M5.1. Medication - Repeat Authorisation

The following table describes the use of medication statements and related classes to convey information about an authorisation for a repeat prescription created separately from a record of a prescription issued against that authorisation.

Where the authorisation and initial prescription are recorded together this can be represented with the prescribing action by including the appropriate additional Authorise instance as well as a Prescribe (see Issue of Repeat Prescriptions). All other prescriptions against an authorisation should refer to the appropriate authorisation using the Prescribe/inFulfillmentOf relationship.

An expired or cancelled authorisation is indicated by its statusCode value. A renewal or change of an authorisation is recorded as a new authorisation with a reference to the previous authorisation through the Authorise/predecessor relationship.

MedicationStatement (MedicationStatement)

A statement that represents the authorisation for a series of repeat prescription for a therapeutic substance or appliance.

[1..1] classCode (CS){ Fixed="SBADM " }

[1..1] moodCode (CS) {CNE:INT}

Indicates that this is an intention to prescribe (i.e. an authorisation for future prescribing).

[1..1] id (II)

An instance identifier of this statement represented as using the Identifier Global flavour of the II data type.

[1..1] statusCode (CS) {CNE:EhrMedicationState}

Indicates the status of the authorisation:

Active - a currently valid authorisation against which repeat issues may be made.
Complete - a valid record of an expired or discontinued authorisation is no longer active.
Obsolete - an erroneous authorisation record that has been replaced by a correction.
Nullified - an erroneous authorisation record that has been deleted.

[1..1] availabilityTime (TS)

The date and time of recording this authorisation. If the status is "complete" the date and time of recording the inactivation of this authorisation.

[0..1] pertinentInformation (MedicationStatement/pertinentInformation)

Relationship to the dosage for which the prescription is authorised.

[1..1] typeCode (CS){ Fixed="COMP " }

[1..1] MedicationDosage (MedicationDosage)

Details of the authorised prescription dosage.

[1..1] classCode (CS){ Fixed="SBADM " }

[1..1] moodCode (CS) {CNE:RMD}

Indicates that this is a dosage instruction rather than an actual administered dosage.

[1..1] text (ED)

A textual description of the dosage instructions.

Note

At present there is no provision for structured representation of dosage. This information is not available on the sending systems and is not included in current UK electronic prescribing. However, should structured data be required this could be supported by adding the doseQuantity and effectiveTime to represent the quantity and frequency of individual doses. If necessary routeCode could also be added.

[0..*] participant (EhrStatement/participant)

Refers to one or more agent roles that are related in some specified way to this component.

[1..1] typeCode (CS) {CNE:ParticipationType}

Identifies the nature of the involvement or association of this related agent with this particular component.

[0..1] time (IVL<TS>)

The date and time of authorisation.

[1..1] AgentRef (AgentRef)

A reference to a role which contains detailed information about a particular person, organisation or device.

[1..1] classCode (CS){ Fixed="AGNT " }

Indicates that this is a reference to a related agent.

[1..1] id (II)

The unique instance identifier of the referenced role as specified in the role directory.

If a message contains several Folders, the referenced role directory is in the same Folder as the component that refers to it.

[1..1] consumable (MedicationStatement/consumable)

Include this to identify the nature of the product.

[1..1] typeCode (CS){ Fixed="CSM " }

[1..1] manufacturedProduct (ManufacturedProduct)

Details of the medicinal product prescribed.

May include, drugs, nutritional supplements, devices used to administer drugs, dressing, appliances, diagnostic reagents, etc.

[1..1] classCode (CS){ Fixed="MANU " }

Indicates that this is a manufactured product.

[1..1] manufacturedMaterial (Material)

Information about the material or substance that forms the medicinal product.

[1..1] Material

The details of a medicinal product.

[1..1] classCode (CS){ Fixed="MMAT " }

Indicates that this is an manufactured material.

[1..1] determinerCode (CS) {CNE:KIND}

Indicates that this represents a kind of material.

[1..1] code (CE)

The code representing the nature of the product as one of the following:

virtual medicinal product
virtual medicinal product pack
actual medicinal product
actual medicinal product pack.

If the native coding scheme for medicinal product is the Read Codes then the appropriate code is represented using the Coded with Original Text flavour of the data type CE. Otherwise the Coded Translated flavour should be used with the medicinal product represented in the coding system used in the sending system with a translation to an appropriate (possibly more generalised) Read Code.

Note

The source of these codes should eventually be an agreed UK medicinal product dictionary.

[0..1] quantity (PQ)

The quantity of the product.

Express simple quantities such as "100 ml" or "3 grams" using Quantity in Standard Units.
Express numbers of tablets, capsules, etc. where the item is explicit elsewhere using Quantity in Standard Units with the unit "1" (unity).
Express quantities that cannot be represented adequately using standard units using Quantity in Arbitrary Units.

[0..3] component (MedicationStatement/component)

Medication authorisations always have one instance of MedicationStatement/component containing the authorisation (Authorise) as detailed here.

First instance of MedicationStatement/component

Relationship to details of the product to be supplied or actually supplied and/or administered.

Includes details of repeat prescription authorisations.

[1..1] typeCode (CS){ Fixed="COMP " }

Indicates that this is the supply details for a related to a medication statement (substance administration).

[1..1] Authorise (EhrSupply)

Represents an authorisation for one or more prescriptions for a specified medication item in a stated dosage.

[1..1] classCode (CS){ Fixed="SPLY " }

[1..1] moodCode (CS){ Fixed="INT " }

[1..1] id (II)

An identifier of the prescription.

[1..1] code (CV) {CNE:EhrSupplyType}

A code representing the type of prescription authorised by this authorisation.

[1..1] statusCode (CS) {CNE:EhrSupplyState}

Indicates the status of the authorisation:

Active - a currently valid authorisation against which repeat issues may be made.
Complete - a valid record of an expired or discontinued authorisation is no longer active.
Obsolete - an erroneous authorisation record that has been replaced by a correction.
Nullified - an erroneous authorisation record that has been deleted.

[0..1] effectiveTime (IVL<TS>)

A period starting with the time of authorisation and ending (if appropriate) with the expiry date of the period of authorisation.

Note that for an active authorisation the end date of the effective time is the review date. That is the date after which this authorisation will no longer be valid unless reviewed and reauthorised. Reauthorisation after a review is regarded as new instance of the MedicationStatement class with a new associated Authorise that refers to the previous authorisation.

In the case of an inactive medication (statusCode "complete"), the end date represents the actual date of expiry.

[1..1] availabilityTime (TS)

The date and time that the authorisation was recorded.

[0..1] repeatNumber (INT){ Default="1 " }

The number of authorised prescriptions that were authorised for issue by this authorisation record. The number of actual issues against the prescription can be determined from the number of Prescribe instances referring to this authorisation.

[1..1] quantity (PQ)

The quantity prescribed on each prescription issued in compliance with this authorisation.

Express simple quantities such as "100 ml" or "3 grams" using Quantity in Standard Units.
Express numbers of doses, tablets, capsules, etc. where the size of the dose or item is explicit elsewhere in the authorisation data using Quantity in Standard Units with the unit "1" (unity).
Express quantities that cannot be represented adequately using standard units using Quantity in Arbitrary Units (e.g. "3 packs each containing 21 tablets of substance A and 7 tablets of substance B".

[0..1] pertinentInformation (EhrSupply/pertinentInformation)

[1..1] typeCode (CS){ Fixed="PERT " }

[1..1] pertinentSupplyAnnotation (SupplyAnnotation)

Details of the annotation.

[1..1] classCode (CS){ Fixed="OBS " }

Indicates that this is an Observation.

[1..1] moodCode (CS){ Fixed="EVN " }

Indicates that this is an actual event.

[1..1] text (ED)

A textual note to be sent from the prescriber to the dispenser as part of the prescription.

Note

This is not the place for recording dosage instructions.

[0..1] performer (EhrSupply/performer)

Include this only if the authoriser is not the EhrComposition/author of the containing EhrComposition.

[1..1] typeCode (CS){ Fixed="PRF " }

[1..1] time (TS)

The date and time of prescribing.

[1..1] AgentRef (AgentRef)

Refers to the person (or other agent) responsible for this authorisation.

[1..1] classCode (CS){ Fixed="AGNT " }

Indicates that this is a reference to a related agent.

[1..1] id (II)

The unique instance identifier of the referenced role as specified in the role directory.

If a message contains several Folders, the referenced role directory is in the same Folder as the component that refers to it.

[0..1] Authorise/predecessor (Authorise/predecessor)

A reference to a previously recorded authorisation which is reauthorised by the source act.

[1..1] typeCode (CS){ Fixed="SUCC " }

[1..1] MedicationRef (MedicationRef)

A reference to a previously recorded MedicationStatement statement that represented the previous authorisation of this repeat authorisation.

[1..1] classCode (CS){ Fixed="SBADM" }

Indicates that the referenced class is based on the Substance Administration class.

[1..1] moodCode (CS){CNE:x_MedicationMood}

Indicates whether this is an intention (INT), recommendation (RMD), order (ORD) or an actual event (EVN). The value used here should be the same as the moodCode of the MedicationStatement being referenced.

[1..1] id (II)

Refers to the id of the referenced medication statement.