Pan-Canadian Patient Summary (PS-CA) v2.1.0 DFT
2.1.0-DFT 
DFT - For a full list of available versions, see the Directory of published versions
Releases of the PS-CA Implementation Guide may be found on a table on the Home Page of this Project.
Medication (PS-CA)
Links
Profile
Derived from
http://hl7.org/fhir/StructureDefinition/Medication
Examples
Description
This profile represents the constraints applied to the Medication resource by the PS-CA project to represent a medication in the patient summary. It is informed by the constraints of the Medication IPS-UV profile and the Canadian Baseline Profile to allow for cross-border and cross-jurisdiction sharing of Medication Summary information.
References to this resource
MedicationRequestPSCA, MedicationStatementPSCA
Resource Content
| MedicationPSCA (Medication) | C | Medication | |
| id | Σ | 0..1 | string |
| meta | Σ | 0..1 | Meta |
| implicitRules | Σ ?! | 0..1 | uri |
| language | 0..1 | codeBinding | |
| text | 0..1 | Narrative | |
| contained | 0..* | Resource | |
| extension | C | 0..* | Extension |
| strength | C | 0..1 | Extension(string) |
| modifierExtension | ?! C | 0..* | Extension |
| identifier | Σ | 0..* | Identifier |
| code | S Σ | 1..1 | CodeableConceptMedicationPSCABinding |
| status | Σ ?! | 0..1 | codeBinding |
| manufacturer | Σ | 0..1 | Reference(Organization) |
| form | S | 0..1 | CodeableConceptPSCABinding |
| amount | Σ | 0..1 | Ratio |
| ingredient | 0..* | BackboneElement | |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| modifierExtension | Σ ?! C | 0..* | Extension |
| item[x] | 1..1 | ||
| itemReference | Reference(Substance | Medication) | ||
| itemCodeableConcept | 0..1 | CodeableConceptBinding | |
| isActive | 0..1 | boolean | |
| strength | C | 0..1 | RatioPSCA |
| batch | 0..1 | BackboneElement | |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| modifierExtension | Σ ?! C | 0..* | Extension |
| lotNumber | 0..1 | string | |
| expirationDate | 0..1 | dateTime |
| MedicationPSCA (Medication) | C | Medication | |
| id | Σ | 0..1 | string |
| meta | Σ | 0..1 | Meta |
| implicitRules | Σ ?! | 0..1 | uri |
| language | 0..1 | codeBinding | |
| text | 0..1 | Narrative | |
| contained | 0..* | Resource | |
| extension | C | 0..* | Extension |
| strength | C | 0..1 | Extension(string) |
| modifierExtension | ?! C | 0..* | Extension |
| identifier | Σ | 0..* | Identifier |
| code | S Σ | 1..1 | CodeableConceptMedicationPSCABinding |
| status | Σ ?! | 0..1 | codeBinding |
| manufacturer | Σ | 0..1 | Reference(Organization) |
| form | S | 0..1 | CodeableConceptPSCABinding |
| amount | Σ | 0..1 | Ratio |
| ingredient | 0..* | BackboneElement | |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| modifierExtension | Σ ?! C | 0..* | Extension |
| item[x] | 1..1 | ||
| itemReference | Reference(Substance | Medication) | ||
| itemCodeableConcept | 0..1 | CodeableConceptBinding | |
| isActive | 0..1 | boolean | |
| strength | C | 0..1 | RatioPSCA |
| batch | 0..1 | BackboneElement | |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| modifierExtension | Σ ?! C | 0..* | Extension |
| lotNumber | 0..1 | string | |
| expirationDate | 0..1 | dateTime |
<description value="This profile represents the constraints applied to the Medication resource by the PS-CA project to represent a medication in the patient summary. It is informed by the constraints of the [Medication IPS-UV profile](http://hl7.org/fhir/uv/ips/StructureDefinition-Medication-uv-ips.html) and the [Canadian Baseline Profile](http://build.fhir.org/ig/HL7-Canada/ca-baseline/branches/master/StructureDefinition-profile-medication.html) to allow for cross-border and cross-jurisdiction sharing of Medication Summary information." />
<copyright value="Copyright © 2024+ 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)." />
<definition value="This resource is primarily used for the identification and definition of a medication for the purposes of prescribing, dispensing, and administering a medication as well as for making statements about medication use." />
</base>
<human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources" />
</constraint>
<human value="If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource" />
<expression value="contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()" />
<xpath value="not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))" />
</constraint>
<human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated" />
<xpath value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))" />
</constraint>
<human value="If a resource is contained in another resource, it SHALL NOT have a security label" />
</constraint>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
<valueMarkdown value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." />
</extension>
</constraint>
</mapping>
<map value="NewRx/MedicationPrescribed\n-or-\nRxFill/MedicationDispensed\n-or-\nRxHistoryResponse/MedicationDispensed\n-or-\nRxHistoryResponse/MedicationPrescribed" />
</mapping>
</mapping>
</element>
<definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes." />
<comment value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation." />
</base>
</extension>
</type>
</element>
<definition value="The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource." />
</base>
</type>
</constraint>
</element>
<definition value="A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc." />
<comment value="Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc." />
</base>
</type>
</constraint>
<isModifierReason value="This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation" />
</element>
<comment value="Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute)." />
</base>
</type>
</constraint>
</extension>
</extension>
</extension>
</binding>
</element>
<definition value="A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety." />
<comment value="Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later." />
</base>
</type>
</constraint>
</mapping>
</element>
<definition value="These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope." />
<comment value="This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels." />
</base>
</type>
</mapping>
</element>
</discriminator>
</slicing>
<definition value="May be used to represent additional information that is not part of the basic definition of the resource. 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 value="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." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</element>
<definition value="The overall medication strength, rather than the strength of a specific ingredient." />
<comment value="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." />
</base>
<profile value="http://prescribeit.ca/fhir/StructureDefinition/ext-medication-strength-description" />
</type>
</constraint>
</constraint>
</mapping>
</element>
<definition value="May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="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." />
<requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." />
</base>
</type>
</constraint>
</constraint>
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them" />
</mapping>
</element>
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
</extension>
</extension>
<comment value="A variety of terminology is used across the Canadian Landscape to codify medications. Various code systems in use in Canada are put forward as examples and using the additional bindings extension.\n\nFuture releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content.\n\n In Canada, CCDD is the preferred binding type for medication codes. However, for broader international comprehension, it's recommended that, where mappings exist, implementers also include IPS concepts alongside CCDD. This approach aims to balance national preferences with the need for international interoperability. Additionally, systems have the flexibility to send other Canadian codes, such as SNOMED CT CA, DIN, and NPN.\n\nIPS-UV Note: Several kinds of medication coding could be provided as:\n\n1. The IDMP Pharmaceutical Product Identifier (PhPID), Level 1, [Substance(s)]. Example: Amoxicillin and Clavulanate Potassium; or any other equivalent coded concept;\n2. The IDMP Pharmaceutical Product Identifier (PhPID), Level 2 [Substance(s) + Strength + reference strength]. Example: Amoxicillin 875 mg and Clavulanate Potassium 125 mg; or any other equivalent coded concept;\n3. The IDMP Pharmaceutical Product Identifier (PhPID), Level 3 [Substance(s) + administrable dose form]. Example: Amoxicillin and Clavulanate Potassium, Oral Tablet; or any other equivalent coded concept;\n4. The IDMP Pharmaceutical Product Identifier (PhPID), Level 4 [Substance(s) + strength + reference strength + administrable dose form]. Example: Amoxicillin 875 mg and clavulanate potassium 125 mg, oral tablet; or any other equivalent coded concept 5. The IDMP Medicinal Product Identifier (MPID) or any equivalent Medicinal Product Identifier. IDMP MPID uniquely identifies a Medicinal Product, reflecting (but not replacing) any other authorization numbers allocated by a regulator. MPID implies one (set of) PhPID. The MPID shall use a common segment pattern related to a Medicinal Product, which, when each segment is valued shall define a specific MPID concept.\n6. The IDMP Packaged Medicinal Product Identifier (PCID) or any equivalent Packaged Medicinal Product Identifier. Uniquely identifies a Medicinal Product based on its packaging. This implies one MPID can be associated with more than one PCID, if the same Medicinal Product has more than one type of package.\n7. Any other kind of code that that identifies, classifies or cluster the administered product (e.g. the medicinal product or the product class)\n\nThe value sets used for the PhPID, MPID and PCID identifiers are provisional and include only few equivalent concepts used for exemplification purposes, they will be updated with real IDMP identifiers when they will become available." />
</base>
<profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-medication-ca-ps" />
</type>
</coding>
</valueCodeableConcept>
</example>
</coding>
</valueCodeableConcept>
</example>
<display value="AVEENO ANTI-ITCH LOTION (calamine 3 % and pramoxine hydrochloride 1 % lotion) JOHNSON & JOHNSON INC" />
</coding>
</valueCodeableConcept>
</example>
</constraint>
</extension>
</extension>
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ValueSet/LicensedNaturalHealthProducts" />
</extension>
<valueMarkdown value="All Natural Product Number (NPN) and Homeopathic Medicine Number (DIN-HM) codes that are licensed by Health Canada and present in the Licensed Natural Health Products Database." />
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<valueCanonical value="https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticalbiologicproductandsubstancecode" />
</extension>
<valueMarkdown value="This is the combination of the PharmaceuticalBiologicProductCode and SubstanceCode subsets." />
</extension>
</extension>
</binding>
<map value="coding.code = //element(*,MedicationType)/DrugCoded/ProductCode\n\ncoding.system = //element(*,MedicationType)/DrugCoded/ProductCodeQualifier\n\ncoding.display = //element(*,MedicationType)/DrugDescription" />
</mapping>
</mapping>
<map value="RXO-1.1-Requested Give Code.code / RXE-2.1-Give Code.code / RXD-2.1-Dispense/Give Code.code / RXG-4.1-Give Code.code /RXA-5.1-Administered Code.code / RXC-2.1 Component Code" />
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<comment value="This status is intended to identify if the medication in a local system is in active use within a drug database or inventory. For example, a pharmacy system may create a new drug file record for a compounded product "ABC Hospital Special Cream" with an active status. At some point in the future, it may be determined that the drug record was created with an error and the status is changed to "entered in error". This status is not intended to specify if a medication is part of a particular formulary. It is possible that the drug record may be referenced by multiple formularies or catalogues and each of those entries would have a separate status." />
</base>
</type>
</constraint>
</extension>
</binding>
</mapping>
</element>
<definition value="Describes the details of the manufacturer of the medication product. This is not intended to represent the distributor of a medication product." />
</base>
</type>
</constraint>
</mapping>
</mapping>
<map value="RXD-20-Substance Manufacturer Name / RXG-21-Substance Manufacturer Name / RXA-17-Substance Manufacturer Name" />
</mapping>
</mapping>
</element>
</extension>
</extension>
<definition value="Administrable Pharmaceutical Dose Form.\n\nThis code represents the form of the medication (e.g. tablet, capsule, liquid)\n\nSince the EDQM Standards Terms, together with UCUM, is one of the IDMP terminologies actually available for usage, this code system has been selected as reference terminology for representing Pharmaceutical Dose forms; Packages and Route of Administration\n\nIt is known that also alternative jurisdictional and international terminologies are known to be used for this concept domain, as NCI or SNOMED CT." />
</base>
<profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" />
</type>
</constraint>
</extension>
</extension>
</extension>
<valueMarkdown value="This binding includes HL7 V3 Codes from the PrescribeIT value set indicating the form in which the drug product is capable of being administered, dispensed, or ordered. Implementers should anticipate that data collected and or exchanged in the context of ePrescribing may contain concepts from this valueSet. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology." />
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</binding>
<map value="coding.code = //element(*,DrugCodedType)/FormCode\n\ncoding.system = //element(*,DrugCodedType)/FormSourceCode" />
</mapping>
<map value="RXO-5-Requested Dosage Form / RXE-6-Give Dosage Form / RXD-6-Actual Dosage Form / RXG-8-Give Dosage Form / RXA-8-Administered Dosage Form" />
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Specific amount of the drug in the packaged product. For example, when specifying a product that has the same strength (For example, Insulin glargine 100 unit per mL solution for injection), this attribute provides additional clarification of the package amount (For example, 3 mL, 10mL, etc.)." />
</base>
</type>
</constraint>
</mapping>
</element>
<comment value="IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content." />
</base>
</type>
</constraint>
</mapping>
</element>
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
</base>
</extension>
</type>
</mapping>
</element>
<definition value="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 value="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." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</element>
<definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="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." />
<requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." />
</base>
</type>
</constraint>
</constraint>
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
</mapping>
</element>
</discriminator>
</slicing>
<definition value="The actual ingredient - either a substance (simple ingredient) or another medication of a medication." />
<requirements value="The ingredient may reference a substance (for example, amoxicillin) or another medication (for example in the case of a compounded product, Glaxal Base)." />
</base>
</type>
</type>
</constraint>
<map value="coding.code = //element(*,MedicationType)/DrugCoded/ProductCode\n\ncoding.system = //element(*,MedicationType)/DrugCoded/ProductCodeQualifier\n\ncoding.display = //element(*,MedicationType)/DrugDescription" />
</mapping>
<map value="RXC-2-Component Code if medication: RXO-1-Requested Give Code / RXE-2-Give Code / RXD-2-Dispense/Give Code / RXG-4-Give Code / RXA-5-Administered Code" />
</mapping>
</mapping>
</element>
<definition value="The actual ingredient - either a substance (simple ingredient) or another medication of a medication." />
<comment value="IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content.\n\nFuture releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain this element within the context of their own jurisdictional content.\n\nIPS UV Note: The IDMP ISO 11238 standard addresses the identification and exchange of regulated information on substances.\n\nThe Global Ingredient Archival System (GInAS) will provide a common global identifier for all of the substances used in medicinal products, providing a definition of substances globally consistent with this standard.\n\nThose identifiers however are yet available for concrete usage, therefore in this version of the template, SNOMED CT has been chosen as reference terminology also for the active substances.\n\nThis choice will be revised based on the availability and the maturity of GInAS." />
<requirements value="The ingredient may reference a substance (for example, amoxicillin) or another medication (for example in the case of a compounded product, Glaxal Base)." />
</base>
</type>
</constraint>
</binding>
<map value="coding.code = //element(*,MedicationType)/DrugCoded/ProductCode\n\ncoding.system = //element(*,MedicationType)/DrugCoded/ProductCodeQualifier\n\ncoding.display = //element(*,MedicationType)/DrugDescription" />
</mapping>
<map value="RXC-2-Component Code if medication: RXO-1-Requested Give Code / RXE-2-Give Code / RXD-2-Dispense/Give Code / RXG-4-Give Code / RXA-5-Administered Code" />
</mapping>
</mapping>
</element>
<definition value="Indication of whether this ingredient affects the therapeutic action of the drug." />
<requirements value="True indicates that the ingredient affects the therapeutic action of the drug (i.e. active). \nFalse indicates that the ingredient does not affect the therapeutic action of the drug (i.e. inactive)." />
</base>
</type>
</constraint>
</mapping>
</element>
</extension>
</extension>
<definition value="A relationship of two Quantity values - expressed as a numerator and a denominator." />
<comment value="IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content." />
</base>
</type>
</constraint>
<human value="Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present" />
<expression value="(numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists())" />
<xpath value="(count(f:numerator) = count(f:denominator)) and ((count(f:numerator) > 0) or (count(f:extension) > 0))" />
</constraint>
</mapping>
<map value="RXC-3-Component Amount & RXC-4-Component Units if medication: RXO-2-Requested Give Amount - Minimum & RXO-4-Requested Give Units / RXO-3-Requested Give Amount - Maximum & RXO-4-Requested Give Units / RXO-11-Requested Dispense Amount & RXO-12-Requested Dispense Units / RXE-3-Give Amount - Minimum & RXE-5-Give Units / RXE-4-Give Amount - Maximum & RXE-5-Give Units / RXE-10-Dispense Amount & RXE-10-Dispense Units" />
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
</base>
</extension>
</type>
</mapping>
</element>
<definition value="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 value="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." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</element>
<definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="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." />
<requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." />
</base>
</type>
</constraint>
</constraint>
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
</mapping>
</element>
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
</base>
</type>
</constraint>
</mapping>
</mapping>
<map value="participation[typeCode=CSM].role[classCode=INST].scopedRole.scoper[classCode=MMAT].expirationTime" />
</mapping>
</element>
</snapshot>
<definition value="The overall medication strength, rather than the strength of a specific ingredient." />
<profile value="http://prescribeit.ca/fhir/StructureDefinition/ext-medication-strength-description" />
</type>
</element>
<comment value="A variety of terminology is used across the Canadian Landscape to codify medications. Various code systems in use in Canada are put forward as examples and using the additional bindings extension.\n\nFuture releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content.\n\n In Canada, CCDD is the preferred binding type for medication codes. However, for broader international comprehension, it's recommended that, where mappings exist, implementers also include IPS concepts alongside CCDD. This approach aims to balance national preferences with the need for international interoperability. Additionally, systems have the flexibility to send other Canadian codes, such as SNOMED CT CA, DIN, and NPN.\n\nIPS-UV Note: Several kinds of medication coding could be provided as:\n\n1. The IDMP Pharmaceutical Product Identifier (PhPID), Level 1, [Substance(s)]. Example: Amoxicillin and Clavulanate Potassium; or any other equivalent coded concept;\n2. The IDMP Pharmaceutical Product Identifier (PhPID), Level 2 [Substance(s) + Strength + reference strength]. Example: Amoxicillin 875 mg and Clavulanate Potassium 125 mg; or any other equivalent coded concept;\n3. The IDMP Pharmaceutical Product Identifier (PhPID), Level 3 [Substance(s) + administrable dose form]. Example: Amoxicillin and Clavulanate Potassium, Oral Tablet; or any other equivalent coded concept;\n4. The IDMP Pharmaceutical Product Identifier (PhPID), Level 4 [Substance(s) + strength + reference strength + administrable dose form]. Example: Amoxicillin 875 mg and clavulanate potassium 125 mg, oral tablet; or any other equivalent coded concept 5. The IDMP Medicinal Product Identifier (MPID) or any equivalent Medicinal Product Identifier. IDMP MPID uniquely identifies a Medicinal Product, reflecting (but not replacing) any other authorization numbers allocated by a regulator. MPID implies one (set of) PhPID. The MPID shall use a common segment pattern related to a Medicinal Product, which, when each segment is valued shall define a specific MPID concept.\n6. The IDMP Packaged Medicinal Product Identifier (PCID) or any equivalent Packaged Medicinal Product Identifier. Uniquely identifies a Medicinal Product based on its packaging. This implies one MPID can be associated with more than one PCID, if the same Medicinal Product has more than one type of package.\n7. Any other kind of code that that identifies, classifies or cluster the administered product (e.g. the medicinal product or the product class)\n\nThe value sets used for the PhPID, MPID and PCID identifiers are provisional and include only few equivalent concepts used for exemplification purposes, they will be updated with real IDMP identifiers when they will become available." />
<profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-medication-ca-ps" />
</type>
</coding>
</valueCodeableConcept>
</example>
</coding>
</valueCodeableConcept>
</example>
<display value="AVEENO ANTI-ITCH LOTION (calamine 3 % and pramoxine hydrochloride 1 % lotion) JOHNSON & JOHNSON INC" />
</coding>
</valueCodeableConcept>
</example>
</extension>
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ValueSet/LicensedNaturalHealthProducts" />
</extension>
<valueMarkdown value="All Natural Product Number (NPN) and Homeopathic Medicine Number (DIN-HM) codes that are licensed by Health Canada and present in the Licensed Natural Health Products Database." />
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<valueCanonical value="https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticalbiologicproductandsubstancecode" />
</extension>
<valueMarkdown value="This is the combination of the PharmaceuticalBiologicProductCode and SubstanceCode subsets." />
</extension>
</extension>
</binding>
</element>
<definition value="Administrable Pharmaceutical Dose Form.\n\nThis code represents the form of the medication (e.g. tablet, capsule, liquid)\n\nSince the EDQM Standards Terms, together with UCUM, is one of the IDMP terminologies actually available for usage, this code system has been selected as reference terminology for representing Pharmaceutical Dose forms; Packages and Route of Administration\n\nIt is known that also alternative jurisdictional and international terminologies are known to be used for this concept domain, as NCI or SNOMED CT." />
<profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" />
</type>
</extension>
</extension>
<valueMarkdown value="This binding includes HL7 V3 Codes from the PrescribeIT value set indicating the form in which the drug product is capable of being administered, dispensed, or ordered. Implementers should anticipate that data collected and or exchanged in the context of ePrescribing may contain concepts from this valueSet. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology." />
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</binding>
</element>
<comment value="IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content." />
</element>
<comment value="IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content.\n\nFuture releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain this element within the context of their own jurisdictional content.\n\nIPS UV Note: The IDMP ISO 11238 standard addresses the identification and exchange of regulated information on substances.\n\nThe Global Ingredient Archival System (GInAS) will provide a common global identifier for all of the substances used in medicinal products, providing a definition of substances globally consistent with this standard.\n\nThose identifiers however are yet available for concrete usage, therefore in this version of the template, SNOMED CT has been chosen as reference terminology also for the active substances.\n\nThis choice will be revised based on the availability and the maturity of GInAS." />
</binding>
</element>
<comment value="IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content." />
</type>
</element>
</differential>
</StructureDefinition>
{
"description": "This profile represents the constraints applied to the Medication resource by the PS-CA project to represent a medication in the patient summary. It is informed by the constraints of the [Medication IPS-UV profile](http://hl7.org/fhir/uv/ips/StructureDefinition-Medication-uv-ips.html) and the [Canadian Baseline Profile](http://build.fhir.org/ig/HL7-Canada/ca-baseline/branches/master/StructureDefinition-profile-medication.html) to allow for cross-border and cross-jurisdiction sharing of Medication Summary information.",
"copyright": "Copyright © 2024+ 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).",
{
"definition": "This resource is primarily used for the identification and definition of a medication for the purposes of prescribing, dispensing, and administering a medication as well as for making statements about medication use.",
},
{
},
{
"human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource",
"expression": "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()",
"xpath": "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
},
{
"human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
},
{
},
{
{
},
{
"valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
}
],
}
],
{
},
{
"map": "NewRx/MedicationPrescribed\n-or-\nRxFill/MedicationDispensed\n-or-\nRxHistoryResponse/MedicationDispensed\n-or-\nRxHistoryResponse/MedicationPrescribed"
},
{
}
]
},
{
"definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
},
{
{
}
],
}
],
},
{
"definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.",
},
],
{
}
],
},
{
"definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.",
"comment": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.",
},
],
{
}
],
"isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation",
},
{
"comment": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).",
},
],
{
}
],
{
},
{
},
{
}
],
}
},
{
"definition": "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
"comment": "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.",
"narrative",
"html",
"xhtml",
"display"
],
},
],
{
}
],
]
},
{
"definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
"comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.",
"inline resources",
"anonymous resources",
"contained resources"
],
},
],
]
},
{
},
"definition": "May be used to represent additional information that is not part of the basic definition of the resource. 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.",
"extensions",
"user content"
],
},
],
{
},
{
}
],
]
},
{
"definition": "The overall medication strength, rather than the strength of a specific ingredient.",
"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.",
"extensions",
"user content"
],
},
{
"http://prescribeit.ca/fhir/StructureDefinition/ext-medication-strength-description"
]
}
],
"ele-1"
],
{
},
{
}
],
]
},
{
"definition": "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"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.",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"extensions",
"user content"
],
},
],
{
},
{
}
],
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
]
},
{
},
],
{
}
],
]
},
{
{
},
{
}
],
"comment": "A variety of terminology is used across the Canadian Landscape to codify medications. Various code systems in use in Canada are put forward as examples and using the additional bindings extension.\n\nFuture releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content.\n\n In Canada, CCDD is the preferred binding type for medication codes. However, for broader international comprehension, it's recommended that, where mappings exist, implementers also include IPS concepts alongside CCDD. This approach aims to balance national preferences with the need for international interoperability. Additionally, systems have the flexibility to send other Canadian codes, such as SNOMED CT CA, DIN, and NPN.\n\nIPS-UV Note: Several kinds of medication coding could be provided as:\n\n1. The IDMP Pharmaceutical Product Identifier (PhPID), Level 1, [Substance(s)]. Example: Amoxicillin and Clavulanate Potassium; or any other equivalent coded concept;\n2. The IDMP Pharmaceutical Product Identifier (PhPID), Level 2 [Substance(s) + Strength + reference strength]. Example: Amoxicillin 875 mg and Clavulanate Potassium 125 mg; or any other equivalent coded concept;\n3. The IDMP Pharmaceutical Product Identifier (PhPID), Level 3 [Substance(s) + administrable dose form]. Example: Amoxicillin and Clavulanate Potassium, Oral Tablet; or any other equivalent coded concept;\n4. The IDMP Pharmaceutical Product Identifier (PhPID), Level 4 [Substance(s) + strength + reference strength + administrable dose form]. Example: Amoxicillin 875 mg and clavulanate potassium 125 mg, oral tablet; or any other equivalent coded concept 5. The IDMP Medicinal Product Identifier (MPID) or any equivalent Medicinal Product Identifier. IDMP MPID uniquely identifies a Medicinal Product, reflecting (but not replacing) any other authorization numbers allocated by a regulator. MPID implies one (set of) PhPID. The MPID shall use a common segment pattern related to a Medicinal Product, which, when each segment is valued shall define a specific MPID concept.\n6. The IDMP Packaged Medicinal Product Identifier (PCID) or any equivalent Packaged Medicinal Product Identifier. Uniquely identifies a Medicinal Product based on its packaging. This implies one MPID can be associated with more than one PCID, if the same Medicinal Product has more than one type of package.\n7. Any other kind of code that that identifies, classifies or cluster the administered product (e.g. the medicinal product or the product class)\n\nThe value sets used for the PhPID, MPID and PCID identifiers are provisional and include only few equivalent concepts used for exemplification purposes, they will be updated with real IDMP identifiers when they will become available.",
},
{
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-medication-ca-ps"
]
}
],
{
{
}
],
}
},
{
{
}
],
}
},
{
{
"display": "AVEENO ANTI-ITCH LOTION (calamine 3 % and pramoxine hydrochloride 1 % lotion) JOHNSON & JOHNSON INC"
}
],
}
}
],
"ele-1"
],
{
}
],
{
},
{
{
},
{
},
{
"valueMarkdown": "All Natural Product Number (NPN) and Homeopathic Medicine Number (DIN-HM) codes that are licensed by Health Canada and present in the Licensed Natural Health Products Database."
}
],
},
{
{
},
{
},
{
}
],
},
{
{
},
{
},
{
}
],
},
{
{
},
{
},
{
}
],
},
{
{
},
{
"valueCanonical": "https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticalbiologicproductandsubstancecode"
},
{
"valueMarkdown": "This is the combination of the PharmaceuticalBiologicProductCode and SubstanceCode subsets."
}
],
}
],
},
{
"map": "coding.code = //element(*,MedicationType)/DrugCoded/ProductCode\n\ncoding.system = //element(*,MedicationType)/DrugCoded/ProductCodeQualifier\n\ncoding.display = //element(*,MedicationType)/DrugDescription"
},
{
},
{
"map": "RXO-1.1-Requested Give Code.code / RXE-2.1-Give Code.code / RXD-2.1-Dispense/Give Code.code / RXG-4.1-Give Code.code /RXA-5.1-Administered Code.code / RXC-2.1 Component Code"
},
{
},
{
},
{
},
{
},
{
}
]
},
{
"comment": "This status is intended to identify if the medication in a local system is in active use within a drug database or inventory. For example, a pharmacy system may create a new drug file record for a compounded product \"ABC Hospital Special Cream\" with an active status. At some point in the future, it may be determined that the drug record was created with an error and the status is changed to \"entered in error\". This status is not intended to specify if a medication is part of a particular formulary. It is possible that the drug record may be referenced by multiple formularies or catalogues and each of those entries would have a separate status.",
},
],
{
}
],
{
}
],
},
]
},
{
"definition": "Describes the details of the manufacturer of the medication product. This is not intended to represent the distributor of a medication product.",
},
{
}
],
{
}
],
{
},
{
},
{
"map": "RXD-20-Substance Manufacturer Name / RXG-21-Substance Manufacturer Name / RXA-17-Substance Manufacturer Name"
},
{
}
]
},
{
{
},
{
}
],
"definition": "Administrable Pharmaceutical Dose Form.\n\nThis code represents the form of the medication (e.g. tablet, capsule, liquid)\n\nSince the EDQM Standards Terms, together with UCUM, is one of the IDMP terminologies actually available for usage, this code system has been selected as reference terminology for representing Pharmaceutical Dose forms; Packages and Route of Administration\n\nIt is known that also alternative jurisdictional and international terminologies are known to be used for this concept domain, as NCI or SNOMED CT.",
},
{
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
]
}
],
"ele-1"
],
{
}
],
{
},
{
{
},
{
},
{
"valueMarkdown": "This binding includes HL7 V3 Codes from the PrescribeIT value set indicating the form in which the drug product is capable of being administered, dispensed, or ordered. Implementers should anticipate that data collected and or exchanged in the context of ePrescribing may contain concepts from this valueSet. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology."
}
],
},
{
{
},
{
},
{
}
],
}
],
},
{
"map": "coding.code = //element(*,DrugCodedType)/FormCode\n\ncoding.system = //element(*,DrugCodedType)/FormSourceCode"
},
{
"map": "RXO-5-Requested Dosage Form / RXE-6-Give Dosage Form / RXD-6-Actual Dosage Form / RXG-8-Give Dosage Form / RXA-8-Administered Dosage Form"
},
{
},
{
},
{
},
{
},
{
}
]
},
{
"definition": "Specific amount of the drug in the packaged product. For example, when specifying a product that has the same strength (For example, Insulin glargine 100 unit per mL solution for injection), this attribute provides additional clarification of the package amount (For example, 3 mL, 10mL, etc.).",
},
],
{
}
],
]
},
{
"comment": "IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content.",
},
],
{
}
],
]
},
{
"xmlAttr"
],
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
},
{
{
}
],
}
],
]
},
{
"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.",
"extensions",
"user content"
],
},
],
{
},
{
}
],
]
},
{
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"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.",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"extensions",
"user content",
"modifiers"
],
},
],
{
},
{
}
],
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
]
},
{
},
"definition": "The actual ingredient - either a substance (simple ingredient) or another medication of a medication.",
"requirements": "The ingredient may reference a substance (for example, amoxicillin) or another medication (for example in the case of a compounded product, Glaxal Base).",
},
{
},
{
"http://hl7.org/fhir/StructureDefinition/Substance",
"http://hl7.org/fhir/StructureDefinition/Medication"
]
}
],
{
}
],
{
"map": "coding.code = //element(*,MedicationType)/DrugCoded/ProductCode\n\ncoding.system = //element(*,MedicationType)/DrugCoded/ProductCodeQualifier\n\ncoding.display = //element(*,MedicationType)/DrugDescription"
},
{
"map": "RXC-2-Component Code if medication: RXO-1-Requested Give Code / RXE-2-Give Code / RXD-2-Dispense/Give Code / RXG-4-Give Code / RXA-5-Administered Code"
},
{
}
]
},
{
"definition": "The actual ingredient - either a substance (simple ingredient) or another medication of a medication.",
"comment": "IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content.\n\nFuture releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain this element within the context of their own jurisdictional content.\n\nIPS UV Note: The IDMP ISO 11238 standard addresses the identification and exchange of regulated information on substances.\n\nThe Global Ingredient Archival System (GInAS) will provide a common global identifier for all of the substances used in medicinal products, providing a definition of substances globally consistent with this standard.\n\nThose identifiers however are yet available for concrete usage, therefore in this version of the template, SNOMED CT has been chosen as reference terminology also for the active substances.\n\nThis choice will be revised based on the availability and the maturity of GInAS.",
"requirements": "The ingredient may reference a substance (for example, amoxicillin) or another medication (for example in the case of a compounded product, Glaxal Base).",
},
],
{
}
],
},
{
"map": "coding.code = //element(*,MedicationType)/DrugCoded/ProductCode\n\ncoding.system = //element(*,MedicationType)/DrugCoded/ProductCodeQualifier\n\ncoding.display = //element(*,MedicationType)/DrugDescription"
},
{
"map": "RXC-2-Component Code if medication: RXO-1-Requested Give Code / RXE-2-Give Code / RXD-2-Dispense/Give Code / RXG-4-Give Code / RXA-5-Administered Code"
},
{
}
]
},
{
"requirements": "True indicates that the ingredient affects the therapeutic action of the drug (i.e. active). \nFalse indicates that the ingredient does not affect the therapeutic action of the drug (i.e. inactive).",
},
],
{
}
],
]
},
{
{
},
{
}
],
"definition": "A relationship of two Quantity values - expressed as a numerator and a denominator.",
"comment": "IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content.",
},
{
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/Ratio-ca-ps"
]
}
],
"ele-1"
],
{
},
{
"human": "Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present",
"expression": "(numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists())",
"xpath": "(count(f:numerator) = count(f:denominator)) and ((count(f:numerator) > 0) or (count(f:extension) > 0))",
}
],
{
},
{
"map": "RXC-3-Component Amount & RXC-4-Component Units if medication: RXO-2-Requested Give Amount - Minimum & RXO-4-Requested Give Units / RXO-3-Requested Give Amount - Maximum & RXO-4-Requested Give Units / RXO-11-Requested Dispense Amount & RXO-12-Requested Dispense Units / RXE-3-Give Amount - Minimum & RXE-5-Give Units / RXE-4-Give Amount - Maximum & RXE-5-Give Units / RXE-10-Dispense Amount & RXE-10-Dispense Units"
},
{
},
{
},
{
},
{
}
]
},
{
},
],
{
}
],
{
},
{
}
]
},
{
"xmlAttr"
],
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
},
{
{
}
],
}
],
]
},
{
"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.",
"extensions",
"user content"
],
},
],
{
},
{
}
],
]
},
{
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"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.",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"extensions",
"user content",
"modifiers"
],
},
],
{
},
{
}
],
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
]
},
{
},
],
{
}
],
{
},
{
},
{
}
]
},
{
},
],
{
}
],
{
},
{
},
{
"map": "participation[typeCode=CSM].role[classCode=INST].scopedRole.scoper[classCode=MMAT].expirationTime"
}
]
}
]
},
{
"definition": "The overall medication strength, rather than the strength of a specific ingredient.",
{
"http://prescribeit.ca/fhir/StructureDefinition/ext-medication-strength-description"
]
}
]
},
{
"comment": "A variety of terminology is used across the Canadian Landscape to codify medications. Various code systems in use in Canada are put forward as examples and using the additional bindings extension.\n\nFuture releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content.\n\n In Canada, CCDD is the preferred binding type for medication codes. However, for broader international comprehension, it's recommended that, where mappings exist, implementers also include IPS concepts alongside CCDD. This approach aims to balance national preferences with the need for international interoperability. Additionally, systems have the flexibility to send other Canadian codes, such as SNOMED CT CA, DIN, and NPN.\n\nIPS-UV Note: Several kinds of medication coding could be provided as:\n\n1. The IDMP Pharmaceutical Product Identifier (PhPID), Level 1, [Substance(s)]. Example: Amoxicillin and Clavulanate Potassium; or any other equivalent coded concept;\n2. The IDMP Pharmaceutical Product Identifier (PhPID), Level 2 [Substance(s) + Strength + reference strength]. Example: Amoxicillin 875 mg and Clavulanate Potassium 125 mg; or any other equivalent coded concept;\n3. The IDMP Pharmaceutical Product Identifier (PhPID), Level 3 [Substance(s) + administrable dose form]. Example: Amoxicillin and Clavulanate Potassium, Oral Tablet; or any other equivalent coded concept;\n4. The IDMP Pharmaceutical Product Identifier (PhPID), Level 4 [Substance(s) + strength + reference strength + administrable dose form]. Example: Amoxicillin 875 mg and clavulanate potassium 125 mg, oral tablet; or any other equivalent coded concept 5. The IDMP Medicinal Product Identifier (MPID) or any equivalent Medicinal Product Identifier. IDMP MPID uniquely identifies a Medicinal Product, reflecting (but not replacing) any other authorization numbers allocated by a regulator. MPID implies one (set of) PhPID. The MPID shall use a common segment pattern related to a Medicinal Product, which, when each segment is valued shall define a specific MPID concept.\n6. The IDMP Packaged Medicinal Product Identifier (PCID) or any equivalent Packaged Medicinal Product Identifier. Uniquely identifies a Medicinal Product based on its packaging. This implies one MPID can be associated with more than one PCID, if the same Medicinal Product has more than one type of package.\n7. Any other kind of code that that identifies, classifies or cluster the administered product (e.g. the medicinal product or the product class)\n\nThe value sets used for the PhPID, MPID and PCID identifiers are provisional and include only few equivalent concepts used for exemplification purposes, they will be updated with real IDMP identifiers when they will become available.",
{
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-medication-ca-ps"
]
}
],
{
{
}
],
}
},
{
{
}
],
}
},
{
{
"display": "AVEENO ANTI-ITCH LOTION (calamine 3 % and pramoxine hydrochloride 1 % lotion) JOHNSON & JOHNSON INC"
}
],
}
}
],
{
{
},
{
},
{
"valueMarkdown": "All Natural Product Number (NPN) and Homeopathic Medicine Number (DIN-HM) codes that are licensed by Health Canada and present in the Licensed Natural Health Products Database."
}
],
},
{
{
},
{
},
{
}
],
},
{
{
},
{
},
{
}
],
},
{
{
},
{
},
{
}
],
},
{
{
},
{
"valueCanonical": "https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticalbiologicproductandsubstancecode"
},
{
"valueMarkdown": "This is the combination of the PharmaceuticalBiologicProductCode and SubstanceCode subsets."
}
],
}
],
}
},
{
"definition": "Administrable Pharmaceutical Dose Form.\n\nThis code represents the form of the medication (e.g. tablet, capsule, liquid)\n\nSince the EDQM Standards Terms, together with UCUM, is one of the IDMP terminologies actually available for usage, this code system has been selected as reference terminology for representing Pharmaceutical Dose forms; Packages and Route of Administration\n\nIt is known that also alternative jurisdictional and international terminologies are known to be used for this concept domain, as NCI or SNOMED CT.",
{
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
]
}
],
{
{
},
{
},
{
"valueMarkdown": "This binding includes HL7 V3 Codes from the PrescribeIT value set indicating the form in which the drug product is capable of being administered, dispensed, or ordered. Implementers should anticipate that data collected and or exchanged in the context of ePrescribing may contain concepts from this valueSet. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology."
}
],
},
{
{
},
{
},
{
}
],
}
],
}
},
{
"comment": "IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content."
},
{
"comment": "IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content.\n\nFuture releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain this element within the context of their own jurisdictional content.\n\nIPS UV Note: The IDMP ISO 11238 standard addresses the identification and exchange of regulated information on substances.\n\nThe Global Ingredient Archival System (GInAS) will provide a common global identifier for all of the substances used in medicinal products, providing a definition of substances globally consistent with this standard.\n\nThose identifiers however are yet available for concrete usage, therefore in this version of the template, SNOMED CT has been chosen as reference terminology also for the active substances.\n\nThis choice will be revised based on the availability and the maturity of GInAS.",
}
},
{
"comment": "IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content.",
{
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/Ratio-ca-ps"
]
}
]
}
]
}
}
Terminology bindings (Differential)
| Path | Conformance | ValueSet |
|---|---|---|
| Medication.code | preferred | https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct |
| Medication.form | preferred | https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticaldoseformcode |
| Medication.ingredient.itemCodeableConcept | preferred | https://fhir.infoway-inforoute.ca/ValueSet/drugormedicamentsubstancecode |
Terminology bindings (Snapshot)
| Path | Conformance | ValueSet |
|---|---|---|
| Medication.language | preferred | http://hl7.org/fhir/ValueSet/languages |
| Medication.code | preferred | https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct |
| Medication.status | required | http://hl7.org/fhir/ValueSet/medication-status|4.0.1 |
| Medication.form | preferred | https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticaldoseformcode |
| Medication.ingredient.item[x]:itemCodeableConcept | preferred | https://fhir.infoway-inforoute.ca/ValueSet/drugormedicamentsubstancecode |
Constraints
Obligations
Key Differences between the IPS-UV and PS-CA
Must Support Differences:
The following elements are considered Must Support in the Medication (IPS) profile that are relaxed in this version of the PS-CA profile:
Medication.ingredientand sub-elementsNote: Systems that support these elements are encouraged to send them in patient summaries
Cardinality Differences:
There are no cardinality differences between this profile and IPS-UV
Vocabulary Differences:
Medication.code- added preferred binding of PrescriptionMedicinalProduct
- additionalBindings added for:
- LicensedNaturalHealthProducts (NPN & DIN-HM) codes,
- WHO ATC Classification (already additionalBinding in IPS),
- IPS medications (preferred binding in IPS)
- Health Canada Drug Identification Number DIN
- Pharmaceutical Biologic Product And SubstanceCode PharmaceuticalBiologicProductAndSubstanceCode
Medication.form- PharmaceuticalDoseFormCode indicated as preferred
- additionalBindings added for:
- Prescribe IT PrescriptionDrugForm (derived from HL7 v3)
- MedicineDoseFormUvIps (already additionalBinding in IPS)
Medication.ingredient.itemCodeableConcept.coding- DrugOrMedicamentSubstanceCode indicated as preferred
Terminology Guidance: In Canada, CCDD is the preferred binding type for medication codes. However, for broader international comprehension, it's recommended that, where mappings exist, implementers also include IPS concepts alongside CCDD. This approach aims to balance national preferences with the need for international interoperability. Additionally, systems have the flexibility to send other Canadian codes, such as SNOMED CT CA, DIN, and NPN.
Other differences between the IPS and PS-CA Include:
- Data type profiles (e.g., CodeableConcept) and reference targets (e.g., Patient) replaced with PS-CA equivalents when appropriate