883.11.22.33]] Medicine Route of Administration
*[[2.16.840.1.113883.11.22.34]] IPS No Drug Substances
*[[2.16.840.1.113883.11.22.35]] IPS Procedures
*[[2.16.840.1.113883.11.22.36]] Absent or Unknown Procedures
*[[2.16.840.1.113883.11.22.37]] IPS Results Organizer
*[[2.16.840.1.113883.11.22.38]] IPS Results Observation
*[[2.16.840.1.113883.11.22.39]] IPS Results Observation Laboratory
*[[2.16.840.1.113883.11.22.40]] IPS Results Observation Radiology
*[[2.16.840.1.113883.11.22.41]] IPS Results Observation Pathology
*[[2.16.840.1.113883.11.22.42]] IPS Allergy Status Code
*[[2.16.840.1.113883.11.22.43]] Absent or Unknown Immunization
*[[2.16.840.1.113883.11.22.44]] IPS Vaccines
*[[2.16.840.1.113883.11.22.45]] IPS Multingredients Products
*[[2.16.840.1.113883.11.22.46]] IPS Results Coded Values Laboratory
*[[2.16.840.1.113883.11.22.47]] IPS Results Coded Values Pathology
*[[2.16.840.1.113883.11.22.48]] IPS Results Coded Values Radiology
*[[2.16.840.1.113883.11.22.49]] IPS Results Microorganism
*[[2.16.840.1.113883.11.22.50]] IPS Results Blood Group phenotypes
*[[2.16.840.1.113883.11.22.51]] IPS Results ABO+RH GROUP
*[[2.16.840.1.113883.11.22.52]] IPS Results Presence/Absence
*[[2.16.840.1.113883.11.22.53]] IPS Healthcare Professional Roles
*[[2.16.840.1.113883.11.22.54]] IPS Personal Relationship
*[[2.16.840.1.113883.11.22.55]] IPS Target Site
*[[2.16.840.1.113883.11.22.56]] IPS Specimen Type
*[[2.16.840.1.113883.11.22.57]] Laterality (qualifier)
*[[2.16.840.1.113883.11.22.58]] Topographical modifier (qualifier)
*[[2.16.840.1.113883.11.22.59]] IPS Current Smoking Status
*[[2.16.840.1.113883.11.22.60]] Allergy-intolerance Criticality

==Value Sets References==
*[[2.16.840.1.113883.1.11.1]] AdministrativeGender
*[[2.16.840.1.113883.1.11.10706]] Timing Event
*[[2.16.840.1.113883.1.11.11610]] x_ActRelationshipDocument
*[[2.16.840.1.113883.1.11.15933]] ActStatus
*[[2.16.840.1.113883.1.11.16926]] HL7 BasicConfidentialityKind
*[[2.16.840.1.113883.1.11.19446]] x_ActRelationshipEntry
*[[2.16.840.1.113883.1.11.19563]] PersonalRelationshipRoleType
*[[2.16.840.1.113883.1.11.19601]] x_ServiceEventPerformer
*[[2.16.840.1.113883.1.11.19709]] ActSubstanceAdministrationImmunizationCode
*[[2.16.840.1.113883.1.11.19890]] x_ActStatusActiveComplete
*[[2.16.840.1.113883.1.11.201]] TelecommunicationAddressUse
*[[2.16.840.1.113883.1.11.20386]] SeverityObservationCode
*[[2.16.840.1.113883.1.11.78]] Observation Interpretation
*[[2.16.840.1.113883.11.20.9.18]] MoodCodeEvnInt
*[[2.16.840.1.113883.11.20.9.33]] INDRoleclassCodes
*[[2.16.840.1.113883.3.88.12.80.60]] Social History Type

==Data Types ==
Data types for element definitions used
*AD – Address
*AD.IPS – IPS Address (see [https://docs.art-decor.org/documentation/datatypes/DTr1_AD.IPS/])
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CD.IPS – IPS CD (see [https://docs.art-decor.org/documentation/datatypes/DTr1_CD.IPS])
*CE – Coded with Equivalents
*CE.IPS – IPS CE (see [https://docs.art-decor.org/documentation/datatypes/DTr1_CE.IPS])
*CR – Concept Role
*CS – Coded Simple Value
*CV – Coded Value
*CV.IPS – IPS CV (see [https://docs.art-decor.org/documentation/datatypes/DTr1_CV.IPS])
*ED – Encapsulated Data
*EIVL.event – Event-Related Interval of Time
*EIVL_TS – Event-related time interval
*EN – Entity Name
*ENXP – Entity Name Part
*II – Instance Identifier
*INT – Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVL_TS.IPS.TZ – IPS IVL Time Stamp TZ (see [https://docs.art-decor.org/documentation/datatypes/DTr1_IVL_TS.IPS.TZ])
*IVL_TS.IPS.TZ.OPT
*IVXB_TS – Interval Boundary of Time Stamp
*ON – Organization Name
*PIVL_TS – Periodic Interval of Timezone
*PN – Person Name
*PQ – Physical Quantity
*SC – String with Codes
*SD.TEXT – Structured Document Text
*ST – Character String
*SXPR_TS – Parenthetic Set Expression of Time Stamp
*TEL – Telecommunication Address
*TEL.IPS – IPS TEL (see [https://docs.art-decor.org/documentation/datatypes/DTr1_IVL_TS.IPS.TZ.OPT])
*TS – Time Stamp
*TS.IPS.TZ – IPS Time Stamp TZ (see [https://docs.art-decor.org/documentation/datatypes/DTr1_TS.IPS.TZ])

Data types for attributes used
*bl – boolean code
*cs – code
*oid – identifier
*set_cs – code
*st – string
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for [[ IPS_implementationguide_1#Medicinal_Product_Identification|Medicinal Product Identification]] and as used in template 2.16.840.1.113883.10.22.4.3 ''IPS Manufactured Material''. The extension uses the namespace <code>urn:hl7-org:pharm</code>.

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

===Translation of designations===
This specification recommends the introduction of an optional extension for properly recording multilingual designations, that is further described in the [[IPS_implementationguide_1#Translation_of_designations_2|section on the translation of designations]]
*ips:designation

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Whiting-O'Keefe QE, Simborg DW, Epstein WV, Warger A: A computerized summary medical record system can provide more information than the standard medical record. JAMA. 1985 Sep 6;254(9):1185-92.
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

IPS Authors and Contributors

2023-07-19T15:35:44Z

Admin:

<div class="column clearfix">
<div class="col-md-12">
<table class="table table-bordered wikitable">

<tr>
<td width="20%">Primary Editor</td>
<td>Giorgio Cangioli, PhD<br/>Consultant, HL7 Italy <br/>giorgio.cangioli@gmail.com
</td>
</tr>

<tr>
<td>Primary Editor</td>
<td>Rob Hausam<br/> Hausam Consulting LLC <br/>rob@hausamconsulting.com
</td>
</tr>

<tr>
<td>Primary Editor</td>
<td>Dr Kai U. Heitmann<br/>Heitmann Consulting and Services, HL7 Germany, ART-DECOR Open Tools GmbH<br/>info@kheitmann.de</td>
</tr>

<tr>
<td>Primary Editor</td>
<td>François Macary <br/>Phast<br/>francois.macary@phast.fr </td>
</tr>

<tr>
<td>Contributor</td>
<td> Dr Philip Scott <br/>HL7 UK<br/>philip.scott@uwtsd.ac.uk</td>
</tr>

<tr>
<td>Contributor</td>
<td> Dr Christof Geßner <br/>Gematik<br/>christof.gessner@gematik.de </td>
</tr>

<tr>
<td>Contributor</td>
<td> Dr Stefan Sabutsch <br/>ELGA, HL7 Austria<br/>stefan.sabutsch@elga.gv.at </td>
</tr>

<tr>
<td>Contributor</td>
<td> Gary Dickinson <br/>CentriHealth<br/>gary.dickinson@ehr-standards.com </td>
</tr>

<tr>
<td>Contributor</td>
<td> Catherine Chronaki<br/>HL7 International Foundation<br/>chronaki@gmail.com </td>
</tr>

<tr>
<td>Contributor</td>
<td> Dr Stephen Chu <br/> HL7 Australia<br/>chuscmi88@gmail.com </td>
</tr>

<tr>
<td>Contributor</td>
<td> Didi Davis <br/>The Sequoia Project<br/>ddavis@sequoiaproject.org </td>
</tr>

<tr>
<td>Other Contributors</td>
<td> Alexander Berler (a.berler@gnomon.com.gr) ; Carina Seerainer (carina.seerainer@elga.gv.at); John Roberts (John.A.Roberts@tn.gov); Julie James (julie_james@bluewaveinformatics.co.uk); Mark Shafarman (mark.shafarman@earthlink.net); Fernando Portilla (fportila@gmail.com); Ed Hammond (william.hammond@duke.edu); Steve Kay (s.kay@histandards.net)</td>
</tr>

</table>
</div>
</div>

IPS implementationguide 1

2023-07-13T08:16:53Z

Admin:

HL7 Important Note

2023-04-20T06:36:02Z

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PHARM Templates Implementationguide

2023-04-08T10:43:30Z

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__NOTOC__
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<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
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This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
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{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Edition 1 (Universal Realm)<br/>Standard for Trial use<br/>1.2.0<br/>April 2023</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 1.2.0
|Sponsored = Pharmacy Workgroup
|Date = April 1, 2023
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2023 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_E1_STU2_2023APR
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. Dispensing is defined as supplying a medication in fulfilment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Content===
{{:2.16.840.1.113883.10.21.4.17/dynamic}}

===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}
===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Generalized Medicine Class===
{{:2.16.840.1.113883.10.21.4.19/dynamic}}

===UV Ingredient===
{{:2.16.840.1.113883.10.21.4.18/dynamic}}

===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense
* [[2.16.840.1.113883.10.21.4.17]] UV Content
* [[2.16.840.1.113883.10.21.4.18]] UV Ingredient
* [[2.16.840.1.113883.10.21.4.19]] UV Generalized Medicine Class

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period


==Unconstrained Templates from the original CDA specification==
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
===ActStatusCodeActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}

==Referenced HL7 Version 3 Value Sets==
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2023-04-08T10:31:06Z

Admin:

__NOTOC__
<div class="online-document-information">
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<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
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This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Edition 1 (Universal Realm)<br/>Standard for Trial use<br/>1.2.0<br/>April 2023</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 1.2.0
|Sponsored = Pharmacy Workgroup
|Date = April 1, 2023
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2023 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_E1_STU2_2023APR
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. Dispensing is defined as supplying a medication in fulfilment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Content===
{{:2.16.840.1.113883.10.21.4.17/dynamic}}

===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}
===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Generalized Medicine Class===
{{:2.16.840.1.113883.10.21.4.19/dynamic}}

===UV Ingredient===
{{:2.16.840.1.113883.10.21.4.18/dynamic}}

===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense
* [[2.16.840.1.113883.10.21.4.17]] UV Content
* [[2.16.840.1.113883.10.21.4.18]] UV Ingredient
* [[2.16.840.1.113883.10.21.4.19]] UV Generalized Medicine Class

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period


==Unconstrained Templates from the original CDA specification==
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
===ActStatusCodeActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}

==Referenced HL7 Version 3 Value Sets==
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2023-04-08T09:22:09Z

Admin:

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<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
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This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Edition 1 (Universal Realm)<br/>Standard for Trial use<br/>1.2.0<br/>April 2023</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 1.2.0
|Sponsored = Pharmacy Workgroup
|Date = April 1, 2023
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2023 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_E1_STU2_2023APR
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. Dispensing is defined as supplying a medication in fulfilment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Content===
{{:2.16.840.1.113883.10.21.4.17/dynamic}}

===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}
===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Generalized Medicine Class===
{{:2.16.840.1.113883.10.21.4.19/dynamic}}

===UV Ingredient===
{{:2.16.840.1.113883.10.21.4.18/dynamic}}

===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense
* [[2.16.840.1.113883.10.21.4.17]] UV Content
* [[2.16.840.1.113883.10.21.4.18]] UV Ingredient
* [[2.16.840.1.113883.10.21.4.19]] UV Generalized Medicine Class

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period


==Unconstrained Templates from the original CDA specification==
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
===ActStatusCodeActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}

==Referenced HL7 Version 3 Value Sets==
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2023-04-06T07:59:34Z

Admin:

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Edition 1 (Universal Realm)<br/>Standard for Trial use<br/>1.2.0<br/>April 2023</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 1.2.0
|Sponsored = Pharmacy Workgroup
|Date = April 1, 2023
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2023 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_E1_STU2_2023APR
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. Dispensing is defined as supplying a medication in fulfilment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Content===
{{:2.16.840.1.113883.10.21.4.17/dynamic}}

===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}
===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Generalized Medicine Class===
{{:2.16.840.1.113883.10.21.4.19/dynamic}}

===UV Ingredient===
{{:2.16.840.1.113883.10.21.4.18/dynamic}}

===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense
* [[2.16.840.1.113883.10.21.4.17]] UV Content
* [[2.16.840.1.113883.10.21.4.18]] UV Ingredient
* [[2.16.840.1.113883.10.21.4.19]] UV Generalized Medicine Class

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period


==Unconstrained Templates from the original CDA specification==
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
===ActStatusCodeActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}

==Referenced HL7 Version 3 Value Sets==
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

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| CDAR2_INTLPATSUMMARY_R1_D2_2018JUL = <div id="bottomleftline1">HL7 CDA® R2 Implementation Guide: International Patient Summary, Release 1</div><div id="bottomleftline2">July 2018 STU – © 2016-2018 Health Level Seven International. All rights reserved.</div>
| CDAR2_INTLPATSUMMARY_STU_R1_2018SEP = <div id="bottomleftline1">HL7 CDA® R2 Implementation Guide: International Patient Summary, STU Release 1</div><div id="bottomleftline2">September 2018 – ©2018 Health Level Seven International. All rights reserved.</div>
| CDAR2_INTLPATSUMMARY_STU_R1_2018OCT = <div id="bottomleftline1">HL7 CDA® R2 Implementation Guide: International Patient Summary, STU Release 1</div><div id="bottomleftline2">October 2018 – ©2018 Health Level Seven International. All rights reserved.</div>
| CDAR2_IG_PHARM_TEMPLATES_R1_D2_2019MAY = <div id="bottomleftline1">HL7 CDA® R2 Implementation Guide: Pharmacy Templates, Release 1</div><div id="bottomleftline2">May 2019 Ballot – © 2016-2019 Health Level Seven International. All rights reserved.</div>
| CDAR2_IG_PHARM_TEMPLATES_R1_STU_2019SEP = <div id="bottomleftline1">HL7 CDA® R2 Implementation Guide: Pharmacy Templates, Release 1 STU Release 1</div><div id="bottomleftline2">2019 September – © 2019 Health Level Seven International. All rights reserved.</div>
| CDAR2_IG_PHARM_TEMPLATES_R1_STU_2019DEC = <div id="bottomleftline1">HL7 CDA® R2 Implementation Guide: Pharmacy Templates, Release 1 STU Release 1</div><div id="bottomleftline2">2019 December – © 2019 Health Level Seven International. All rights reserved.</div>
| CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022SEP = <div id="bottomleftline1">HL7 CDA® R2 Implementation Guide: Pharmacy Templates, Release 1 Standard for Trial Use - Ballot 2</div><div id="bottomleftline2">September 2022 Ballot – © 2016-2022 Health Level Seven International. All rights reserved.</div>
| CDAR2_IG_PHARM_TEMPLATES_E1_STU2_2023APR = <div id="bottomleftline1">HL7 CDA® R2 Implementation Guide: Pharmacy Templates, Edition 1</div><div id="bottomleftline2">1.2.0 April 2023 – © 2016-2023 Health Level Seven International. All rights reserved.</div>

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</includeonly>

PHARM Templates Implementationguide

2023-03-10T10:47:48Z

Admin:

__NOTOC__
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<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
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This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Edition 1 (Universal Realm)<br/>Standard for Trial use<br/>1.2.0<br/>April 2023</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 1.2.0
|Sponsored = Pharmacy Workgroup
|Date = April 1, 2023
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2023 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_STU2_2023APR
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. Dispensing is defined as supplying a medication in fulfilment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Content===
{{:2.16.840.1.113883.10.21.4.17/dynamic}}

===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}
===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Generalized Medicine Class===
{{:2.16.840.1.113883.10.21.4.19/dynamic}}

===UV Ingredient===
{{:2.16.840.1.113883.10.21.4.18/dynamic}}

===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense
* [[2.16.840.1.113883.10.21.4.17]] UV Content
* [[2.16.840.1.113883.10.21.4.18]] UV Ingredient
* [[2.16.840.1.113883.10.21.4.19]] UV Generalized Medicine Class

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period


==Unconstrained Templates from the original CDA specification==
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
===ActStatusCodeActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}

==Referenced HL7 Version 3 Value Sets==
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

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PHARM Templates Implementationguide

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__NOTOC__
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<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
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This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
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{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Edition 1 (Universal Realm)<br/>Ballot 3</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 1.2.0
|Sponsored = Pharmacy Workgroup
|Date = April 1, 2023
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2023 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D3_2023APR
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. Dispensing is defined as supplying a medication in fulfilment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Content===
{{:2.16.840.1.113883.10.21.4.17/dynamic}}

===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}
===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Generalized Medicine Class===
{{:2.16.840.1.113883.10.21.4.19/dynamic}}

===UV Ingredient===
{{:2.16.840.1.113883.10.21.4.18/dynamic}}

===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense
* [[2.16.840.1.113883.10.21.4.17]] UV Content
* [[2.16.840.1.113883.10.21.4.18]] UV Ingredient
* [[2.16.840.1.113883.10.21.4.19]] UV Generalized Medicine Class

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period


==Unconstrained Templates from the original CDA specification==
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
===ActStatusCodeActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}

==Referenced HL7 Version 3 Value Sets==
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2023-03-07T19:24:24Z

Admin:

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Edition 1 (Universal Realm)<br/>Ballot 3</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 1.2.0
|Sponsored = Pharmacy Workgroup
|Date = April 1, 2023
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D3_2023APR
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. Dispensing is defined as supplying a medication in fulfilment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Content===
{{:2.16.840.1.113883.10.21.4.17/dynamic}}

===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}
===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Generalized Medicine Class===
{{:2.16.840.1.113883.10.21.4.19/dynamic}}

===UV Ingredient===
{{:2.16.840.1.113883.10.21.4.18/dynamic}}

===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense
* [[2.16.840.1.113883.10.21.4.17]] UV Content
* [[2.16.840.1.113883.10.21.4.18]] UV Ingredient
* [[2.16.840.1.113883.10.21.4.19]] UV Generalized Medicine Class

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period


==Unconstrained Templates from the original CDA specification==
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
===ActStatusCodeActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}

==Referenced HL7 Version 3 Value Sets==
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2023-03-07T19:20:39Z

Admin:

__NOTOC__
<div class="online-document-information">
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<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Edition 1 (Universal Realm)<br/>Ballot 3</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 1.2.0
|Sponsored = Pharmacy Workgroup
|Date = April 1, 2023
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D3_2023APR
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. Dispensing is defined as supplying a medication in fulfilment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Content===
{{:2.16.840.1.113883.10.21.4.17/dynamic}}

===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}
===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Generalized Medicine Class===
{{:2.16.840.1.113883.10.21.4.19/dynamic}}

===UV Ingredient===
{{:2.16.840.1.113883.10.21.4.18/dynamic}}

===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense
* [[2.16.840.1.113883.10.21.4.17]] UV Content
* [[2.16.840.1.113883.10.21.4.18]] UV Ingredient
* [[2.16.840.1.113883.10.21.4.19]] UV Generalized Medicine Class

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period


===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
== ActStatusCodeActiveCompletedAbortedSuspended==
{{:2.16.840.1.113883.11.21.2/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2023-03-07T19:19:19Z

Admin:

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<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
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This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Edition 1<br/>(Universal Realm) Ballot 3</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 1.2.0
|Sponsored = Pharmacy Workgroup
|Date = April 1, 2023
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D3_2023APR
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. Dispensing is defined as supplying a medication in fulfilment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Content===
{{:2.16.840.1.113883.10.21.4.17/dynamic}}

===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}
===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Generalized Medicine Class===
{{:2.16.840.1.113883.10.21.4.19/dynamic}}

===UV Ingredient===
{{:2.16.840.1.113883.10.21.4.18/dynamic}}

===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense
* [[2.16.840.1.113883.10.21.4.17]] UV Content
* [[2.16.840.1.113883.10.21.4.18]] UV Ingredient
* [[2.16.840.1.113883.10.21.4.19]] UV Generalized Medicine Class

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period


===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
== ActStatusCodeActiveCompletedAbortedSuspended==
{{:2.16.840.1.113883.11.21.2/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

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| CDAR2_IG_PHARM_TEMPLATES_R1_D2_2023APR = <div id="bottomleftline1">HL7 CDA® R2 Implementation Guide: Pharmacy Templates, Edition 1</div><div id="bottomleftline2">April 2023 Ballot – © 2016-2023 Health Level Seven International. All rights reserved.</div>

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PHARM Templates Implementationguide

2023-03-02T12:56:01Z

Admin: /* UV Content */

__NOTOC__
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<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
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This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.02
|Sponsored = Pharmacy Workgroup
|Date = July 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022SEP
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. Dispensing is defined as supplying a medication in fulfilment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Content===
{{:2.16.840.1.113883.10.21.4.17/dynamic}}

===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}
===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Generalized Medicine Class===
{{:2.16.840.1.113883.10.21.4.19/dynamic}}

===UV Ingredient===
{{:2.16.840.1.113883.10.21.4.18/dynamic}}

===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense
* [[2.16.840.1.113883.10.21.4.17]] UV Content
* [[2.16.840.1.113883.10.21.4.18]] UV Ingredient
* [[2.16.840.1.113883.10.21.4.19]] UV Generalized Medicine Class

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period


===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
== ActStatusCodeActiveCompletedAbortedSuspended==
{{:2.16.840.1.113883.11.21.2/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2023-03-02T12:47:17Z

Admin:

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.02
|Sponsored = Pharmacy Workgroup
|Date = July 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022SEP
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. Dispensing is defined as supplying a medication in fulfilment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Content===
{{:2.16.840.1.113883.10.21.4.17/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}
===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Generalized Medicine Class===
{{:2.16.840.1.113883.10.21.4.19/dynamic}}

===UV Ingredient===
{{:2.16.840.1.113883.10.21.4.18/dynamic}}

===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense
* [[2.16.840.1.113883.10.21.4.17]] UV Content
* [[2.16.840.1.113883.10.21.4.18]] UV Ingredient
* [[2.16.840.1.113883.10.21.4.19]] UV Generalized Medicine Class

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period


===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
== ActStatusCodeActiveCompletedAbortedSuspended==
{{:2.16.840.1.113883.11.21.2/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2023-03-02T12:44:18Z

Admin:

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.02
|Sponsored = Pharmacy Workgroup
|Date = July 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022SEP
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. Dispensing is defined as supplying a medication in fulfilment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Content===
{{: 2.16.840.1.113883.3.1937.777.15.10.1/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}
===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Generalized Medicine Class===
{{:2.16.840.1.113883.3.1937.777.15.10.3/dynamic}}

===UV Ingredient===
{{:2.16.840.1.113883.3.1937.777.15.10.2/dynamic}}

===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense
* [[2.16.840.1.113883.10.21.4.17]] UV Content
* [[2.16.840.1.113883.10.21.4.18]] UV Ingredient
* [[2.16.840.1.113883.10.21.4.19]] UV Generalized Medicine Class

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period


===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
== ActStatusCodeActiveCompletedAbortedSuspended==
{{:2.16.840.1.113883.11.21.2/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2023-03-02T12:42:42Z

Admin:

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.02
|Sponsored = Pharmacy Workgroup
|Date = July 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022SEP
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. Dispensing is defined as supplying a medication in fulfilment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Content===
{{: 2.16.840.1.113883.3.1937.777.15.10.1/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}
===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Generalized Medicine Class===
{{:2.16.840.1.113883.3.1937.777.15.10.3/dynamic}}

===UV Ingredient===
{{:2.16.840.1.113883.3.1937.777.15.10.2/dynamic}}

===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense
* [[2.16.840.1.113883.10.21.4.17]] UV Content
* [[2.16.840.1.113883.10.21.4.18]] UV Ingredient
* [[2.16.840.1.113883.10.21.4.19]] UV Generalized Medicine Class

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period


===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
== ActStatusCodeActiveCompletedAbortedSuspended==
{{:2.16.840.1.113883.11.21.2/dynamic}}
== MoodCodeEvnIntRqo ==
{{:2.16.840.1.113883.11.21.4/dynamic}}
== Unknownorabsentmedication ==
{{:2.16.840.1.113883.11.21.5/dynamic}}

===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2023-03-02T12:38:40Z

Admin:

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.02
|Sponsored = Pharmacy Workgroup
|Date = July 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022SEP
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. Dispensing is defined as supplying a medication in fulfilment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Content===
{{: 2.16.840.1.113883.3.1937.777.15.10.1/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}
===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Generalized Medicine Class===
{{:2.16.840.1.113883.3.1937.777.15.10.3/dynamic}}

===UV Ingredient===
{{:2.16.840.1.113883.3.1937.777.15.10.2/dynamic}}

===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense
* [[2.16.840.1.113883.10.21.4.17]] UV Content
* [[2.16.840.1.113883.10.21.4.18]] UV Ingredient
* [[2.16.840.1.113883.10.21.4.19]] UV Generalized Medicine Class

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period


===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}

===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2023-03-02T12:33:16Z

Admin: /* Functional requirements and high-level use cases */

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.02
|Sponsored = Pharmacy Workgroup
|Date = July 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022SEP
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. Dispensing is defined as supplying a medication in fulfilment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Content===
{{: 2.16.840.1.113883.3.1937.777.15.10.1/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}
===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Generalized Medicine Class===
{{:2.16.840.1.113883.3.1937.777.15.10.3/dynamic}}

===UV Ingredient===
{{:2.16.840.1.113883.3.1937.777.15.10.2/dynamic}}

===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period


===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}

===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2023-03-02T12:32:56Z

Admin: /* Functional requirements and high-level use cases */

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.02
|Sponsored = Pharmacy Workgroup
|Date = July 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
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{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. Dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Content===
{{: 2.16.840.1.113883.3.1937.777.15.10.1/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}
===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Generalized Medicine Class===
{{:2.16.840.1.113883.3.1937.777.15.10.3/dynamic}}

===UV Ingredient===
{{:2.16.840.1.113883.3.1937.777.15.10.2/dynamic}}

===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period


===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}

===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2023-02-02T12:17:36Z

Admin: /* UV Generalized Medicine Class */

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.02
|Sponsored = Pharmacy Workgroup
|Date = July 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022SEP
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications.
For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Content===
{{: 2.16.840.1.113883.3.1937.777.15.10.1/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}
===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Generalized Medicine Class===
{{:2.16.840.1.113883.3.1937.777.15.10.3/dynamic}}

===UV Ingredient===
{{:2.16.840.1.113883.3.1937.777.15.10.2/dynamic}}

===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period


===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}

===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2023-02-02T12:15:33Z

Admin: /* Templates */

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.02
|Sponsored = Pharmacy Workgroup
|Date = July 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022SEP
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications.
For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Content===
{{: 2.16.840.1.113883.3.1937.777.15.10.1/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}
===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
==UV Generalized Medicine Class==
{{:2.16.840.1.113883.3.1937.777.15.10.3/dynamic}}

===UV Ingredient===
{{:2.16.840.1.113883.3.1937.777.15.10.2/dynamic}}

===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period


===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}

===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2023-02-02T12:12:17Z

Admin: /* List of all artifacts used in this guide */

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.02
|Sponsored = Pharmacy Workgroup
|Date = July 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022SEP
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications.
For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}

===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
==UV Generalized Medicine Class==
{{:2.16.840.1.113883.3.1937.777.15.10.3/dynamic}}
===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period


===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}

===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2023-02-02T12:09:41Z

Admin: /* Templates */

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.02
|Sponsored = Pharmacy Workgroup
|Date = July 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022SEP
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications.
For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}

===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
==UV Generalized Medicine Class==
{{:2.16.840.1.113883.3.1937.777.15.10.3/dynamic}}
===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period

===References (re-used) from current C-CDA===
* [[2.16.840.1.113883.10.20.22.4.19]] Indication (V2)

===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}

===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

2.16.840.1.113883.10.12.300/hgraph

2023-02-01T11:51:10Z

Admin: Created page with "<table class="ad-template-table"> <tr> <td style="padding: 7px 7px 17px 7px;"> <ol class="ad-nobullets" style="padding: 0px !im..."

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<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
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<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)<ol>
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<div class="nowrapinline ad-templatetype @"> @ </div> CDA Act (2.16.840.1.113883.10.12.301)</li>
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<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Encounter (2.16.840.1.113883.10.12.302)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
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<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
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<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ObservationMedia (2.16.840.1.113883.10.12.304)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Organizer (2.16.840.1.113883.10.12.305)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Procedure (2.16.840.1.113883.10.12.306)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RegionOfInterest (2.16.840.1.113883.10.12.307)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA SubstanceAdministration (2.16.840.1.113883.10.12.308)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ManufacturedProduct (2.16.840.1.113883.10.12.312)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA LabeledDrug (2.16.840.1.113883.10.12.310)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Material (2.16.840.1.113883.10.12.311)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Supply (2.16.840.1.113883.10.12.309)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ManufacturedProduct (2.16.840.1.113883.10.12.312)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA LabeledDrug (2.16.840.1.113883.10.12.310)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Material (2.16.840.1.113883.10.12.311)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Encounter (2.16.840.1.113883.10.12.302)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Act (2.16.840.1.113883.10.12.301)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Encounter (2.16.840.1.113883.10.12.302)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Observation (2.16.840.1.113883.10.12.303)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ObservationMedia (2.16.840.1.113883.10.12.304)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Organizer (2.16.840.1.113883.10.12.305)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Procedure (2.16.840.1.113883.10.12.306)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RegionOfInterest (2.16.840.1.113883.10.12.307)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA SubstanceAdministration (2.16.840.1.113883.10.12.308)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ManufacturedProduct (2.16.840.1.113883.10.12.312)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA LabeledDrug (2.16.840.1.113883.10.12.310)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Material (2.16.840.1.113883.10.12.311)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Supply (2.16.840.1.113883.10.12.309)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ManufacturedProduct (2.16.840.1.113883.10.12.312)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA LabeledDrug (2.16.840.1.113883.10.12.310)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Material (2.16.840.1.113883.10.12.311)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Observation (2.16.840.1.113883.10.12.303)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Act (2.16.840.1.113883.10.12.301)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Encounter (2.16.840.1.113883.10.12.302)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Observation (2.16.840.1.113883.10.12.303)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ObservationMedia (2.16.840.1.113883.10.12.304)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Organizer (2.16.840.1.113883.10.12.305)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Procedure (2.16.840.1.113883.10.12.306)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RegionOfInterest (2.16.840.1.113883.10.12.307)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA SubstanceAdministration (2.16.840.1.113883.10.12.308)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ManufacturedProduct (2.16.840.1.113883.10.12.312)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA LabeledDrug (2.16.840.1.113883.10.12.310)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Material (2.16.840.1.113883.10.12.311)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Supply (2.16.840.1.113883.10.12.309)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ManufacturedProduct (2.16.840.1.113883.10.12.312)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA LabeledDrug (2.16.840.1.113883.10.12.310)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Material (2.16.840.1.113883.10.12.311)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ObservationMedia (2.16.840.1.113883.10.12.304)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Act (2.16.840.1.113883.10.12.301)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Encounter (2.16.840.1.113883.10.12.302)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Observation (2.16.840.1.113883.10.12.303)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA ObservationMedia (2.16.840.1.113883.10.12.304)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Organizer (2.16.840.1.113883.10.12.305)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Procedure (2.16.840.1.113883.10.12.306)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RegionOfInterest (2.16.840.1.113883.10.12.307)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA SubstanceAdministration (2.16.840.1.113883.10.12.308)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ManufacturedProduct (2.16.840.1.113883.10.12.312)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA LabeledDrug (2.16.840.1.113883.10.12.310)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Material (2.16.840.1.113883.10.12.311)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Supply (2.16.840.1.113883.10.12.309)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ManufacturedProduct (2.16.840.1.113883.10.12.312)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA LabeledDrug (2.16.840.1.113883.10.12.310)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Material (2.16.840.1.113883.10.12.311)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Organizer (2.16.840.1.113883.10.12.305)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Act (2.16.840.1.113883.10.12.301)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Encounter (2.16.840.1.113883.10.12.302)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Observation (2.16.840.1.113883.10.12.303)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ObservationMedia (2.16.840.1.113883.10.12.304)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Organizer (2.16.840.1.113883.10.12.305)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Procedure (2.16.840.1.113883.10.12.306)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RegionOfInterest (2.16.840.1.113883.10.12.307)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA SubstanceAdministration (2.16.840.1.113883.10.12.308)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ManufacturedProduct (2.16.840.1.113883.10.12.312)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA LabeledDrug (2.16.840.1.113883.10.12.310)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Material (2.16.840.1.113883.10.12.311)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Supply (2.16.840.1.113883.10.12.309)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ManufacturedProduct (2.16.840.1.113883.10.12.312)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA LabeledDrug (2.16.840.1.113883.10.12.310)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Material (2.16.840.1.113883.10.12.311)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Procedure (2.16.840.1.113883.10.12.306)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Act (2.16.840.1.113883.10.12.301)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Encounter (2.16.840.1.113883.10.12.302)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Observation (2.16.840.1.113883.10.12.303)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ObservationMedia (2.16.840.1.113883.10.12.304)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Organizer (2.16.840.1.113883.10.12.305)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Procedure (2.16.840.1.113883.10.12.306)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RegionOfInterest (2.16.840.1.113883.10.12.307)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA SubstanceAdministration (2.16.840.1.113883.10.12.308)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ManufacturedProduct (2.16.840.1.113883.10.12.312)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA LabeledDrug (2.16.840.1.113883.10.12.310)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Material (2.16.840.1.113883.10.12.311)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Supply (2.16.840.1.113883.10.12.309)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ManufacturedProduct (2.16.840.1.113883.10.12.312)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA LabeledDrug (2.16.840.1.113883.10.12.310)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Material (2.16.840.1.113883.10.12.311)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RegionOfInterest (2.16.840.1.113883.10.12.307)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Act (2.16.840.1.113883.10.12.301)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Encounter (2.16.840.1.113883.10.12.302)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Observation (2.16.840.1.113883.10.12.303)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ObservationMedia (2.16.840.1.113883.10.12.304)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Organizer (2.16.840.1.113883.10.12.305)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Procedure (2.16.840.1.113883.10.12.306)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA RegionOfInterest (2.16.840.1.113883.10.12.307)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA SubstanceAdministration (2.16.840.1.113883.10.12.308)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ManufacturedProduct (2.16.840.1.113883.10.12.312)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA LabeledDrug (2.16.840.1.113883.10.12.310)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Material (2.16.840.1.113883.10.12.311)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Supply (2.16.840.1.113883.10.12.309)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ManufacturedProduct (2.16.840.1.113883.10.12.312)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA LabeledDrug (2.16.840.1.113883.10.12.310)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Material (2.16.840.1.113883.10.12.311)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA SubstanceAdministration (2.16.840.1.113883.10.12.308)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ManufacturedProduct (2.16.840.1.113883.10.12.312)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA LabeledDrug (2.16.840.1.113883.10.12.310)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Material (2.16.840.1.113883.10.12.311)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Act (2.16.840.1.113883.10.12.301)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Encounter (2.16.840.1.113883.10.12.302)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Observation (2.16.840.1.113883.10.12.303)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ObservationMedia (2.16.840.1.113883.10.12.304)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Organizer (2.16.840.1.113883.10.12.305)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Procedure (2.16.840.1.113883.10.12.306)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RegionOfInterest (2.16.840.1.113883.10.12.307)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA SubstanceAdministration (2.16.840.1.113883.10.12.308)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Supply (2.16.840.1.113883.10.12.309)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ManufacturedProduct (2.16.840.1.113883.10.12.312)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA LabeledDrug (2.16.840.1.113883.10.12.310)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Material (2.16.840.1.113883.10.12.311)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Supply (2.16.840.1.113883.10.12.309)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ManufacturedProduct (2.16.840.1.113883.10.12.312)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA LabeledDrug (2.16.840.1.113883.10.12.310)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Material (2.16.840.1.113883.10.12.311)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Act (2.16.840.1.113883.10.12.301)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Encounter (2.16.840.1.113883.10.12.302)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Observation (2.16.840.1.113883.10.12.303)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ObservationMedia (2.16.840.1.113883.10.12.304)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Organizer (2.16.840.1.113883.10.12.305)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Procedure (2.16.840.1.113883.10.12.306)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RegionOfInterest (2.16.840.1.113883.10.12.307)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA SubstanceAdministration (2.16.840.1.113883.10.12.308)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Subject (Body) (2.16.840.1.113883.10.12.320)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Specimen (2.16.840.1.113883.10.12.322)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ManufacturedProduct (2.16.840.1.113883.10.12.312)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA LabeledDrug (2.16.840.1.113883.10.12.310)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Material (2.16.840.1.113883.10.12.311)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Performer (Body) (2.16.840.1.113883.10.12.323)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Author (Body) (2.16.840.1.113883.10.12.318)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Informant (Body) (2.16.840.1.113883.10.12.319)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA AssignedEntity (2.16.840.1.113883.10.12.153)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Organization (2.16.840.1.113883.10.12.151)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA RelatedEntity (2.16.840.1.113883.10.12.316)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype *"> * </div> CDA Person (2.16.840.1.113883.10.12.152)</li>
</ol>
</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Participant (Body) (2.16.840.1.113883.10.12.321)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Device (2.16.840.1.113883.10.12.315)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA PlayingEntity (2.16.840.1.113883.10.12.313)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Clinical Statement (2.16.840.1.113883.10.12.300)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype @"> @ </div> CDA Supply (2.16.840.1.113883.10.12.309)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Reference (2.16.840.1.113883.10.12.324)<ol>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalAct (2.16.840.1.113883.10.12.325)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalObservation (2.16.840.1.113883.10.12.326)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalProcedure (2.16.840.1.113883.10.12.327)</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA ExternalDocument (2.16.840.1.113883.10.12.328)</li>
</ol>
</li>
<li class="ad-template">
<div class="nowrapinline ad-templatetype cdaentrylevel"> Entry</div> CDA Precondition (2.16.840.1.113883.10.12.329)</li>
</ol>
</li>
</ol>
</li>
</ol>
</td>
</tr>
</table>

PHARM Templates Implementationguide

2023-02-01T10:00:50Z

Admin: /* Detailed medications information */

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.02
|Sponsored = Pharmacy Workgroup
|Date = July 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022SEP
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications.
For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}

===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

==Templates drawn from C-CDA (not subject of this guide)==
===Indication (V2)===
{{:2.16.840.1.113883.10.20.22.4.19/dynamic}}
</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period

===References (re-used) from current C-CDA===
* [[2.16.840.1.113883.10.20.22.4.19]] Indication (V2)

===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}

===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <pre>urn:hl7-org:pharm</pre>

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2023-02-01T09:58:41Z

Admin: /* Namespace Identifier */

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.02
|Sponsored = Pharmacy Workgroup
|Date = July 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022SEP
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications.
For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}

===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

==Templates drawn from C-CDA (not subject of this guide)==
===Indication (V2)===
{{:2.16.840.1.113883.10.20.22.4.19/dynamic}}
</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period

===References (re-used) from current C-CDA===
* [[2.16.840.1.113883.10.20.22.4.19]] Indication (V2)

===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}

===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <code>urn:hl7-org:pharm</code>.

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2023-02-01T09:58:26Z

Admin: /* Namespace Identifier */

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.02
|Sponsored = Pharmacy Workgroup
|Date = July 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022SEP
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <pre>urn:hl7-org:pharm</pre> and typically use the namespace prefix <pre>pharm:</pre>.

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications.
For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}

===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

==Templates drawn from C-CDA (not subject of this guide)==
===Indication (V2)===
{{:2.16.840.1.113883.10.20.22.4.19/dynamic}}
</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period

===References (re-used) from current C-CDA===
* [[2.16.840.1.113883.10.20.22.4.19]] Indication (V2)

===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}

===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <code>urn:hl7-org:pharm</code>.

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2023-02-01T09:42:45Z

Admin: /* Medication Time Units (UCUM) */

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.02
|Sponsored = Pharmacy Workgroup
|Date = July 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022SEP
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <code>urn:hl7-org:pharm</code> and typically use the namespace prefix <code>pharm:</code>.

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications.
For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}

===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

==Templates drawn from C-CDA (not subject of this guide)==
===Indication (V2)===
{{:2.16.840.1.113883.10.20.22.4.19/dynamic}}
</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period

===References (re-used) from current C-CDA===
* [[2.16.840.1.113883.10.20.22.4.19]] Indication (V2)

===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}

===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <code>urn:hl7-org:pharm</code>.

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

DocumentUse

2023-02-01T09:39:29Z

Admin: /* How to read this document */

==How to read this document==

All artifacts (templates, value sets etc.) listed with the status [[File:Kyellow.png|14px]] ''Draft'' or [[File:Korange.png|14px]] ''Pending'' are subject to ballot comments.

Artifacts with other status information, especially [[File:Kgreen.png|14px]] ''Final'' or ''Active'' are not (directly) part of the ballot and some artifacts actually even come from external sources. Reference artifacts are indicated by the symbol <div class="repo refonly">ref</div>. These reference artifacts are also not subject to the ballot, as they might be balloted elsewhere already.

The PDF version contains a ruler on the left side of the pages. A ruler has the page number on top of it and allows locating a line at the page by simply specifying the number at the scale tick. This is more precise and allows also commenting on graphics and pictures.

For example if you have a comment on page 29 because of a typo (see figure), you simply specify the error with its location p0029-04.

Of course you can also refer by classical chapter and section numbers. The use of the ruler has the ballot team's preference, though.

{{IncludeImage|IPS_ballotruler.jpg|500px|70%}}
<ref group="Figure">Locating ballot comments</ref> To locate a typo on page 29 as a ballot comment, simply specify the location p0029-04.

PHARM Templates Implementationguide

2023-01-31T12:14:28Z

Admin: /* Operational information */

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.02
|Sponsored = Pharmacy Workgroup
|Date = July 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022SEP
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <code>urn:hl7-org:pharm</code> and typically use the namespace prefix <code>pharm:</code>.

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications.
For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}

===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

==Templates drawn from C-CDA (not subject of this guide)==
===Indication (V2)===
{{:2.16.840.1.113883.10.20.22.4.19/dynamic}}
</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page https://art-decor.org/ad/#/pharmcda-/project/overview</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period

===References (re-used) from current C-CDA===
* [[2.16.840.1.113883.10.20.22.4.19]] Indication (V2)

===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <code>urn:hl7-org:pharm</code>.

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2022-08-03T21:35:29Z

Admin:

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.02
|Sponsored = Pharmacy Workgroup
|Date = July 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022SEP
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <code>urn:hl7-org:pharm</code> and typically use the namespace prefix <code>pharm:</code>.

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications.
For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}

===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

==Templates drawn from C-CDA (not subject of this guide)==
===Indication (V2)===
{{:2.16.840.1.113883.10.20.22.4.19/dynamic}}
</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page http://art-decor.org/art-decor/decor-project--pharmcda-</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period

===References (re-used) from current C-CDA===
* [[2.16.840.1.113883.10.20.22.4.19]] Indication (V2)

===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <code>urn:hl7-org:pharm</code>.

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2022-08-03T21:32:09Z

Admin: /* Operational information */

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.01
|Sponsored = Pharmacy Workgroup
|Date = July 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022SEP
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <code>urn:hl7-org:pharm</code> and typically use the namespace prefix <code>pharm:</code>.

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications.
For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}

===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

==Templates drawn from C-CDA (not subject of this guide)==
===Indication (V2)===
{{:2.16.840.1.113883.10.20.22.4.19/dynamic}}
</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page http://art-decor.org/art-decor/decor-project--pharmcda-</ref>.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period

===References (re-used) from current C-CDA===
* [[2.16.840.1.113883.10.20.22.4.19]] Indication (V2)

===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <code>urn:hl7-org:pharm</code>.

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2022-08-03T21:19:18Z

Admin:

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.01
|Sponsored = Pharmacy Workgroup
|Date = July 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022SEP
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <code>urn:hl7-org:pharm</code> and typically use the namespace prefix <code>pharm:</code>.

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications.
For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}

===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

==Templates drawn from C-CDA (not subject of this guide)==
===Indication (V2)===
{{:2.16.840.1.113883.10.20.22.4.19/dynamic}}
</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page http://art-decor.org/art-decor/decor-project--pharmcda-</ref>.
* Any ''Medication on CDA'' specification release in HTML format resides at the Publication Page<ref name="pharmpubpage"></ref>. It is likely that the publication site will move to hl7.org permanently, we will inform about that process.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period

===References (re-used) from current C-CDA===
* [[2.16.840.1.113883.10.20.22.4.19]] Indication (V2)

===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <code>urn:hl7-org:pharm</code>.

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

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PHARM Templates Implementationguide

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__NOTOC__
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This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''Pharmacy Templates''' (will be incorrect/inconsistent at times).<p/>
See the [https://www.hl7.org/implement/standards/product_brief.cfm?product_id=514 Directory of the published standard].
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{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.01
|Sponsored = Pharmacy Workgroup
|Date = March 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022JAN
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <code>urn:hl7-org:pharm</code> and typically use the namespace prefix <code>pharm:</code>.

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications.
For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}

===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

==Templates drawn from C-CDA (not subject of this guide)==
===Indication (V2)===
{{:2.16.840.1.113883.10.20.22.4.19/dynamic}}
</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page http://art-decor.org/art-decor/decor-project--pharmcda-</ref>.
* Any ''Medication on CDA'' specification release in HTML format resides at the Publication Page<ref name="pharmpubpage"></ref>. It is likely that the publication site will move to hl7.org permanently, we will inform about that process.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period

===References (re-used) from current C-CDA===
* [[2.16.840.1.113883.10.20.22.4.19]] Indication (V2)

===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <code>urn:hl7-org:pharm</code>.

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2022-04-13T19:50:03Z

Admin:

__NOTOC__
<div class="online-document-information">
<div class="col-md-12">
<div class="panel panel-warning-white-border">
<div class="panel-heading"> <span class="panel-title"><i class="fa fa-cogs"></i> Continuous Build </span> </div>
<div class="panel-body"> <p class="bs">
This is the '''Continuous Build''' of the HL7 CDA® R2 Implementation Guide '''International Patient Summary''' (will be incorrect/inconsistent at times).<p/>
See the [http://www.hl7.org/implement/standards/product_brief.cfm?product_id=483 Directory of the published standard].
</div></div></div></div></div>
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.01
|Sponsored = Pharmacy Workgroup
|Date = March 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022JAN
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <code>urn:hl7-org:pharm</code> and typically use the namespace prefix <code>pharm:</code>.

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications.
For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}

===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

==Templates drawn from C-CDA (not subject of this guide)==
===Indication (V2)===
{{:2.16.840.1.113883.10.20.22.4.19/dynamic}}
</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page http://art-decor.org/art-decor/decor-project--pharmcda-</ref>.
* Any ''Medication on CDA'' specification release in HTML format resides at the Publication Page<ref name="pharmpubpage"></ref>. It is likely that the publication site will move to hl7.org permanently, we will inform about that process.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period

===References (re-used) from current C-CDA===
* [[2.16.840.1.113883.10.20.22.4.19]] Indication (V2)

===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <code>urn:hl7-org:pharm</code>.

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2022-03-21T09:17:11Z

Admin:

__NOTOC__
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.01
|Sponsored = Pharmacy Workgroup
|Date = March 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022JAN
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <code>urn:hl7-org:pharm</code> and typically use the namespace prefix <code>pharm:</code>.

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications.
For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}

===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

==Templates drawn from C-CDA (not subject of this guide)==
===Indication (V2)===
{{:2.16.840.1.113883.10.20.22.4.19/dynamic}}
</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page http://art-decor.org/art-decor/decor-project--pharmcda-</ref>.
* Any ''Medication on CDA'' specification release in HTML format resides at the Publication Page<ref name="pharmpubpage"></ref>. It is likely that the publication site will move to hl7.org permanently, we will inform about that process.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period

===References (re-used) from current C-CDA===
* [[2.16.840.1.113883.10.20.22.4.19]] Indication (V2)

===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <code>urn:hl7-org:pharm</code>.

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2022-03-21T09:14:10Z

Admin:

__NOTOC__
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Ballot 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.00
|Sponsored = Pharmacy Workgroup
|Date = March 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022JAN
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <code>urn:hl7-org:pharm</code> and typically use the namespace prefix <code>pharm:</code>.

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications.
For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}

===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

==Templates drawn from C-CDA (not subject of this guide)==
===Indication (V2)===
{{:2.16.840.1.113883.10.20.22.4.19/dynamic}}
</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page http://art-decor.org/art-decor/decor-project--pharmcda-</ref>.
* Any ''Medication on CDA'' specification release in HTML format resides at the Publication Page<ref name="pharmpubpage"></ref>. It is likely that the publication site will move to hl7.org permanently, we will inform about that process.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period

===References (re-used) from current C-CDA===
* [[2.16.840.1.113883.10.20.22.4.19]] Indication (V2)

===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <code>urn:hl7-org:pharm</code>.

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2022-03-21T09:08:07Z

Admin: /* Introduction */

__NOTOC__
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Release 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.00
|Sponsored = Pharmacy Workgroup
|Date = March 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022JAN
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <code>urn:hl7-org:pharm</code> and typically use the namespace prefix <code>pharm:</code>.

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications.
For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}

===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

==Templates drawn from C-CDA (not subject of this guide)==
===Indication (V2)===
{{:2.16.840.1.113883.10.20.22.4.19/dynamic}}
</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page http://art-decor.org/art-decor/decor-project--pharmcda-</ref>.
* Any ''Medication on CDA'' specification release in HTML format resides at the Publication Page<ref name="pharmpubpage"></ref>. It is likely that the publication site will move to hl7.org permanently, we will inform about that process.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period

===References (re-used) from current C-CDA===
* [[2.16.840.1.113883.10.20.22.4.19]] Indication (V2)

===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <code>urn:hl7-org:pharm</code>.

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Authors and Contributors

2022-03-21T09:07:46Z

Admin:

<div class="column clearfix">
<div class="col-md-12">
<table class="table table-bordered wikitable">

<tr>
<td width="20%">Co-Chair, Primary Editor</td>
<td>Melva Peters<br/>Jenaker Consulting<br/>melva@jenakerconsulting.com
</td>
</tr>

<tr>
<td>Co-Chair, Primary Editor</td>
<td>John Hatem<br/>jnhatem@hotmail.com
</td>
</tr>

<tr>
<td>Co-Chair</td>
<td>Scott Robertson PharmD <br/>scott.m.robertson@kp.org
</td>
</tr>

<tr>
<td>Co-Chair</td>
<td>Jean Duteau <br/>jean@duteaudesign.com
</td>
</tr>

<tr>
<td> Contributor </td>
<td>Dr Kai U. Heitmann<br/>Heitmann Consulting and Services, ART-DECOR Open Tools GmbH, HL7 Germany<br/>info@kheitmann.de</td>
</tr>

<tr>
<td> Contributor </td>
<td>Giorgio Cangioli, PhD<br/>Consultant, HL7 Italy <br/>giorgio.cangioli@gmail.com
</td>
</tr>

<tr>
<td> Contributor </td>
<td> Tom de Jong <br/>VZVZ, HL7 The Netherlands<br/>tom@nova-pro.nl</td>
</tr>

<tr>
<td> Contributor </td>
<td>Dr Christof Geßner<br/>Gematik GmbH, HL7 Germany<br/>christof.gessner@gematik.de</td>
</tr>

</table>
</div>
</div>

PHARM Templates Implementationguide

2022-03-21T09:04:56Z

Admin: /* Validation artifacts */

__NOTOC__
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Release 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.00
|Sponsored = Pharmacy Workgroup
|Date = March 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
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|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022JAN
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{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <code>urn:hl7-org:pharm</code> and typically use the namespace prefix <code>pharm:</code>.

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications.
For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}

===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

==Templates drawn from C-CDA (not subject of this guide)==
===Indication (V2)===
{{:2.16.840.1.113883.10.20.22.4.19/dynamic}}
</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...

* ...the W3C schemas (actually valid for any CDA specification) located at the PHARM Materials Page on HL7 GitHub<ref name="pharmgithub"></ref>.

* ..the ISO schematron, automatically generated by ART-DECOR based on the definitions, located at the Pharmacy Templates Material Publication Page on ART-DECOR<ref name="adpubpage">Pharmacy Templates Material Publication Page on ART-DECOR https://hl7intl.art-decor.pub/index.php?prefix=pharmcda-</ref>. These are files to do validation locally by associating PHARM CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local PHARM CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page http://art-decor.org/art-decor/decor-project--pharmcda-</ref>.
* Any ''Medication on CDA'' specification release in HTML format resides at the Publication Page<ref name="pharmpubpage"></ref>. It is likely that the publication site will move to hl7.org permanently, we will inform about that process.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period

===References (re-used) from current C-CDA===
* [[2.16.840.1.113883.10.20.22.4.19]] Indication (V2)

===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <code>urn:hl7-org:pharm</code>.

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2022-03-21T09:00:19Z

Admin: /* Integrated examples */

__NOTOC__
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Release 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.00
|Sponsored = Pharmacy Workgroup
|Date = March 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022JAN
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <code>urn:hl7-org:pharm</code> and typically use the namespace prefix <code>pharm:</code>.

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications.
For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}

===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

==Templates drawn from C-CDA (not subject of this guide)==
===Indication (V2)===
{{:2.16.840.1.113883.10.20.22.4.19/dynamic}}
</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmgithub">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...
* ...the W3C schemas (actually valid for any CDA specification) located at the Materials Page<ref name="pharmpubpage"></ref>. The actual release has a link to the XML materials as which the W3C schemas are part of; it also includes example CDA document instances.
* ..the ISO schematron, automatically generated by the tool. These are files to do validation locally by associating IPS CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local IPS CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page http://art-decor.org/art-decor/decor-project--pharmcda-</ref>.
* Any ''Medication on CDA'' specification release in HTML format resides at the Publication Page<ref name="pharmpubpage"></ref>. It is likely that the publication site will move to hl7.org permanently, we will inform about that process.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period

===References (re-used) from current C-CDA===
* [[2.16.840.1.113883.10.20.22.4.19]] Indication (V2)

===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <code>urn:hl7-org:pharm</code>.

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]

PHARM Templates Implementationguide

2022-03-21T08:57:12Z

Admin: /* Integrated examples */

__NOTOC__
{{Infobox_Document
|Title = <center>HL7 CDA® R2 Implementation Guide:<br/>Pharmacy Templates<br/><div style="font-size:60%">Release 1 (Universal Realm)<br/>Standard for Trial Use<br/>Release 2</div></center>
|Short = Pharmacy Templates
|Namespace = cdapharm
|Type =
|Version = 2.00
|Sponsored = Pharmacy Workgroup
|Date = March 18, 2022
|Status = Draft
|Period = STUPUB
|OID = n.n.
|Realm = Universal
|Custodian = HL7
|Copyrighttext = Copyright © 2022 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.<br/>Use of this material is governed by HL7's IP Compliance Policy.
|Topright = CDAR2_IG_PHARM_TEMPLATES_R1_D2_2022JAN
}}

{{:HL7_Important_Note}}

{{:PHARM_Authors_and_Contributors}}

__TOC__
=Introduction=
This Implementation Guide provides CDA R2 templates for ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration'' that can be used by HL7 standards developers and external projects to develop models for pharmacy related content. The implementation guide is intended to provide consistency of pharmacy related models across all uses regardless of the method of transport by '''creating a library of Universal (UV) Pharmacy Templates that can be used by other Work Groups to derive constrained versions'''.

==Purpose==

===Background===
Historically multiple HL7 Work Groups have developed specifications for pharmacy related content and as a result, there is inconsistency in how medication related content is represented in HL7 V2, V3, CDA and FHIR.
The Pharmacy Work Group often receives questions as to how to model pharmacy related content but in some cases, the use case cannot be met with the existing models.

This Implementation Guide provides a CDA R2 library of pharmacy templates that can be used by HL7 Work Groups or external projects to derive constrained versions of models for pharmacy related content.

==Scope==
This Pharmacy Templates Implementation Guide defines common pharmacy artifacts (order, dispense, administration and statement) in CDA R2 format. The scope of the Implementation Guide is limited to ''Medication Order'' and ''Medication Statement'', '' Medication Dispense'' and ''Medication Administration''. The content was developed by aligning and harmonizing the existing specifications for Consolidated CDA (C-CDA Release 2.1<ref name="ccda21">http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).

==Ballot Status of the Document==
The Implementation Guide was balloted as Standard for Trial Use (STU) and then goes to Normative.

==Audience==
*Clinical and Public Health laboratories
*Immunization Registries
*Pharmaceutical Vendors
*EHR/PHR vendors
*Clinical Decision Support Systems
*HIS Vendors
*Emergency Services Providers
*Healthcare Institutions
*Pharmacists
*Physicians and other Clinicians

==Relationships with other projects and guides==
*Consolidated CDA (C-CDA)
*HL7 Version 3 Pharmacy Models
*HL7 FHIR® Pharmacy Resources
*International Patient Summary (IPS), where all pharmacy related templates are specialisations of the corresponding templates defined in this guide

=Principles and background=
The Pharmacy Work Group has a set of rich set of existing models that were used as the basis for the implementation guide including HL7 V3 models and FHIR resources.

This implementation guide was created by the Pharmacy Work Group using the following approach:
*Review of Consolidated CDA (C-CDA<ref name="ccda21"></ref>) to identify templates that include pharmacy related content
*Compare C-CDA templates to existing Pharmacy HL7 V3 models and Pharmacy FHIR resources to identify differences and gaps
*Create universal templates to that can be constrained for use for new templates.

For the Medication Model reflected in template 2.16.840.1.113883.10.21.4.11 UV Medication Information (detail), the Common Message Element Type CMET R_Medication Universal” (COCT_MT230100UV02), Release 2 (as published in HL7 V3 2017, V2.0.2 Dec 2010, derived from Common Product Model) was used to construct the CDA extension elements (see also "Extensions" used in this guide in the appendix).

The template rules are formalized using the computable format defined by the HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1<ref name="teits">HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=377</ref> in order to facilitate also the automatic generation of consistent testing and validation capabilities.

= Technical Background =
{{:CDA Background}}

==Identifiers for Templates and Value Sets==
This specification specifies CDA '''Entry Level Templates''' only. They can be re-used in any appropriate context, such as an Entry of a ''medication'' section.

Two "root" Entry Templates are provided as entry points for the four described use cases:
*UV Medication Order (2.16.840.1.113883.10.21.4.1)
*UV Medication Statement (2.16.840.1.113883.10.21.4.7)
*UV Medication Administration (2.16.840.1.113883.10.21.4.13)
*UV Medication Dispense (2.16.840.1.113883.10.21.4.15)
These templates use other Entry Level Templates that are all listed in a subsequent section of this document.

This specification uses the following OIDs for the artifacts that are registered at the HL7 OID registry.
*The root OID for templates is 2.16.840.1.113883.10.21
**Entry Level templates are summarized under 2.16.840.1.113883.10.21'''.4''', e.g. 2.16.840.1.113883.10.21.4.5 ''UV Substitution Permission''
**“other” assistance templates are summarized under 2.16.840.1.113883.10.21'''.9''', e.g. 2.16.840.1.113883.10.22.9.1 ''UV Use Period''
* The root OID for Value Sets is 2.16.840.1.113883.11
The sub branches for templates follow the recommendations of HL7 International and ISO 13582<ref>ISO/TS 13582:2013 Health informatics -- Sharing of OID registry information</ref>.

==Namespace Identifier==
The CDA extensions for Pharmacy defined by the Pharmacy Workgroup are handled under the XML namespace identifier <code>urn:hl7-org:pharm</code> and typically use the namespace prefix <code>pharm:</code>.

{{:DocumentUse}}

==Reading Publication Artifacts==
A reading guide is available that explains the formalisms used to express the publication artifacts, i.e. template meta data and template design. For convenience the guide is included in the appendix.

=Functional requirements and high-level use cases=
The following use cases are relevant to the pharmacy domain for both community and institutional settings:
*Prescribing a medication (aka Prescription or Order or Request)
*Dispensing a medication
*Recording the administration of a medication
*Recording the use of a medication (in the past, current or future)
The following definitions are relevant to this Implementation Guide:
*''Prescribing'' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of authorizing the usage of a medication in various settings for example, inpatient, community, and long term care. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*''Dispensing'' is the provision of a medication or other material to a caregiver in fulfillment of a prescription or medication order. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications.
For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing is usually performed by a pharmacist, other health care providers such as nurses or physicians may also dispense.
*''Administration'' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.
*''Medication Statement'' is an activity that can be performed by a variety of healthcare professionals, or the patient, or non-healthcare professionals. Examples of recording medication statements include taking a patient's medication history, recording reported use of medications where the source of the patient information is from a third party and not the patient e.g. a family member when the patient is unable to communicate their medication history.

<div class="landscape">

=Templates=

==Use Case Entry Level Templates==
As mentioned before, this specification defines two "root" Entry Level Templates, one for each of the covered use cases. All entry templates are used in the context of a CDA section.

===UV Medication Order===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

''Note: If you need to include multiple ordered medications as part of a single order, you can include multiple CDA entries under one CDA section. CDA Section definitions are not part of this guide.''

{{:2.16.840.1.113883.10.21.4.1/hgraph}}

The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.1/dynamic}}

===UV Medication Statement===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.7/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.7/dynamic}}

===UV Medication Administration===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.13/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.13/dynamic}}

===UV Medication Dispense===
The following graph gives an overview of the high-level template components of this template, followed by the actual definition.

{{:2.16.840.1.113883.10.21.4.15/hgraph}}
The boxes reflect the CDA Template Types. Symbols: * denotes templates with more than one classification, @ indicates a recursion in the definition
<br>
{{:2.16.840.1.113883.10.21.4.15/dynamic}}

==Entry Level Templates==
These entry level templates are used Section "Use Case Entry Level Templates".
===UV ClinicalStatement Encounter===
{{:2.16.840.1.113883.10.21.4.4/dynamic}}
===UV ClinicalStatement Observation===
{{:2.16.840.1.113883.10.21.4.3/dynamic}}
===UV Comment Activity===
{{:2.16.840.1.113883.10.21.4.12/dynamic}}
===UV Dispense Request===
{{:2.16.840.1.113883.10.21.4.2/dynamic}}

===UV Dispense Event Reference===
{{:2.16.840.1.113883.10.21.4.9/dynamic}}
===UV Medication Information (detail)===
{{:2.16.840.1.113883.10.21.4.11/dynamic}}

===UV Medication Information (simple)===
{{:2.16.840.1.113883.10.21.4.10/dynamic}}

===UV Medication Order Reference===
{{:2.16.840.1.113883.10.21.4.8/dynamic}}
===UV Subordinate Substance Administration===
{{:2.16.840.1.113883.10.21.4.6/dynamic}}
===UV Substitution Event Adminstration===
{{:2.16.840.1.113883.10.21.4.14/dynamic}}
===UV Substitution Permission===
{{:2.16.840.1.113883.10.21.4.5/dynamic}}
===UV Use Period===
{{:2.16.840.1.113883.10.21.9.1/dynamic}}

==Templates drawn from C-CDA (not subject of this guide)==
===Indication (V2)===
{{:2.16.840.1.113883.10.20.22.4.19/dynamic}}
</div>

=Appendix (Informative) =
==Acronyms and abbreviations ==
*'''C-CDA''': Consolidated CDA
*'''CDA''': Clinical Document Architecture
*'''DSTU''': Draft Standard for Trial Use
*'''EDQM''': European Directorate for the Quality of Medicines & Healthcare
*'''EHR''': Electronic Healthcare Record
*'''HL7''': Health Level Seven
*'''HP''': Healthcare Professional
*'''IDMP''': IDentification of Medicinal Products (ISO Standard)
*'''IHE''': Integrating the Healthcare Enterprise
*'''ISO''': International Organization for Standardization
*'''JIC''': Joint Initiative Council on SDO Global Health Informatics Standardization
*'''LOINC''': Logical Observation Identifiers Names & Codes
*'''MPID''': Medicinal Product Identifier
*'''PCID ''': Medicinal Product Package Identifier
*'''PhPID(s)''': Pharmaceutical Product Identifier(s)
*'''SDO''': Standard Developing Organization
*'''STU''': Standard for Trial Use
*'''UCUM''': Unified Code for Units of Measure

==Glossary ==
*'''Prescribing''' is an activity that can be performed by a variety of healthcare professionals and involves a variety of orderable items (see glossary entry). For the purposes of the following Implementation Guide, prescribing is defined as the act of prescribing a medication in either an ambulatory or an institutional setting. This could include initiating a new medication order or making all kinds of modifications to existing orders.
*'''Dispensing''' is an activity undertaken to fulfill the logistical requirements of a prescription. It supplies the materials needed to perform the prescribed actions by those who will perform them. Examples of dispensing include eyeglasses, contact lenses and medications. For the purposes of the following ballot material, dispensing is defined as supplying a medication in fulfillment of a prescription or medication order. While dispensing in these circumstances would usually be performed by a pharmacist, other health care providers such as nurses or physicians might also dispense medications.
*'''Administration''' is an activity undertaken to give medication to the patient. In the community, this process is usually not recorded, since the majority occurs in the patient's home; only administrations undertaken by a healthcare professional, such as vaccination, tend to be formally documented. Administration of medication in the institutional setting is usually recorded on a dose-by-dose basis, and may be messaged on that basis, or a summary of all the administrations occurring during an inpatient stay may be described.

==Integrated examples==
The ''Medication on CDA'' specification releases are published at the Pharmacy Templates Material Publication Page on HL7 GitHub<ref name="pharmpubpage">Pharmacy Templates Material Publication Page on HL7 GitHub https://github.com/HL7/CDA-pharma</ref>. This GitHub offers XML materials (also compacted as a ZIP to download) like the W3C schemas and example CDA document instances. A set of use cases have been defined and represented in ''Medication on CDA'' format.

==Validation artifacts ==
You can test your implementation (instances) against the ''Medication on CDA'' specification. To download materials to your computer for local testing and validation consider...
* ...the W3C schemas (actually valid for any CDA specification) located at the Materials Page<ref name="pharmpubpage"></ref>. The actual release has a link to the XML materials as which the W3C schemas are part of; it also includes example CDA document instances.
* ..the ISO schematron, automatically generated by the tool. These are files to do validation locally by associating IPS CDA instances with the main schematron using an XML editor or to use the derived XSLT conversions and apply the according XSLT derivation to your local IPS CDA instance.

For further information you can follow the documentation.

==Operational information ==
* The original specification is hosted on the logical ART-DECOR main server art-decor.org under the ''Governance Group'' '''HL7 International''', the project is reachable at the Project Live Landing Page<ref> Pharmacy Templates Project Live Landing Page http://art-decor.org/art-decor/decor-project--pharmcda-</ref>.
* Any ''Medication on CDA'' specification release in HTML format resides at the Publication Page<ref name="pharmpubpage"></ref>. It is likely that the publication site will move to hl7.org permanently, we will inform about that process.

==Licenses==
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
*'''SNOMED CT''': SNOMED International (formerly know as International Healthcare Terminology Standards Development Organization IHTSDO)<ref>Get SNOMED CT http://www.ihtsdo.org/snomed-ct/get-snomed-ct</ref> or info@ihtsdo.org
*'''Logical Observation Identifiers Names & Codes''' (LOINC): The Regenstrief Institute, Inc.
*'''Unified Code for Units of Measure (UCUM) : Regenstrief Institute, Inc. and the UCUM Organization

=List of all artifacts used in this guide=
==CDA Templates==
* [[2.16.840.1.113883.10.21.4.1]] UV Medication Order
* [[2.16.840.1.113883.10.21.4.2]] UV Dispense Request
* [[2.16.840.1.113883.10.21.4.3]] UV ClinicalStatement Observation
* [[2.16.840.1.113883.10.21.4.4]] UV ClinicalStatement Encounter
* [[2.16.840.1.113883.10.21.4.5]] UV Substitution Permission
* [[2.16.840.1.113883.10.21.4.6]] UV Subordinate Substance Administration
* [[2.16.840.1.113883.10.21.4.7]] UV Medication Statement
* [[2.16.840.1.113883.10.21.4.8]] UV Medication Order Reference
* [[2.16.840.1.113883.10.21.4.9]] UV Dispense Event Reference
* [[2.16.840.1.113883.10.21.4.10]] UV Medication Information (simple)
* [[2.16.840.1.113883.10.21.4.11]] UV Medication Information (detail)
* [[2.16.840.1.113883.10.21.4.12]] UV Comment Activity
* [[2.16.840.1.113883.10.21.4.13]] UV Medication Administration
* [[2.16.840.1.113883.10.21.4.14]] UV Substitution Event Adminstration
* [[2.16.840.1.113883.10.21.4.15]] UV Medication Dispense

* [[2.16.840.1.113883.10.21.9.1]] UV Use Period

===References (re-used) from current C-CDA===
* [[2.16.840.1.113883.10.20.22.4.19]] Indication (V2)

===Unconstrained Templates from the original CDA specification===
* [[2.16.840.1.113883.10.12.151]] CDA Organization
* [[2.16.840.1.113883.10.12.152]] CDA Person
* [[2.16.840.1.113883.10.12.153]] CDA AssignedEntity
* [[2.16.840.1.113883.10.12.310]] CDA LabeledDrug
* [[2.16.840.1.113883.10.12.311]] CDA Material
* [[2.16.840.1.113883.10.12.312]] CDA ManufacturedProduct
* [[2.16.840.1.113883.10.12.313]] CDA PlayingEntity
* [[2.16.840.1.113883.10.12.315]] CDA Device
* [[2.16.840.1.113883.10.12.316]] CDA RelatedEntity
* [[2.16.840.1.113883.10.12.318]] CDA Author (Body)
* [[2.16.840.1.113883.10.12.319]] CDA Informant (Body)
* [[2.16.840.1.113883.10.12.320]] CDA Subject (Body)
* [[2.16.840.1.113883.10.12.321]] CDA Participant (Body)
* [[2.16.840.1.113883.10.12.322]] CDA Specimen
* [[2.16.840.1.113883.10.12.323]] CDA Performer (Body)
* [[2.16.840.1.113883.10.12.324]] CDA Reference
* [[2.16.840.1.113883.10.12.325]] CDA ExternalAct
* [[2.16.840.1.113883.10.12.326]] CDA ExternalObservation
* [[2.16.840.1.113883.10.12.327]] CDA ExternalProcedure
* [[2.16.840.1.113883.10.12.328]] CDA ExternalDocument
* [[2.16.840.1.113883.10.12.329]] CDA Precondition

==Value Sets ==
===Medication Time Units (UCUM)===
{{:2.16.840.1.113883.11.21.1/dynamic}}
===ActStatusActiveCompletedAbortedSuspended===
{{:2.16.840.1.113883.11.21.2/dynamic}}
===Substance Administration Code===
{{:2.16.840.1.113883.11.21.3/dynamic}}
=== Mood Code Evn Int Rqo===
{{:2.16.840.1.113883.11.21.4/dynamic}}
=== Unknown or absent medication===
{{:2.16.840.1.113883.11.21.5/dynamic}}
=== ActStatusCodeActiveCompleted ===
{{:2.16.840.1.113883.11.21.6/dynamic}}

===Referenced HL7 Version 3 Value Sets===
*2.16.840.1.113883.1.11.13955 ActEncounterCode
*2.16.840.1.113883.1.11.16208 ActPharmacySupplyType
*2.16.840.1.113883.1.11.16866 ActPriority
*2.16.840.1.113883.1.11.15933 ActStatus
*2.16.840.1.113883.1.11.19708 ActSubstanceAdministrationCode
*2.16.840.1.113883.1.11.16621 ActSubstanceAdminSubstitutionCode
*2.16.840.1.113883.1.11.14570 AdministrableDrugForm
*2.16.840.1.113883.1.11.11526 HumanLanguage
*2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt
*2.16.840.1.113883.1.11.78 Observation Interpretation
*2.16.840.1.113883.1.11.14079 ObservationMethod
*2.16.840.1.113883.1.11.14581 RouteOfAdministration
*2.16.840.1.113883.1.11.19719 SubstanceAdminSubstitutionNotAllowedReason
*2.16.840.1.113883.1.11.19377 SubstanceAdminSubstitutionReason
*2.16.840.1.113883.1.11.10706 TimingEvent
*2.16.840.1.113883.1.11.19447 x_ActRelationshipEntryRelationship
*2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete

==Datatypes ==
Datatypes for element definitions used
*ANY – ANY
*BL – Boolean
*CD – Concept Descriptor
*CE – Coded with Equivalents
*CS – Coded Simple Value
*ED – Encapsulated Data
*EN – Entity Name
*II – Instance Identifier
*INT – Integer
*INT.NONNEG – Interval of Integer, non-negative
*IVL_INT – Interval of Integer
*IVL_PQ – Interval of Physical Quantity
*IVL_TS – Interval of Time Stamp
*IVXB_TS – Interval Boundary of Time Stamp
*PIVL_TS – Periodic Interval of Timezone
*PQ – Physical Quantity
*RTO_PQ_PQ – Ratio Physical Quantity / Physical Quantity
*ST – Character String
*TEL – Telecommunication Address
*TS – Time Stamp

Datatypes for attributes used
*bl – boolean code
*cs – code
*uid – identifier

==Extensions==
=== Detailed medications information ===
This specification uses CDA extensions in order to provide details about medications, as further described in the section on the design conventions for Medicinal Product Identification and as used in template 2.16.840.1.113883.10.21.4.11 ''UV Medication Information (detail)''. The extension uses the namespace <code>urn:hl7-org:pharm</code>.

This is the list of elements defined for that template.

*pharm:formCode (Administrable Pharmaceutical Dose Form)
*pharm:asContent (Packaging of the medication)
**pharm:quantity
**pharm:containerPackagedMedicine (Most inner Package Item or the Packaged Medicinal Product)
***pharm:code
***pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
***pharm:formCode (type of the most inner package item or of the or the Packaged Medicinal Product)
***pharm:capacityQuantity (the functional capacity of the container)
***pharm:asContent (Containing package)
****pharm:quantity
****pharm:containerPackagedMedicine (Intermediate Package Item or the Packaged Medicinal Product)
*****pharm:code
*****pharm:name (Name of the Package Item or of the Packaged Medicinal Product)
*****pharm:formCode (type of the intermediate package item or of the or the Packaged Medicinal Product)
*****pharm:capacityQuantity (the functional capacity of the container)
*****pharm:asContent (Containing package)
******pharm:quantity
******pharm:containerPackagedMedicine (Packaged Medicinal Product)
*******pharm:code
*******pharm:name (Name of the Packaged Medicinal Product)
*******pharm:formCode (type of the Packaged Medicinal Product)
*******pharm:capacityQuantity (the functional capacity of the container)
*pharm:asSpecializedKind (used to represent any classification of the product (ATC code, future PhPIDs,..) )
**pharm:generalizedMaterialKind
***pharm:code
***pharm:name
*pharm:ingredient (list of active substances used for this product)
**pharm:quantity (strength)
**pharm:ingredientSubstance (active substance)
***pharm:code
***pharm:name

{{:Reading_Guide_for_Publication_Artefacts}}

=References=
==Literature==
* Boone KW: The CDA Book. Springer 2011, ISBN 978-0-85729-336-7

==Links==
<references/>

==Figures==
<references group="Figure"/>

[[Category:IG]]