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MED_Oral_Med_5_Themes_PRN.xml
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MED_Oral_Med_5_Themes_PRN.xml
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<section>
<templateId root="2.16.840.1.113883.10.20.22.2.1.1"/>
<!-- Medication Section (entries required) -->
<code code="10160-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of Medication Use"/>
<title>MEDICATIONS</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Medication</th>
<th>Instructions</th>
<th>Dosage</th>
<th>Effective Dates (start - stop)</th>
<th>Status</th>
</tr>
</thead>
<!-- These five examples illustrate multiple ways that a medication can be prescribed for pain-->
<!-- Examples 1-4 use precondition to specify the PRN, but the example 5 uses an indication since PRN not directly specified-->
<!-- These examples were first developed by George Cole for review by the CDA example task force-->
<tbody>
<tr ID="Medication_0">
<td>
<content ID="MedicationName_0">Ibuprofen 600mg Oral Tablet</content>
</td>
<td>
<content ID="MedicationSig_0">take 1 tablet QID PRN</content>
</td>
<td>
<content ID="MedicationDosage_0">600 MG</content>
</td>
<td>Mar-10-2013 - </td>
<td>Active</td>
</tr>
<tr ID="Medication_1">
<td>
<content ID="MedicationName_1">Ibuprofen 600mg Oral Tablet</content>
</td>
<td>
<content ID="MedicationSig_1">take 1 tablet QID PRN as Directed</content>
</td>
<td>
<content ID="MedicationDosage_1">600 MG</content>
</td>
<td>Mar-10-2013 - </td>
<td>Active</td>
</tr>
<tr ID="Medication_2">
<td>
<content ID="MedicationName_2">Ibuprofen 600mg Oral Tablet</content>
</td>
<td>
<content ID="MedicationSig_2">take 1 tablet QID PRN for joint pain</content>
</td>
<td>
<content ID="MedicationDosage_2">600 MG</content>
</td>
<td>Mar-10-2013 - </td>
<td>Active</td>
</tr>
<tr ID="Medication_3">
<td>
<content ID="MedicationName_3">Ibuprofen 600mg Oral Tablet</content>
</td>
<td>
<content ID="MedicationSig_3">take 1 tablet QID as needed for joint pain</content>
</td>
<td>
<content ID="MedicationDosage_3">600 MG</content>
</td>
<td>Mar-10-2013 - </td>
<td>Active</td>
</tr>
<tr ID="Medication_4">
<td>
<content ID="MedicationName_4">Ibuprofen 600mg Oral Tablet</content>
</td>
<td>
<content ID="MedicationSig_4">take 1 tablet QID for <content ID="MedicationIndication_4">joint pain</content></content>
</td>
<td>
<content ID="MedicationDosage_4">600 MG</content>
</td>
<td>Mar-10-2013 - </td>
<td>Active</td>
</tr>
</tbody>
</table>
</text>
<!-- Example #1 - Ibuprofen 600mg Oral Tablet, 1 tablet Every 6 Hours PRN -->
<entry>
<substanceAdministration classCode="SBADM" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.16"/>
<id extension="100035" root="1.3.6.1.4.1.22812.3.99930.3.4.9"/>
<id extension="100013" root="1.3.6.1.4.1.22812.3.99930.3.4.9"/>
<text>
<reference value="#Medication_0"/>
</text>
<statusCode code="active"/>
<effectiveTime xsi:type="IVL_TS">
<low value="20110310000000-0500"/>
<high nullFlavor="NI"/>
</effectiveTime>
<effectiveTime xsi:type="PIVL_TS" institutionSpecified="false" operator="A">
<period value="6" unit="h"/>
</effectiveTime>
<doseQuantity value="1"/>
<consumable typeCode="CSM">
<manufacturedProduct classCode="MANU">
<templateId root="2.16.840.1.113883.10.20.22.4.23"/>
<manufacturedMaterial>
<code code="308182" codeSystem="2.16.840.1.113883.6.88" codeSystemName="RxNorm" displayName="Ibuprofen 600mg Oral Tablet">
<originalText>
<reference value="#MedicationName_0"/>
</originalText>
<translation code="67253014050" codeSystem="2.16.840.1.113883.6.69" codeSystemName="NDC" displayName="Ibuprofen 600mg Oral Tablet"/>
</code>
<name>Ibuprofen</name>
</manufacturedMaterial>
</manufacturedProduct>
</consumable>
<precondition typeCode="PRCN">
<criterion>
<!-- ** Precondition for substance administration ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.25"/>
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
<!-- If a precondition were specified in medication sig, you would include code here. Include nullFlavor="NI" when PRN specified but without precondition-->
<value xsi:type="CD" nullFlavor="NI" />
</criterion>
</precondition>
</substanceAdministration>
</entry>
<!-- Example # 2 - Ibuprofen 600mg Oral Tablet, 1 tablet Every 6 Hours PRN as Directed
as basic PRN, but the question now becomes: what is "as directed"? Is it a patient instruction or precondition?
"as directed" is coded here as a precondition using a SNOMED code-->
<entry>
<substanceAdministration classCode="SBADM" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.16"/>
<id extension="200035" root="1.3.6.1.4.1.22812.3.99930.3.4.9"/>
<id extension="200013" root="1.3.6.1.4.1.22812.3.99930.3.4.9"/>
<text>
<reference value="#Medication_1"/>
</text>
<statusCode code="active"/>
<effectiveTime xsi:type="IVL_TS">
<low value="20110310000000-0500"/>
<high nullFlavor="NI"/>
</effectiveTime>
<effectiveTime xsi:type="PIVL_TS" institutionSpecified="false" operator="A">
<period value="6" unit="h"/>
</effectiveTime>
<doseQuantity value="1"/>
<consumable typeCode="CSM">
<manufacturedProduct classCode="MANU">
<templateId root="2.16.840.1.113883.10.20.22.4.23"/>
<manufacturedMaterial>
<code code="308182" codeSystem="2.16.840.1.113883.6.88" codeSystemName="RxNorm" displayName="Ibuprofen 600mg Oral Tablet">
<originalText>
<reference value="#MedicationName_1"/>
</originalText>
<translation code="67253014050" codeSystem="2.16.840.1.113883.6.69" codeSystemName="NDC" displayName="Ibuprofen 600mg Oral Tablet"/>
</code>
<name>Ibuprofen</name>
</manufacturedMaterial>
</manufacturedProduct>
</consumable>
<precondition typeCode="PRCN">
<criterion>
<!-- ** Precondition for substance administration ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.25"/>
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
<!-- as directed as the precondition -->
<value xsi:type="CD" code="422135004" codeSystem="2.16.840.1.113883.6.96" displayName="As directed for" />
</criterion>
</precondition>
</substanceAdministration>
</entry>
<!-- Example # 3 - Ibuprofen 600mg Oral Tablet, 1 tablet Every 6 Hours PRN for joint pain
adding for joint pain raises the question: is this a precondition or an indication?
coded here as an precondition-->
<entry>
<substanceAdministration classCode="SBADM" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.16"/>
<id extension="300035" root="1.3.6.1.4.1.22812.3.99930.3.4.9"/>
<id extension="300013" root="1.3.6.1.4.1.22812.3.99930.3.4.9"/>
<text>
<reference value="#Medication_2"/>
</text>
<statusCode code="active"/>
<effectiveTime xsi:type="IVL_TS">
<low value="20110310000000-0500"/>
<high nullFlavor="NI"/>
</effectiveTime>
<effectiveTime xsi:type="PIVL_TS" institutionSpecified="false" operator="A">
<period value="6" unit="h"/>
</effectiveTime>
<doseQuantity value="1"/>
<consumable typeCode="CSM">
<manufacturedProduct classCode="MANU">
<templateId root="2.16.840.1.113883.10.20.22.4.23"/>
<manufacturedMaterial>
<code code="308182" codeSystem="2.16.840.1.113883.6.88" codeSystemName="RxNorm" displayName="Ibuprofen 600mg Oral Tablet">
<originalText>
<reference value="#MedicationName_2"/>
</originalText>
<translation code="67253014050" codeSystem="2.16.840.1.113883.6.69" codeSystemName="NDC" displayName="Ibuprofen 600mg Oral Tablet"/>
</code>
<name>Ibuprofen</name>
</manufacturedMaterial>
</manufacturedProduct>
</consumable>
<precondition typeCode="PRCN">
<criterion>
<!-- ** Precondition for substance administration ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.25"/>
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
<!-- joint pain -->
<value xsi:type="CD" code="57676002" codeSystem="2.16.840.1.113883.6.96" displayName="Joint pain" />
</criterion>
</precondition>
</substanceAdministration>
</entry>
<!-- Example # 4 - Ibuprofen 600mg Oral Tablet, 1 tablet Every 6 Hours as needed for joint pain
maybe this is not a realistic example, but the question this raises is: does the phrase "as needed" constitute
a PRCN as if PRN had been used instead of "as needed" ? propose that Yes, they are the same -->
<entry>
<substanceAdministration classCode="SBADM" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.16"/>
<id extension="400035" root="1.3.6.1.4.1.22812.3.99930.3.4.9"/>
<id extension="400013" root="1.3.6.1.4.1.22812.3.99930.3.4.9"/>
<text>
<reference value="#Medication_3"/>
</text>
<statusCode code="active"/>
<effectiveTime xsi:type="IVL_TS">
<low value="20110310000000-0500"/>
<high nullFlavor="NI"/>
</effectiveTime>
<effectiveTime xsi:type="PIVL_TS" institutionSpecified="false" operator="A">
<period value="6" unit="h"/>
</effectiveTime>
<doseQuantity value="1"/>
<consumable typeCode="CSM">
<manufacturedProduct classCode="MANU">
<templateId root="2.16.840.1.113883.10.20.22.4.23"/>
<manufacturedMaterial>
<code code="308182" codeSystem="2.16.840.1.113883.6.88" codeSystemName="RxNorm" displayName="Ibuprofen 600mg Oral Tablet">
<originalText>
<reference value="#MedicationName_3"/>
</originalText>
<translation code="67253014050" codeSystem="2.16.840.1.113883.6.69" codeSystemName="NDC" displayName="Ibuprofen 600mg Oral Tablet"/>
</code>
<name>Ibuprofen</name>
</manufacturedMaterial>
</manufacturedProduct>
</consumable>
<precondition typeCode="PRCN">
<criterion>
<!-- ** Precondition for substance administration ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.25"/>
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
<!-- joint pain -->
<value xsi:type="CD" code="57676002" codeSystem="2.16.840.1.113883.6.96" displayName="Joint pain" />
</criterion>
</precondition>
</substanceAdministration>
</entry>
<!-- Example # 5 - Ibuprofen 600mg Oral Tablet, 1 tablet Every 6 Hours for joint pain
as if "for" was worded as "because of" coded with an indication, no precondition -->
<entry>
<substanceAdministration classCode="SBADM" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.16"/>
<id extension="500035" root="1.3.6.1.4.1.22812.3.99930.3.4.9"/>
<id extension="500013" root="1.3.6.1.4.1.22812.3.99930.3.4.9"/>
<text>
<reference value="#Medication_4"/>
</text>
<statusCode code="active"/>
<effectiveTime xsi:type="IVL_TS">
<low value="20110310000000-0500"/>
<high nullFlavor="NI"/>
</effectiveTime>
<effectiveTime xsi:type="PIVL_TS" institutionSpecified="false" operator="A">
<period value="6" unit="h"/>
</effectiveTime>
<doseQuantity value="1"/>
<consumable typeCode="CSM">
<manufacturedProduct classCode="MANU">
<templateId root="2.16.840.1.113883.10.20.22.4.23"/>
<manufacturedMaterial>
<code code="308182" codeSystem="2.16.840.1.113883.6.88" codeSystemName="RxNorm" displayName="Ibuprofen 600mg Oral Tablet">
<originalText>
<reference value="#MedicationName_4"/>
</originalText>
<translation code="67253014050" codeSystem="2.16.840.1.113883.6.69" codeSystemName="NDC" displayName="Ibuprofen 600mg Oral Tablet"/>
</code>
<name>Ibuprofen</name>
</manufacturedMaterial>
</manufacturedProduct>
</consumable>
<!-- a problem indication of joint pain -->
<entryRelationship typeCode="RSON">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.19"/>
<id extension="44" root="1.3.6.1.4.1.22812.3.99930.3.4.1.3"/>
<code codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" code="404684003"/>
<text>
<reference value="#MedicationIndication_4"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low nullFlavor="NI"/>
</effectiveTime>
<value xsi:type="CD" code="57676002" codeSystem="2.16.840.1.113883.6.96" displayName="Joint pain" />
</observation>
</entryRelationship>
</substanceAdministration>
</entry>
</section>