Clinical Statement Choice - tabular view

A choice of clinical statements that are present in a Discharge Notification or Care Event Report.

Refers to the  subject where the subject is not the patient who is the record target.

Refers to a participant in clinical events.

The following participants are modelled using this participation:

Care Event Service Provider Organization - optional

Care Event care professional - required if different to inherited author  

Refers to the choice of location relevant to clinical data conveyed in a clinical statement.

Refers to the agent / person / device acting in the role of informant.  The patient may at as an informant.

Refers to medication information that is pertinent to a clinical statement .

Refers to supporting information which is pertinent to a clinical statement.  

An act Relationship that supports the linkage of clinical statements using the "Direct Relationship" mechanism.

A relationship to another clinical statement by reference.  The clinical statement may be in the message instance carrying the reference, or on PSIS.

A care event statement present in the discharge notification or care event report.

A consent statement present in the discharge notification or care event report.

An observation statement present in the discharge notification or care event report.

An organizer statement present in the discharge notification or care event report.

A procedure statement present in the discharge notification or care event report.

A relationship statement present in the discharge notification or care event report.

A non-medication substance administration statement present in the discharge notification or care event report.

A non-medication supply statement present in the discharge notification or care event report.

A clinical statement describing an care event.

There can be zero, one or many care event statements.

Indicates that the care event is an encounter.

• Fixed value: "ENC"

The mood code of the Care Event.

The value of mood code should be set according to the information and context of the clinical statement information being carried in the encounter class.  

The CodedOnly datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the x_ActMoodIntentEvent vocabulary.

A list of unique identifiers for this instance of a care event.

The first is mandatory and is a unique identifier for this instance of a specific clinical statement.  The second is optional and allows a care event to be identified by a local identifier.

The Identifier Global datatype flavour is used to carry the first identifier as follows:

• The root attribute shall contain a DCE UUID

The Identifier External datatype flavour is used to carry the second identifier as follows:

• The root carries an OID for the local identifier scheme
• The extension carries a human-readable identifier from that scheme.

A SnomedCT code identifying the encounter type.

 The Concept Descriptor (CD) datatype shall be used to carry this information as follows:

• The code attribute shall contain a code from the relevant vocabulary
• The code System attribute shall contain the OID for SnomedCT
• The display text shall carry a description associated with the code in SnomedCT
• the original text attribute may be used if required
• qualifier(s) may be used if required.

The (optional) status of the CareEvent, e.g. active, suspended, completed.

Shall be present if status is aborted or cancelled.

The Coded Only datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the Act Status vocabulary.

The effective date carries the start and end date/time of the care event. The start date/time is required and the end date/time is optional. 

The date range shall be carried as follows:

If both a start date and an end date are present the Date or Time Interval Complete datatype shall be used:

• The low attribute shall contain the start date
• The high attribute shall contain the end date.

If only a start date is present the Date or Time Interval After datatype shall be used:

• The low attribute shall contain the start date.

The date and time that the care event was recorded on the source system.

Refers to the choice of location relevant to clinical data conveyed in a clinical statement.

Refers to the care event commentary associated with a care event.

Information about the patient's consent with regard to organ donation, surgery, etc.

Each organ / procedure / etc for which there is a positive consent will be carried in an instance of a Consent act.

There is currently no mechanism for specifying negation of consent.

Indicates that this is an act of consent.

• Fixed value: "CONS"

The mood code of the consent act.

The value of mood code should be set appropriately according to the information and context of the consent being modelled.

The CodedOnly datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the x_ActMoodIntentEvent vocabulary.

A list of unique identifiers for this instance of a consent.

The first is mandatory and is a unique identifier for this instance of a consent. The second is optional and allows a consent statement to be identified by a local identifier. 

The Identifier Global datatype flavour is used to carry the first identifier as follows:

• The root attribute shall contain a DCE UUID

The Identifier External datatype flavour is used to carry the second identifier as follows:

• The root carries an OID for the local identifier scheme
• The extension carries a human-readable identifier from that scheme.

A SnomedCT code identifying the type of the consent, e.g. for a surgical procedure or donation of one or more kind of organ.

The Concept Descriptor (CD) datatype shall be used to carry this information as follows:

• The code attribute shall contain a code from the relevant vocabulary
• The code System attribute shall contain the OID for SnomedCT
• The display text shall carry a description associated with the code in SnomedCT
• the original text attribute may be used if required
• qualifier(s) may be used if required.

The (optional) status of the consent act, e.g. active, suspended, completed.

Shall be present if status is aborted or cancelled.

The Coded Only datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the Act Status vocabulary.

The effective date carries the start and end date/time of the consent. The start date/time is required and the end date/time is optional.

The date range shall be carried as follows:

If both a start date and an end date are present the Date or Time Interval Complete datatype shall be used:

• The low attribute shall contain the start date
• The high attribute shall contain the end date

If only a start date is present the Date or Time Interval After datatype shall be used:

• The low attribute shall contain the start date.

The date and time the consent was given.

Information about a clinical statement that describes an observation.

The following clinical statements are modelled as observation acts:                   

Legal Status

Living will  

Religious/Culturally Dependent Needs

Health & Social Issue as described by patient

Health & Social Issue as described by HCP

Attitude of patient to issue

Attitude of carer to issue

Patient awareness of issue

Carer awareness of issue

Diagnosis

Prognosis

Findings

Goal

Family History

Allergy

Risk Statement

Risk Incident

Smoking

Smoking Future Intentions

Alcohol

Alcohol future intentions

Substance misuse

Exercise habits

Occupation

Employment

Housing

Social network

Religion

Ethnic category

Services

Carer

Functioning and wellbeing

Indicates that this is an observation.

• Fixed value: "OBS"

The mood code of the observation act.

The value of mood code should be set according to the information and context of the clinical statement information being carried in the observation class. 

The CodedOnly datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the ActMood vocabulary.

A set of unique identifiers for this instance of an observation.

The first is mandatory and is a unique identifier for this instance of a specific clinical statement. The second is optional and allows an observation to be identified by a local identifier.

The Identifier Global datatype flavour is used to carry the first identifier as follows:

• The root attribute shall contain a DCE UUID

The Identifier External datatype flavour is used to carry the second identifier as follows:

• The root carries an OID for the local identifier scheme
• The extension carries a human-readable identifier from that scheme.

A SnomedCT code identifying the type of observation.

 The Concept Descriptor (CD) datatype shall be used to carry this information as follows:

• The code attribute shall contain a code from the relevant vocabulary
• The code System attribute shall contain the OID for SnomedCT
• The display text shall carry a description associated with the code in SnomedCT
• the original text attribute may be used if required
• qualifier(s) may be used if required.

For each clinical statement that is an observation the usage of Observation.code is described below:

• Patient Legal Status - the informal or Mental Health Act Section current at the time the message is created.
• Living Will - The description of a living will in coded format 
• Religious/Culturally Dependent Needs - a  patient's religious/cultural needs. 
• Health & Social Issue as described by HCP - a type of issue, it's severity and status as identified by an HCP.
• Health & Social Issue as described by patient - a type of issue, it's severity and status as identified by the patient.
• Attitude of carer to issue - the carer's attitude to the issue.
• Patient awareness of issue - the patient's awareness of the issue.
• Carer awareness of issue - the carer's awareness of the issue.
• Diagnosis - a diagnosis including certainty of diagnosis and negation.
• Prognosis - a prognosis associated with a diagnosis.
• Finding - a finding including any additional descriptions that can be coded.
• Outcome - an outcome.
• Goal - a goal identified for the future.
• Family History - family history item, including description of relationship of person with family history to patient.
• Risk Statement - an identified risk to others from the patient.
• Risk Incident - the actual risk in a risk incident.
• Smoking - the current status of the smoking habits of the patient including smoking consumption.
• Smoking future intentions - the patient's future intentions to change smoking habits.
• Alcohol - the alcohol status of the patient at the time of recording, includes alcohol consumption.
• Alcohol future intentions - the patient's future intentions with regard to alcohol consumption.
• Substance misuse - a known drug habit.
• Exercise - the exercise habits of the patient.
• Occupation - the patient's occupation .
• Employment - information on the employment status of a patient Housing - information on the housing situation of the patient in coded form.
• Social Network - the nature of the social network of the patient. Religion - information about the patient's religion.
• Ethnic Category - information about the patient's ethnic category . 
• Services - a type of service being provided by other agents to the patient.
• Care provided by Carer - the nature of care provided by the carer to the patient.
• Functioning and wellbeing - the functioning and wellbeing of the patient.

The (optional) status of the Observation, e.g. active, suspended, completed.

Shall be present if status is aborted or cancelled.

The Coded Only datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the Act Status vocabulary.

The clinically relevant date and time.

For this release the effective time shall be constrained to (IVL<TS>)

For each observation which has a requirement to carry the clinically relevant date and time the usage of Observation.effectiveTime is described below:

• Patient Legal Status - The start and end date of the latest legal status of the patient - optional. 
• Health & Social Issue as described by patient - The date that the patient noticed the issue and the date that the issue was resolved - optional.
• Diagnosis - The date and time the diagnosis was true of the patient - optional
• Finding - the date and time the finding was true of the patient - optional
• Outcome - The date and time the outcome was assessed - optional.
• Risk Incident - The date and time that the incident occurred - optional.

A date range shall be carried as follows:

If both a start date and an end date are present the Date or Time Interval Complete datatype shall be used:

• The low attribute shall contain the start date
• The high attribute shall contain the end date.

If only a start date is present the Date or Time Interval After datatype shall be used:

• The low attribute shall contain the start date.

If only an end date is present the Date or Time Interval Before datatype shall be used:

• The high attribute shall contain the end date.

If the observation occurs with multiple dates / date ranges then multiple observations are required.

The date and time the observation was made.

For each observation which has a requirement to carry the activity date and time the usage of Observation.activityTime is described below:

• Health & Social Issue as described by care professional - The date and time that the problem was identified by the care professional - optional.
• Prognosis - The date and time that the care professional made a diagnosis associated prognosis.
• Family History - The date of stating the family history finding.

The date and time that the observation was recorded on the source system.

The value of the observation.

Refers to a specimen that has been taken from the patient.

Refers to reference ranges for a laboratory result.

An organizer contains a collection of related clinical statements.

The class code of the organizer.

The value of class code should be set according to the type of collection of related clinical statements.

The Coded Only datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the Act Container vocabulary.

Indicates that this is an event.

• Fixed value: "EVN"

This allows for two identifiers of an organizer.

The first is mandatory and is a unique identifier for this instance of a specific clinical statement. The second is optional and allows an organizer to be identified by a local identifier.

The Identifier Global datatype flavour is used to carry the first identifier as follows:

• The root attribute shall contain a DCE UUID

The Identifier External datatype flavour is used to carry the second identifier as follows:

• The root carries an OID for the local identifier scheme
• The extension carries a human-readable identifier from that scheme

A SnomedCT code identifying the Organizer type.

 The Concept Descriptor (CD) datatype shall be used to carry this information as follows:

• The code attribute shall contain a code from the relevant vocabulary
• The code System attribute shall contain the OID for SnomedCT
• The display text shall carry a description associated with the code in SnomedCT
• the original text attribute may be used if required
• qualifier(s) may be used if required.

The (optional) status of the Organizer, e.g. active, suspended, completed.

Shall be present if status is aborted or cancelled.

The Coded Only datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the Act Status vocabulary.

The clinically relevant date and time.

The date and time that the organizer detail was recorded.

Refers to specimens directly related to the organizer.

Refers to the clinical statements grouped within an organizer.

This mechanism uses the 'Containment' method of linking clinical statements.

The type of grouping is determined by the value of Organizer. code.  

NOTE: In the P1R2 version of PSIS, any component of an Organizer will not be explicitly indexed, and cannot be progressed in its own right.  For this reason clinically important statements (e.g. medication and allergy statements) must NOT be organizer components in P1R2. 

Information about clinical statements that are procedures.

A procedure can either be a procedure that has happened or a procedure that is planned.

Indicates that this is a procedure.

• Fixed value: "PROC"

The mood code of the procedure.

The value of mood code should be set according to the information and context of the clinical statement information being carried in the procedure class. The Coded Only datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the  vocabulary;

A list of identifiers for this instance of a procedure.

The first is mandatory and is the unique national identifier for this instance of a specific clinical statement. The second is optional and allows a procedure to be identified by a local identifier. 

 The Identifier Global datatype flavour is used to carry the first identifier as follows:

• The root attribute shall contain a DCE UUID

The Identifier External datatype flavour is used to carry the second identifier as follows:

• The root carries an OID for the local identifier scheme
• The extension carries a human-readable identifier from that scheme

A SnomedCT code identifying the Procedure type.

 The Concept Descriptor (CD) datatype shall be used to carry this information as follows:

• The code attribute shall contain a code from the relevant vocabulary
• The code System attribute shall contain the OID for SnomedCT
• The display text shall carry a description associated with the code in SnomedCT
• the original text attribute may be used if required
• qualifier(s) may be used if required.

The (optional) status of the Procedure, e.g. active, suspended, completed.

Required if status is aborted or cancelled. 

The Coded Only datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the Act Status vocabulary.

The date and time that the patient had the procedure if it has already happened or a future date and time for which a procedure is planned.

The time that the procedure took including preparation and clean up.

The date and time that a procedure that has happened was recorded on the source system.

The Statement Relationship is a clinical statement that establishes a relationship between two other clinical statements.

E.g. Cause/Effect - The Statement Relationship states that clinical statement A is the 'cause' of clinical statement B (and conversely that clinical statement B is 'caused by' clinical statement A).

Statement Relationships are to be used when the relationship being established is a matter of clinical judgement e.g. one statement is the medical cause of another. This is a matter of opinion and two clinicians could validly hold different views. A counter example would be a plain factual assertion, e.g. that a finding was the outcome of procedure. This is a simple matter of fact, and although an error could be made, it is not possible for opposing views to be valid concurrently. (For the latter relationship you would use an ActRelationship with an appropriate typeCode.)

With a Statement Relationship the relationship being asserted is a clinical statement in its own right, and so allow authorship and relevant times that may be distinct from those of the statements referred to. Being clinical statement, these relationships can be revised if necessary in future.

Indicates that this is an observation.

• Fixed value: "OBS"

Indicates that this is an event.

• Fixed value: "EVN"

A list of unique identifiers for this instance of a relationship statement.

The first is mandatory and is the unique national identifier for this instance of a specific clinical statement. The second is optional and allows a statement relationship to be identified by a local identifier.

The Identifier Global datatype flavour is used to carry the first identifier as follows:

• The root attribute shall contain a DCE UUID

The Identifier External datatype flavour is used to carry the second identifier as follows:

• The root carries an OID for the local identifier scheme
• The extension carries a human-readable identifier from that scheme

 A SnomedCT code identifying the type of the relationship between the two clinical statements being related.

 The Concept Descriptor (CD) datatype shall be used to carry this information as follows:

• The code attribute shall contain a code from the relevant vocabulary
• The code System attribute shall contain the OID for SnomedCT
• The display text shall carry a description associated with the code in SnomedCT
• the original text attribute may be used if required
• qualifier(s) may be used if required.

The (optional) status of the Observation, e.g. active, suspended, completed.

Shall be present if status is aborted or cancelled.

The Coded Only datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the Act Status vocabulary.

The date and time that the relationship statement is clinically relevant.

An optional date and time that the relationship was established.

The date and time that the relationship statement was recorded on the source system.

A relationship to the subject (statement) of the StatementRelationship. In the relationship "A is the outcome of B", A is the subject.

A relationship to the object of the StatementRelationship. In the relationship "A is the outcome of B", B is the object.

Information about the administration of substances other than medication.

Indicates that this is a substance administration act.

• Fixed value: "SBADM"

The mood code of the substance administration act.

The value of mood code should be set according to the information and context of the clinical statement information being carried in the substance administration class.

The Coded Only datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the  x_DocumentSubstanceMood vocabulary.

The first identifier is mandatory and is the unique national identifier for this instance of a specific clinical statement. The second identifier carries a local identifier allocated by the source system.

The Identifier Global datatype flavour is used to carry the first identifier as follows:

• The root attribute shall contain a DCE UUID

The Identifier External datatype flavour is used to carry the second identifier as follows:

• The root carries an OID for the local identifier scheme
• The extension carries a human-readable identifier from that scheme

A SnomedCT code identifying the act as Non-medication Substance Administration..

The Concept Descriptor (CD) datatype shall be used to carry this information as follows:

• The code attribute shall contain a code from the relevant vocabulary
• The code System attribute shall contain the OID for SnomedCT
• The display text shall carry a description associated with the code in SnomedCT
• the original text attribute may be used if required
• qualifier(s) may be used if required.

The (optional) status of the Substance Administration, e.g. active, suspended, completed.

Shall be present if status is aborted or cancelled.

The Coded Only datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the Act Status vocabulary.

The clinically relevant date and time.

The date and time that the activity was recorded on the source system.

The quantity of substance used for each administration when it is measured as a dosage.

An optional quantity of substance being supplied for each administration when it is measured at a rate of supply.

Information about clinical statements that are non-medication supply acts.

Indicates that this is a supply act.

• Fixed value: "SPLY"

The mood code of the supply act.

The value of mood code should be set according to the information and context of the clinical statement information being carried in the supply class as follows:

The Coded Only datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the  vocabulary;

Unique identifiers for this instance of a supply act.

The first is mandatory and is the unique national identifier for this instance of a specific clinical statement. The  second is optional and allows a supply to be identified by a local identifier. 

The Identifier Global datatype flavour is used to carry the first identifier as follows:

• The root attribute shall contain a DCE UUID

The Identifier External datatype flavour is used to carry the second identifier as follows:

• The root carries an OID for the local identifier scheme
• The extension carries a human-readable identifier from that scheme

A SnomedCT code identifying the act as non-medication supply

The Concept Descriptor (CD) datatype shall be used to carry this information as follows:

• The code attribute shall contain a code from the relevant vocabulary
• The code System attribute shall contain the OID for SnomedCT
• The display text shall carry a description associated with the code in SnomedCT
• the original text attribute may be used if required
• qualifier(s) may be used if required.

The (optional) status of the non-medication Supply act, e.g. active, suspended, completed.

Shall be present if status is aborted or cancelled.

The Coded Only datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the Act Status vocabulary.

The clinically relevant date and time.

If there are repeat issues the date shall be the date the authorisation for the supply expires.

The date time of recording the information on the source system.

The number of multiple issues authorised

The amount of non-medication substance supplied. This can include the amount, units, pack quantity and sub pack quantity.

Refers to the manufactured product.

Refers to the role of subject where the subject (who must be a person) is not the patient who is the target of the record.

The class code of the subject role.

The value of class code should be set appropriately according to the information and context of the subject being modelled.

The Coded Only datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the  vocabulary.

To provide an optional  identifier of the subject

To identify the relationship between patient and subject in coded form.

The Coded  Plain flavour of the Coded Value (CV) datatype shall be used to carry this information as follows:

• The code attribute shall contain a value from the list of codes in the  vocabulary
• The code System attribute shall contain the OID of the vocabulary
• The display text attribute will carry a description for the code from the vocabulary.

An example of a clinical statement in which there is a subject participant and the usage of  Subject.code is described below:

• Care Event - A code defining the  relationship between patient and subject of information about a family history issue - optional.

The person who is playing the role of subject.

The agent / device / non-agent performing this participation.

The participating person 

A CMET identifying the participating device.

AgentDevcie.classCode shall carry a fixed value of  "AGNT"

AgentDevice. id  shall carry a nationally agreed identifier for the role being played.  This shall be a code from a national coding scheme.

A national code is carried in the following way:

• The root attribute shall contain the OID that identifies the coding scheme
• The extension attribute shall contain the code

If the device can be identified by reference to SDS then

DeviceSDS.classcode shall carry a fixed value of "DEV" to indicates that this is a Device. In this context the device can be hardware or software.

DeviceSDS.determinerCode shall carry a fixed value of "INSTANCE"

DeviceSDS.id shall carry an SDS identifier that uniquely identifies the Device.

This is carried in the following way.

• The root attribute shall contain an OID with the appropriate value 
• The extension attribute shall contain the SDS Device ID

If the device cannot be identified by reference to SDS then

Device.classCode shall carry a fixed value of  "DEV"

Device.determinerCode shall carry a fixed value of "INSTANCE"

Device.id  shall carry an optional identifier that uniquely identifies the Device.   This shall be a code from a national scheme.

A national code is carried in the following way:

• The root attribute shall carry the OID that identifies the coding scheme
• The extension attribute shall contain the code

If an id is not present, then a name shall be included .

Device.code shall carry an optional code to describe the type of device.

If a code is not present, then a description shall be included.

Device.name shall carry an optional  name of the device.

This shall be included if an id is not present.

Device.desc shall carry an optional description of the type of device.

This shall be included if a code is not present.

Device.manufacturerModelName shall optionally carry the model name as allocated by the Device manufacturer.

Device.softwareName shall optionally carry the name of the software used by the Device.

If the device is scoped by an organization then and the organization can be identified by reference to SDS then

OrganizationSDS.classCode shall carry a fixed value of  "ORG"

OrganizationSDS.determinerCode shall carry a fixed value of "INSTANCE".

OrganizationSDS.id shall carry an SDS identifier that uniquely identifies the Organization. This is carried in the following way:

• The root attribute shall contain an OID with the value 1.2.826.0.1285.0.1.10
• The extension attribute shall contain the SDS Organization ID

If the device is scoped by an organization then and the organization cannot be identified by reference to SDS then

Organization.classCode shall carry a fixed value of  "ORG"

Organization.determinerCode shall carry a fixed value of "INSTANCE"

Organization.id shall carry an optional identifier that uniquely identifies the Organization. This shall be a code from a national scheme.

A national code is carried in the following way:

• the root attribute shall contain the OID that identifies the coding scheme
• the extension attribute shall contain the code

If an id is not present, then a name shall be included.

Organization.code shall optionally carry a value from the OrganizationType vocabulary  to identify the type of Organization.

The Coded Only datatype flavour is used to carry this information as follows:

• The code attribute shall contain a value from the list of codes in the OrganizationType vocabulary.

If a code is not present, then a description shall be included.

Organization.name shall optionally contain the name of the Organization. This shall be included if an id is not present.

Organization.desc shall contain a optional description of the type of Organization. This shall be included if a code is not present.

Organization.telecom shall contain optional  telephone contact details for the Organization.

Organization.addr shall contain an optional address of the Organization

NPfIT CMET to identify the person.

The tabular view for this CMETs describes it's usage.

A choice of location relevant to the clinical statement.

The place where the activity took place.

NPfIT CMET to identify the organisation where the activity took place .

The tabular view for this CMETs describes it's usage.

A Choice of an organisation or a person participant.

NPfIT CMET to identify the organisation.

The tabular view for this CMETs describes it's usage.

NPfIT CMET to identify the person.

The tabular view for this CMETs describes it's usage.

A CMET that represents various kinds of statements that can be made about the administration and supply of medication.  It does not cover statements that are specific to electronic prescribing.

A CMET that represents a scheduled / ongoing / ended administration of a complete course of medication.

A CMET that represents a scheduled / ongoing / ended administration of a single dose of medication

 A CMET that describes planned or requested medication administration.

A CMET that represents the various recommendations relevant to medication, i.e. recommendations

• to avoid administration of a medication
• to substitute one medication administration for another
• to administer a medication
• to change the dosage of medication already authorised
• to stop administering a medication
• to carry on administering a medication
• to review medication

A CMET that represents a request to administer medication

A CMET that represents a request for the supply of a medication.  It may be a formal prescription (e.g. from an NHS GP) or a request from a hospital clinician to a hospital pharmacy.

A CMET that represents the planned / ongoing / completed supply of medication to the patient / patient's representative /clinician.

An Act holding overflow information from the Act acting as the root of the clinical statement.  Supporting information shall not contradict the content of the source act, only add to it or explain it.

Indicates that this is an observation. Note that SupportingInfo can be used to supply overflow information for any kind of Act included in the ClinicalStatementChoice, not just Observations.

• Fixed value: "OBS"

Indicates this is an event.

• Fixed value: "EVN"

A SnomedCT code indicating the nature of the supporting information.

The Coded  Plain flavour of the Coded Value (CV) datatype shall be used to carry this information as follows:

• The code attribute shall contain a value from the list of codes in the  vocabulary
• The code System attribute shall contain the OID for SnomedCT
• The display text attribute will carry a description for the code from the coding system .

A clinically relevant date and time that forms supporting information.

The date range shall be carried as follows:

If both a start date and an end date are present the Date or Time Interval Complete datatype shall be used:

• The low attribute shall contain the start date
• The high attribute shall contain the end date.

If only a start date is present the Date or Time Interval After datatype shall be used:

• The low attribute shall contain the start date.

If only an end date is present the Date or Time Interval Before datatype shall be used:

• The high attribute shall contain the end date.

A supporting value.

Refers to a component using a unique identifier.

"ACT" is the highest level of classCode.

For this ActRef to be utilised properly by the relationships identified within the model, this classCode MUST be changed to the code of the item being referenced.

"ActMood" is the highest level of moodCode.

For this ActRef to be utilised properly by the relationships identified within the model, this moodCode MUST be changed to the code of the item being referenced.

The unique identifier of the target clinical statement in the form of a DCE UUID.

Information about the person who is the subject where the subject is not the patient who is the target of the record.

Indicates that the entity is a person.

• Fixed value: "PSN"

Indicates that the entity is a single identifiable person.

• Fixed value: "INSTANCE"

One or more names of the person who is the subject.

A role played by a person who is not an agent  (i.e. not a care professional).

Indicates this is a role.

• Fixed value: "ROL"

An optional unique identifier of the role-player. It shall be an OID for the identification scheme and the identifier within that scheme.

If it is used for the patient then it will carry  the NHS number and person name is not required.
If it is a local identifier then person name must be present.
 

A code identifying the relationship of the non-agent person to the patient, e.g. parent  or carer.

The Coded  Plain flavour of the Coded Value (CV) datatype shall be used to carry this information as follows:

• The code attribute shall contain a value from the list of codes in the  vocabulary
• The code System attribute shall contain the OID for the vocabulary
• The display text attribute will carry a description for the code from the vocabulary.

An optional link to the person playing the non-agent role.

A role played by a location that is not an organizational site.

Indicates that the role is a incidental location

• Fixed value: "ISDLOC"

A SnomedCT code identifying the kind of location being described (e.g. normal residence, ambulance, public place)

The Coded  Plain flavour of the Coded Value (CV) datatype shall be used to carry this information as follows:

• The code attribute shall contain a value from the list of codes in the  vocabulary
• The code System attribute shall contain the OID for SnomedCT
• The display text attribute will carry a description for the code from the coding system .

Details of the individual place playing the role of the IncidentialLocation

Indicates that this is a dedicated service delivery location.

• Fixed value: "DSDLOC"

A SnomedCT code specifying the care setting..

The Coded  Plain flavour of the Coded Value (CV) datatype shall be used to carry this information as follows:

• The code attribute shall contain a value from the list of codes in the  vocabulary
• The code System attribute shall contain the OID for SnomedCT
• The display text attribute will carry a description for the code from the coding system .

Commentary accompanying a care event statement.

This class is used to carry additional text which accompanies the information in a clinical statement. It can be used to clarify or support coded information.

The content must not change, contradict or render as ambiguous the coded information.

Indicates that this is an observation.

• Fixed value: "OBS"

Indicates that this is an event.

• Fixed value: "EVN"

 The commentary accompanying a care event.

Information about the specimen.

Indicates that this is a specimen.

• Fixed value: "SPEC"

Local identifier of a specimen.

The local identifier is carried using the Identifier External datatype flavour as follows:

• The extension attribute shall contain the local id
• The root attribute shall contain an OID for the local id. system

The type of specimen.

• Fixed value: "P" - taken from the patient

Refers to the specimen material.

A reference range for a biological measurement, e.g. height, blood haemoglobin.  It may be specific to people of a given sex, age range, etc

Indicates that this is an observation.

• Fixed value: "OBS"

The mood code is fixed as "Criterion"

• Fixed value: "EVN.CRT"

Optional text to explain or otherwise describe the reference range.

The reference range itself, including the units it is expressed in.  It will usually comprise an upper limit and a lower limit.

An optional code from the vocabulary named providing an interpretation of the normality of the Observation it applies to.

The role that plays the non-medication manufactured product.

The role is used both by SubstanceAdministration and Supply.

Indicates a role scoped by a manufacturer.

• Fixed value: "MANU"

Information about the manufactured material.

Details of the non-agent person.

Indicates that the entity is a person

• Fixed value: "PSN"

Indicates that the entity is a single identifiable person.

• Fixed value: "INSTANCE"

The name(s) of the person

An entity describing a place that is not an organization recognised by SDS.  If Place is used, at least one of the non-structural attributes SHALL be used. 

Indicates that the entity is a place

• Fixed value: "PLC"

Indicates that the entity is a single identifiable place

• Fixed value: "INSTANCE"

The optional name of the place

An optional telecom contact for the place

An optional address of the place

An optional grid reference. It may be as precise as required.

An optional GPS reference.  It may be as precise as required.

Information about the actual specimen taken.

Indicates a material.

• Fixed value: "MAT"

The determiner code of the entity.

The value of determinerCode should be set according to the specification of the specimen being carried in the entity. 

The CodedOnly datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the EntityDeterminer vocabulary;

An optional identifier of the material.  This attribute may only be used if the determinerCode is "INSTANCE"

The Identifier Global datatype flavour is used to carry this information as follows:

• The root attribute shall contain a DCE UUID.

A SnomedCT code identifying the material forming the specimen.

The datatype must be constrained to CD and used as indicated below.

The Concept Descriptor (CD) datatype shall be used to carry this information as follows:

• The code attribute shall contain a code from the relevant vocabulary
• The code System attribute shall contain the OID for SnomedCT
• The display text shall carry a description associated with the code in SnomedCT
• the original text attribute may be used if required
• qualifier(s) may be used if required.

The type of non-medication being administered or supplied.

Indicates that this is a manufactured material.

• Fixed value: "MMAT"

The determiner code of the entity.

The value of determinerCode should be set according to the specification of the drug being carried in the entity. 

The CodedOnly datatype flavour is used to carry this information as follows:

• The code attribute will contain a value from the list of codes in the EntityDeterminer vocabulary;

The type of non-medication being administered or supplied in SnomedCT coded form.

The material can be identified by a virtual or real product description and can be carried either as a textual product representation or as a product pack. The coded form shall include the formulation and strength.

The Coded Plain  datatype shall be used to carry this information as follows:

• the code attribute will contain the dm+d codification associated with the product or device
• the codeSystem attribute will contain the OID for SnomedCT
• the displayText attribute will contain the textual (human readable) description associated with the code.

An optional batch number of the material.

This attribute may only be used if the determinerCode is "INSTANCE"