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{
  "resourceType": "StructureDefinition",
  "id": "ext-medication-rendered-dosage",
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode": "trial-use"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger": 2
    }
  ],
  "url": "http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage",
  "version": "1.1.0",
  "name": "MedicationRenderedDosage",
  "title": "Medication Rendered Dosage Instruction",
  "status": "draft",
  "experimental": false,
  "date": "2025-08-27",
  "publisher": "Canada Health Infoway",
  "contact": [
    {
      "name": "National Standards Release Centre",
      "telecom": [
        {
          "system": "url",
          "value": "http://www.infoway-inforoute.ca"
        },
        {
          "system": "email",
          "value": "standards@infoway-inforoute.ca"
        }
      ]
    }
  ],
  "description": "Provides a complete text rendering of the dosage instruction lines for an order or dispense (separate from the rendering of the overall resource instance)",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "CA"
        }
      ]
    }
  ],
  "copyright": "Copyright © 2025+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy).",
  "fhirVersion": "4.0.1",
  "mapping": [
    {
      "identity": "CACDI",
      "name": "Canadian Core Data for Interoperability (CACDI)"
    }
  ],
  "kind": "complex-type",
  "abstract": false,
  "context": [
    {
      "type": "element",
      "expression": "MedicationRequest"
    },
    {
      "type": "element",
      "expression": "MedicationStatement"
    },
    {
      "type": "element",
      "expression": "Medication"
    }
  ],
  "type": "Extension",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension",
  "derivation": "constraint",
  "snapshot": {
    "element": [
      {
        "id": "Extension",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
            "valueCode": "normative"
          },
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
            "valueCode": "4.0.0"
          }
        ],
        "path": "Extension",
        "short": "Optional Extensions Element",
        "definition": "Optional Extension Element - found in all resources.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Extension",
          "min": 0,
          "max": "*"
        },
        "condition": [
          "ele-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])"
          }
        ],
        "isModifier": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          },
          {
            "identity": "rim",
            "map": "N/A"
          },
          {
            "identity": "CACDI",
            "map": "Medication Dosage Instruction"
          }
        ]
      },
      {
        "id": "Extension.id",
        "path": "Extension.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Extension.extension",
        "path": "Extension.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
        "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "0",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Extension.url",
        "path": "Extension.url",
        "representation": [
          "xmlAttr"
        ],
        "short": "identifies the meaning of the extension",
        "definition": "Source of the definition for the extension code - a logical name or a URL.",
        "comment": "The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Extension.url",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "uri"
              }
            ],
            "code": "http://hl7.org/fhirpath/System.String"
          }
        ],
        "fixedUri": "http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage",
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Extension.value[x]",
        "path": "Extension.value[x]",
        "short": "Rendered Dosage Instruction",
        "definition": "Provides a complete text rendering of the dosage instruction lines for an order or dispense (separate from the overall resource instance)",
        "comment": "Usage Note: This is intended to provide the dosage instructions to the Pharmacist for dispensing. This will be displayed to the Pharmacist upon receipt of the ePrescription. The EMR may not provide individual/structured dosage instructions so all data that would have been conveyed as structured dosage data is provided here as well in human readable form. This is also used to convey the dosage instructions when a fax is used, as there will be no structured prescription on the fax. The rendered dosage instruction must contain all dosage instructions and must be able to stand on its own.\n\nConformance Rule: This field is made up of structured dosage information as well as patient instructions, assembled into one field and formatted as human-readable, meaning that codes should not be used (e.g. 'days' should be used instead of 'd').\n\nConformance Rule: MUST allow all printable characters and carriage return/line feeds.\n\nConformance Rule: The following MUST be included if available, in human-readable form: Dosage quantity, dosage unit, dosage frequency, form, strength, max quantity per period, minimal interval between dispense, route of administration and where applicable, the administration site. Note: Any additional patient instructions that are specified at the dosage line level (e.g. take with food, starting one day before dental appointment) should be included. If an EMR only supports a single separate/discrete field to capture patient instructions in the EMR, this should not be included here.\n\nConformance Rule: If an EMR sends discrete data elements they must also populate this with a textual view of the SIG (as per the MIF definition). E.g. PO value for RouteofAdministration will be conveyed as 'oral' in this field.\n\nConformance Rule: If an EMR has discrete field for Pharmacy Notes (Dispenser Instructions), they should not be included here. If EMR's have both concepts combined into one field, they can both be included here.\n\nUsage Note: It is recognized that very complex instructions may be conveyed as text only (not as structured data). Example: take 500 mg twice a day at breakfast and at lunch AND 250 mg once a day at bedtime - THEN (new dosage line).....). The pharmacy will receive as text, enter it in their system and do the dosage checking. If the EMR submits the structured frequency in the message, this should be consistent with the textual instructions. The PMS may ignore the structured frequency, or override it to align with the textual instructions. Example: the EMR may enter frequency (multiplier of the dose) in their system like this (2 qam and 3 qhs ), in the structured frequency. The textual instructions could say Take 2 tablets in the morning and 3 at bedtime.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Extension.value[x]",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "string"
          }
        ],
        "maxLength": 5000,
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      }
    ]
  },
  "differential": {
    "element": [
      {
        "id": "Extension",
        "path": "Extension",
        "mapping": [
          {
            "identity": "CACDI",
            "map": "Medication Dosage Instruction"
          }
        ]
      },
      {
        "id": "Extension.extension",
        "path": "Extension.extension",
        "max": "0"
      },
      {
        "id": "Extension.url",
        "path": "Extension.url",
        "fixedUri": "http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage"
      },
      {
        "id": "Extension.value[x]",
        "path": "Extension.value[x]",
        "short": "Rendered Dosage Instruction",
        "definition": "Provides a complete text rendering of the dosage instruction lines for an order or dispense (separate from the overall resource instance)",
        "comment": "Usage Note: This is intended to provide the dosage instructions to the Pharmacist for dispensing. This will be displayed to the Pharmacist upon receipt of the ePrescription. The EMR may not provide individual/structured dosage instructions so all data that would have been conveyed as structured dosage data is provided here as well in human readable form. This is also used to convey the dosage instructions when a fax is used, as there will be no structured prescription on the fax. The rendered dosage instruction must contain all dosage instructions and must be able to stand on its own.\n\nConformance Rule: This field is made up of structured dosage information as well as patient instructions, assembled into one field and formatted as human-readable, meaning that codes should not be used (e.g. 'days' should be used instead of 'd').\n\nConformance Rule: MUST allow all printable characters and carriage return/line feeds.\n\nConformance Rule: The following MUST be included if available, in human-readable form: Dosage quantity, dosage unit, dosage frequency, form, strength, max quantity per period, minimal interval between dispense, route of administration and where applicable, the administration site. Note: Any additional patient instructions that are specified at the dosage line level (e.g. take with food, starting one day before dental appointment) should be included. If an EMR only supports a single separate/discrete field to capture patient instructions in the EMR, this should not be included here.\n\nConformance Rule: If an EMR sends discrete data elements they must also populate this with a textual view of the SIG (as per the MIF definition). E.g. PO value for RouteofAdministration will be conveyed as 'oral' in this field.\n\nConformance Rule: If an EMR has discrete field for Pharmacy Notes (Dispenser Instructions), they should not be included here. If EMR's have both concepts combined into one field, they can both be included here.\n\nUsage Note: It is recognized that very complex instructions may be conveyed as text only (not as structured data). Example: take 500 mg twice a day at breakfast and at lunch AND 250 mg once a day at bedtime - THEN (new dosage line).....). The pharmacy will receive as text, enter it in their system and do the dosage checking. If the EMR submits the structured frequency in the message, this should be consistent with the textual instructions. The PMS may ignore the structured frequency, or override it to align with the textual instructions. Example: the EMR may enter frequency (multiplier of the dose) in their system like this (2 qam and 3 qhs ), in the structured frequency. The textual instructions could say Take 2 tablets in the morning and 3 at bedtime.",
        "min": 1,
        "type": [
          {
            "code": "string"
          }
        ],
        "maxLength": 5000,
        "mustSupport": true
      }
    ]
  }
}

name : MedicationRenderedDosage

{

}