EhrExtract - tabular view

The EhrExtract represents a complete set of clinical information communicated about a patient. It may be the entirety of the patient record as held by the sender or it may be a part of that record (e.g. changes since a specified date).

Indicates that this is an Extract.

• Fixed value

Although the classCode is an attribute of the EhrExtract element, it need not be included in message instances as its value is fixed in the schema.

Indicates that this is an actual event.

• Fixed value

Although the moodCode is carried as an attribute of the limitingEhrExtract element, it need not be included in message instances as its value is fixed in the schema.

To provide a unique identifier for this particular Extract.

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

• The root attribute will contain a DCE UUID.

Indicates that the extract is complete (current).

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

• The code attribute will contain value "COMPLETE".

System date and time of generating this extract on the system from which the message originates.

The record target to whom this Extract applies, i.e. the patient.

Author of this Extract.

The intended destination of the extract.

A part of the record within an EhrExtract.

Information about the request message this extract is in fulfillment of.

A specification of the constraints applied to specify the content of this Composition.

Options include:

• The complete record as held by the sending system at the time of generating the extract;
• An update of the record between since last sent by this originator to the specified destination;
• Components added to the record between two specified dates.

For the purposes of P1R2, only the first of these options will be exercised.

Information identifying the patient.

Indicates that this represents the patient role.

• Fixed value

Although the classCode is an attribute of the patient element, it need not be included in message instances as its value is fixed in the schema.

To provide the current nationally recognised identifier for the patient. This identifier will be one of:

• NHS number;
• Temporary NHS number issued by an NHAIS registration authority;
• Old format NHS number.

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

A NHS number is carried in the following way:

• The root attribute will contain an OID with the value "2.16.840.1.113883.2.1.4.1";
• The extension attribute will contain the NHS number itself.

A Temporary NHS number issued by an NHAIS registration authority is carried in the following way:

• The root attribute will contain an OID with the value "2.16.840.1.113883.2.1.3.2.4.3";
• The extension attribute will contain the Temporary NHS number issued by an NHAIS registration authority itself.

An old format NHS number is carried in the following way:

• The root attribute will contain an OID with the value "2.16.840.1.113883.2.1.3.2.4.9";
• The extension attribute will contain the old format NHS number itself.

The record components that form part of this message are enclosed within one or more Folders.

Part of the record that originates from a single source application presented accord with conventions of that originator. If a transfer includes the verbatim content of Extracts from other applications, the Folders from each source are kept passed on.

Nesting of Folders is not permitted in messages based on this RMIM. However nesting may be required in some future developments based on this architecture.

Indicates that this is a Folder.

• Fixed value

Although the classCode is an attribute of the ehrFolder element, it need not be included in message instances as its value is fixed in the schema.

Indicates that this is an actual event.

• Fixed value

Although the moodCode is an attribute of the ehrFolder element, it need not be included in message instances as its value is fixed in the schema.

To provide a unique identifier for this particular Folder.

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

• The root attribute will contain a DCE UUID.

Indicates that the folder is complete (current).

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

• The code attribute will contain value "COMPLETE".

Period of time to which this folder applies. A range from the earliest to most recent EhrComposition effectiveTimes contained within the folder.

This describes the temporal scope of the folder.

The date and time this folder became available with its current status.

Author of this Folder.

Refers to a directory of agents who are referenced using the AgentRef class elsewhere within the containing folder.

• This avoids the need for repetition of details about agents who are referred to in connection with several statements.

The record components that form part of this message are enclosed within one or more Folders.

Part of the record that originates from a single source application presented accord with conventions of that originator. If a transfer includes the verbatim content of Extracts from other applications, the Folders from each source are kept passed on.

Nesting of Folders is not permitted in messages based on this RMIM. However nesting may be required in some future developments based on this architecture.

An indication of categorisation of EhrStatement acts in the message folder.

A reference to the request message that led to the provision of this extract.

Indicates that this is a reference to an Extract.

• Fixed value

Although the classCode is an attribute of the priorEhrRequest element, it need not be included in message instances as its value is fixed in the schema.

Indicates that this is a reference to an Extract Request.

• Fixed value

Although the moodCode is an attribute of the priorEhrRequest element, it need not be included in message instances as its value is fixed in the schema.

To provide a reference to the unique identifier of the EhrRequest message.

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

• The root attribute will contain the DCE UUID of the referenced EhrRequest message.

A specification of the constraints applied to specify the content of an EhrExtract.

Options include:

• The complete record as held by the sending system at the time of generating the extract.
• An update of the record between since last sent by this originator to the specified destination.
• Components added to the record between two specified dates.

Indicates that this is an observation of an EHR Extract Specification.

• Fixed value

Although the classCode is an attribute of the limitingEhrExtractSpecification element, it need not be included in message instances as its value is fixed in the schema.

Indicates that this is a definition of an EHR Extract Specification.

• Fixed value

Although the moodCode is an attribute of the limitingEhrExtractSpecification element, it need not be included in message instances as its value is fixed in the schema.

To provide a unique identifier for this particular Extract Specification.

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

• The root attribute will contain a DCE UUID.

A code indicating the type of the constraints applied to specify the content of this Extract.

Options include:

• The complete record as held by the sending system at the time of generating the extract.
• An update of the record since last sent by this originator to the specified destination.
• Components added to the record between two specified dates.

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

• The code attribute will contain a value from the list of codes in the EhrExtractSpec vocabulary;
• The codeSystem attribute will contain an OID with the value "2.16.840.1.113883.6.96";
• The displayName attribute will contain the text meaning of the code.

Period for which an extract is requested or provided.

• E.g. changes to record since or record changes between dates

This is required for extract specifications that are date bounded; otherwise not used.

A directory of agents who are referenced using the AgentRef class elsewhere within the containing folder.

Indicates that the directory is regarded as a (composite) agent in its own right.

• Fixed value

Although the classCode is an attribute of the AgentDirectory element, it need not be included in message instances as its value is fixed in the schema.

A role link that associates the individual agents with the directory.

A composition represents a discrete transaction between an author and the patient record.

Part of record originating from a single interaction between an author and the record. This is the level at which the main issues of attribution apply.

The detailed content of the record is represented by instances of one or more components contained in the context of Compositions.

Indicates that this is a Composition.

• Fixed value

Although the classCode is an attribute of the ehrComposition element, it need not be included in message instances as its value is fixed in the schema.

Indicates that this is an actual event.

• Fixed value

Although the moodCode is an attribute of the ehrComposition element, it need not be included in message instances as its value is fixed in the schema.

The first instance of the attribute : -

To provide a unique identifier for this particular Composition.

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

• The root attribute will contain a DCE UUID.

The second instance of the attribute is intended to provide a native identifier where the composition is derived from a system construct that supports it. This shall use an appropriate flavour as required, most usually "Identifier External".

A code specifying the name of the composition. This name is taken from a list of composition names.

One of the CD (Concept Descriptor) datatype flavours is used to carry this information, whichever is most appropriate to the sending application.

Indicates whether the composition is complete (current), obsolete (replaced) or nullified (deleted).

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 EhrActState vocabulary.

Date and time or period this composition was effective.

• E.g. Consultation time, time of writing a document, time of using a template, time of generation of summary, etc.

If this is not separately recorded in the sending system, the availabilityTime shall be repeated here.

System date and time of recording or generating this composition on the original system.

If there is no positively identifiable system date for a composition, the composition may be regarded as having been created at the time of generating the enclosing EhrFolder or EhrExtract. However, this only applies to EhrCompositions created to support legacy data and/or special collections of data derived from the source data when generating the message.

The original author of a composition.

Where applicable, information about the location at which the events recorded in this composition took place.

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

A composition represents a discrete transaction between an author and the patient record.

Part of record originating from a single interaction between an author and the record. This is the level at which the main issues of attribution apply.

The detailed content of the record is represented by instances of one or more components contained in the context of Compositions.

Refers to another instance of a composition which represents an obsolete composition which this instance revises.

• NOTE: All revisions are represented by complete replacement of the revised composition.

The act of categorising an EhrStatement

Indicates that the class is a category.

• Fixed value: "CATEGORY"

Indicates that this is an event.

• Fixed value: "EVN"

A code carrying that categorises the clinical statements referenced via the relationship. 

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 EhrCategory
• The display text attribute will carry a description for the code from the coding system.

Refers to the EhrStatement instances that are members of this category.

A choice of Agent roles. This structure was previously the entrypoint to the CMET RCCT_MT120101UK01. The content beneath is structurally identical with a small, optional addition.

Refers to an Agent with a parental relationship to this instance.

Refers to an agent.

Refers to an agent by use of a Spine Directory Services identifier.

Detailed information about a place at which an entity is located.

Indicates that this is a located entity.

• Fixed value

Although the classCode is an attribute of the locatedEntity element, it need not be included in message instances as its value is fixed in the schema.

A code representing the type of location.

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

• The code attribute will contain a value from the list of codes in the EhrLocationType vocabulary;
• The codeSystem attribute will contain an OID with the value "2.16.840.1.113883.2.1.6.7";
• The displayName attribute will contain the text meaning of the code.

Detailed information about a place.

A choice of one of several types of clinical statement.

The person who provided information about the clinical statement where it is not the patient and not a healthcare party. For example, another member of the patient's family.

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

Refers to another instance of a clinical statement of the same type which represents an obsolete clinical statement which this instance revises.

• NOTE: All revisions are represented by complete replacement of the revised clinical statement.

Where the associated clinical statement is an EhrEmpty statement, one repeat of the priorStatementRef via the replacementOf act relationship is required to be present to identify the obsolete statement.

Refers to another statement that indicates the reason for the action recorded in this statement.

• For example a record of treatment or investigation may refer to a statement of the reason for that intervention.

A reference to a file or other attachment or reference appended to a statement in the record.

Refers to another statement that is a predecessor in a sequence of similar or directly related events.

• For example, a diary entry or review date may refer to the previous review.

A container for a collection of clinical statements.

A Compound Statement may be nested within another Compound Statements to support a nested sub-structured within a composition.

An empty Act class used to indicate deletion of a previous instance of a clinical statement with the same id.

NOTE: for any given EhrEmpty statement, a single repeat of a priorStatementRef element (via the replacementOf act relationship) is required to be present to identify the obsolete clinical statement.

A component which provides a focus for a set of relationships between other components within a record.

A statement regarding recommendation, authorisation, prescription, dispensing, administration or cancellation of medication or appliances.

A Narrative Statement is a general catch all used for any free or marked up text with no coding or semantic structure.

A statement about any observation related to the patient.

• Most elements in the GP record will be represented using observation statements. These will include observations representing therapeutic interventions other than medication.
• The observation statement supports coded representation of clinical information with accompanying text. It includes an optional quantitative measurement.

A Plan Statement represents an intention or planned action such as a recall for a particular intervention.

A Registration Statement represents information about a registered, formal or informal relationship between the patient and another party.

• The most common use of this here is to indicate the patient's registered GP and GP Practice. However, this statement can also indicate other relationships and affiliations including usual GP, other carers, etc.

A Request Statement relates to an order or referral for investigation or treatment.

A reference to another composition, using an identifier.

Indicates that the referenced act is another composition.

• Fixed value

Although the classCode is an attribute of the priorCompositionRef element, it need not be included in message instances as its value is fixed in the schema.

Indicates that the referenced act is an actual event.

• Fixed value

Although the moodCode is an attribute of the priorCompositionRef element, it need not be included in message instances as its value is fixed in the schema.

To provide a reference to the unique identifier of the referenced composition.

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

• The root attribute will contain the DCE UUID of the referenced composition.

Used where the role is not defined on SDS. This applies to all Organizations and Devices as well as Persons who are not registered NPfIT users

Indicates that this an Agent role.

• Fixed value: "AGNT"

Although the classCode is an attribute of the Agent element, it need not be included in message instances as its value is fixed in the schema.

One repeat is mandatory to provide a DCE UUID for the agent. This identifier is used as a reference within the message to this particular agent (the id field of the agentRef class will contain this identifier) wherever this agent has participated in a particular act.

Where the agent is a GP not on SDS, a second repeat may be present to provide the national GP code.

Where the agent is a person who is not a GP, or is an organization or device, no second repeat will be present.

To provide a DCE UUID, the Identifier Global datatype flavour is used as follows:

• the root attribute shall contain a DCE UUID.

A national GP code is carried in the following way:

• the root attribute shall contain an OID with the value "2.16.840.1.113883.2.1.4.2";
• the extension attribute shall contain the national GP code itself.

A code identifying the type of role that the agent is playing

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

• The code attribute will contain a value from the list of codes in the EhrEgentType vocabulary that are applicable to the type of agent;
• The codeSystem attribute will contain an OID with the value "2.16.840.1.113883.2.1.3.2.4.15";
• The displayName attribute will contain the text meaning of the code

To optionally provide addresses that are specific to the role being played.

To provide telecommunication contact details that are specific to the role being played.

Information about the entity (person, organization or device) playing the role of agent.

Information about the entity (person or organization) represented by the agent.

Used where the role is defined on SDS. This only applies to Persons who are or were a registered NPfIT user.

Indicates that this is an Agent role

• Fixed value: "AGNT"

Although the typeCode is an attribute of the AgentSDS element, it need not be included in message instances as its value is fixed in the schema.

One repeat is mandatory to provide a DCE UUID for the agent. This identifier is used as a reference within the message to this particular agent (the id field of the agentRef class will contain this identifier) wherever this agent has participated in a particular act.

A second repeat is mandatory to provide the SDS role profile ID for the agent.

To provide a DCE UUID, the Identifier Global datatype flavour is used as follows:

• the root attribute shall contain a DCE UUID.

A SDS role profile ID is carried in the following way:

• the root attribute shall contain an with the value "1.2.826.0.1285.0.2.0.67";
• the extension attribute shall contain the SDS role profile ID itself.

Information about the person on SDS.

Detailed information about a place.

Indicates that this is a place.

• Fixed value

Although the classCode is an attribute of the locatedPlace element, it need not be included in message instances as its value is fixed in the schema.

Indicates that this is an actual instance of a place not a description of general kind of place.

• Fixed value

Although the determinerCode is an attribute of the locatedPlace element, it need not be included in message instances as its value is fixed in the schema.

The name of this place.

Telecommunication numbers at the place.

• Includes email or web addresses where appropriate.

The postal address of the place.

A CompoundStatement contains a collection of other statements.

For example it may represent:

• A topic section within a consultation record
• A section in a consultation note.
• A cluster of closely related statements optionally including information about the circumstances of a particular observation (e.g. posture, post-exercise etc).
• The results of a battery of investigations.
• A blood pressure consisting of diastolic and systolic blood pressures.

Indicates whether this Compound Statement contains items that are part of a:.

• Topic - a subdivision of a Composition related to a particular clinical issue.;
• Category - a subdivision of a Composition or Topic containing similar elements (e.g. Subjective, Objective, Assessment, Plan);
• Cluster - a subdivision of a Composition, Topic or Category containing closely related Statements and or Batteries.(e.g. a series of Blood Pressure readings, a combination of a Full Blood Count and ESR);
• Battery - a subdivision of a Composition, Topic, Category or Cluster containing Statements that comprise the observations from an identifiable investigation (e.g. Blood Pressure, Full Blood Count, Electrolytes and Urea).

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

• The classCode attribute of the CompoundStatement element will contain a value from the x_CompoundStatement vocabulary.

Indicates that this records an actual event or collection of entries recorded as an event.

• Fixed value

Although the moodCode is an attribute of the CompoundStatement element, it need not be included in message instances as its value is fixed in the schema.

One or two identifiers of the compound statement:

1. Mandatory DCE UUID identifying the compound statement. The DCE UUID should be generated by an originating system and may thereafter be reused to refer to the same statement.

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

• The root attribute will contain a DCE UUID.
2. Optional report number as used in NHS PMIP or similar messaging projects. Number or other specific recognisable identifier for the report. A report number is carried in the following way:

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

• The root attribute will contain an OID with the value "2.16.840.1.113883.2.1.4.5.5";
• The extension attribute will contain the report number itself.

A code naming the collection of components in this Compound.

The code list depends upon the value of the classCode attribute:

• Where the classCode is "TOPIC", this code is a clinical code that names the topic;
• Where the classCode is "CATEGORY", this code is a consultation category code;
• Where the classCode is "CLUSTER", this code is a clinical code representing the contents of the cluster (e.g. "Haematology investigations");
• Where the classCode is "BATTERY", this code is a clinical code representing the name of the overall investigation (e.g. "Blood Pressure", "Full blood count").

One of the CD (Concept Descriptor) datatype flavours is used to carry this information, whichever is most appropriate to the sending application.

Indicates whether the compound statement is complete (current), obsolete (replaced) or nullified (deleted).

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 EhrActState vocabulary.

The clinically relevant date and time or period of the compound statement.

System date and time of recording this compound statement on the original system.

If no separate system date and time is recorded for this element in the originating system, the availabilityTime of the enclosing EhrComposition shall be repeated here.

An optional indicator of the priority assigned to actions described within this compound. For example where the compound represents a battery of requests or observations.

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

• The code attribute will contain a value from the list of codes in the EhrPriority vocabulary;
• The codeSystem attribute will contain an OID with the value "2.16.840.1.113883.6.96";
• The displayName attribute will contain the text meaning of the code.

Indicates if the author indicated that the components within the compound statement are in some way uncertain.

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

• The code attribute will contain a value from the list of codes in the ActUncertainty vocabulary;
• The codeSystem attribute will contain an OID with the value "2.16.840.1.113883.5.1053";
• The displayName attribute will contain the text meaning of the code.

The participation of the Specimen in the act, in the sense of it's receipt in the laboratory.

The participation of the specimen in the act, in the sense of its' involvement in the laboratory investigation.

Where there is a common set of data for all results in the report, this participation is significant for all contained ObservationStatement class instances.

The CompoundStatement contains one or more other components chosen from a variety of possible statement types. These contain individual items of data that are associated together by the CompoundStatement.

An empty Act class used to indicate deletion of a previous instance of a clinical statement with the same id.

NOTE: for any given EhrEmpty statement, a single repeat of a priorStatementRef element (via the replacementOf act relationship) is required to be present to identify the obsolete clinical statement.

Indicates that this is an Observation.

• Fixed value

Although the classCode is an attribute of the EhrEmpty element, it need not be included in message instances as its value is fixed in the schema.

Indicates whether this is an intention (INT), recommendation (RMD), order (ORD) or an actual event (EVN).

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

• The moodCode attribute of the EhrEmpty element will contain a value from the x_StatementMood vocabulary.

To provide a unique identifier for this particular empty element.

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

• The root attribute will contain a DCE UUID.

A component which provides a focus for a set of relationships between other components within a record.

Each Link Set is represents a problem grouping within a Problem Oriented Medical Record.

• A link set is used to represent a set of entries linked under a problem name. The "owner" is the problem name and the "members" are entries in the record pertaining to that problem.

NOTE:

• Topic sections within a single consultation record (i.e. where all components are from the same composition) are represented using the Topic level Compound statement and do not require the use of a Link Sets.

Indicates that this is an observation of a link between the members of the set.

• Fixed value

Although the classCode is an attribute of the LinkSet element, it need not be included in message instances as its value is fixed in the schema.

Specifies that the Link Set represents an actual event (i.e. the act of linking together the set).

• Fixed value

Although the moodCode is an attribute of the LinkSet element, it need not be included in message instances as its value is fixed in the schema.

To provide a unique identifier for this particular Link Set.

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

• The root attribute will contain a DCE UUID.

A code specifying the type of problem group.

Link sets support problem orientation with named sets of statements drawn from several compositions.

• Active Problems
• Inactive Problems
• Unspecified Problems

Referenced statements are either components of this set (referenced via the component act relationship) or a former name of this set (referenced via the conditionNamed act relationship). The latter case applies to the former problem title after a problem title has changed in a problem oriented record system.

One of the CD (Concept Descriptor) datatype flavours is used to carry this information, whichever is most appropriate to the sending application.

Indicates whether the link set is complete (current), obsolete (replaced) or nullified (deleted).

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 EhrActState vocabulary.

The date and time or period of time during which the Link Set was valid.

• For example an end date may be used to denote the end of an active problem.

System date and time of recording or generating this Link Set on the original system.

If there is no positively identifiable system date for a Link Set this shall be set to the same value as the availabilityTime of the enclosing EhrComposition.

References to the set of clinical statements that are members of the link set.

• Each of the clinical statements that are associated with a particular problem or topic are referenced by the appropriate link set.

A reference to a record component that names or scopes the link set.

• Each problem or topic may have a current name (for example the name that appears in a problem list). This name is provided by the referenced "owner" of the link set.

A statement that represents the recommendation, authorisation, discontinuation, prescription, dispensing, administration of a therapeutic substance or appliance.

Indicates that this statement relates to substance administration.

• Fixed value

Although the classCode is an attribute of the MedicationStatement element, it need not be included in message instances as its value is fixed in the schema.

Indicating whether this is a recommendation (RMD) an authorisation (INT), prescription (ORD), or supply/administration (EVN) of a therapeutic product.

NOTE:

• The distinction between supply (dispensing) and personal administration is made by the mood applied to the associated dosage.
• The associated supply act(s) record details of the amount prescribed, period of reauthorisation and details or or references to associated medication actions and/or previous authorisations.

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

• The moodCode attribute of the MedicationStatement element will contain a value from the x_MedicationMood vocabulary.

To provide a unique identifier for this particular Medication Statement.

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

• The root attribute will contain a DCE UUID.

Indicates whether the medication is active (applies to a current authorisation record), complete (applies to a now expired authorisation), obsolete (replaced) or nullified (deleted).

Date/time or period of intended or actual treatment.

System date and time of recording this medication on the original system.

• If no separate system date and time is recorded for this element in the originating system, the availabilityTime of the enclosing CompoundStatement or EhrComposition shall be repeated here.

An optional indication of the priority assigned to the provision of this medication.

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

• The code attribute will contain a value from the list of codes in the EhrMedicationPriority vocabulary;
• The codeSystem attribute will contain an OID with the value "2.16.840.1.113883.6.96";
• The displayName attribute will contain the text meaning of the code.

Information about a consumable associated with the medication statement.

Relationship to the supply action which may be one of the following: discontinuation, authorisation, prescription or dispensing.

Information pertinent to the medication statement. This refers to the dosage instructions for this medication.

The Narrative statements exists to accommodate EHR information which is not semantically processable by a computer system. All the contextual information (e.g. authorship) is conveyed in the Composition that conveys this item so no direct participations are represented in association with this class.

The reason that the information is presented in this form may be:

• That it is not semantically processable in the sending system;
• That the semantics in the sending system cannot be reliably represented in the message;
• That the information has been degraded from a semantically processable form to allow receipt by an application that does not support the semantics of the sending system.

Indicates that this is an observation.

• Fixed value

Although the classCode is an attribute of the NarrativeStatement element, it need not be included in message instances as its value is fixed in the schema.

Indicates that this is a record of an event.

• Fixed value

NOTE:

• Although a narrative may refer to a plan or goal the use of narrative implies an unstructured record. Therefore there is no value in indicating the mood more specifically since the content of a narrative item is not for computer processing.

Although the moodCode is an attribute of the NarrativeStatement element, it need not be included in message instances as its value is fixed in the schema.

To provide a unique identifier for this particular Narrative Statement.

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

• The root attribute will contain a DCE UUID.

A code identifying the type of Narrative Statement.

The marked up text content of the Narrative.

NOTE:

• Where marked up text is used, the use of this field is restricted to a subset of XHTML specified in a separate document.
See EhrXhtml.htm

Indicates whether the Narrative Statement is complete (current), obsolete (replaced) or nullified (deleted).

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 EhrActState vocabulary.

System date and time of recording this narrative on the original system.

If no separate system date and time is recorded for this element in the originating system, the availabilityTime of the enclosing CompoundStatement or EhrComposition shall be repeated here.

Observation statements are used for stating most elements of a patient's history, symptoms, signs, investigation results, diagnoses, problems, etc. This observation statement is also used to record the observation that a procedure was carried out.

Indicates that this is an observation.

• Fixed value

Although the classCode is an attribute of the ObservationStatement element, it need not be included in message instances as its value is fixed in the schema.

Indicates that this is an actual event.

• Fixed value

Although the moodCode is an attribute of the ObservationStatement element, it need not be included in message instances as its value is fixed in the schema.

To provide a unique identifier for this particular Observation Statement.

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

• The root attribute will contain a DCE UUID.

A code specifying a the nature of the observation.

• The code is taken from a clinical coding scheme approved for use in the realms in which the message is used.
• This will be a code or concept identifier from the Read Codes, CTV3 and in future SNOMED CT.

NOTES:

• This code may represent the full semantics of some qualitative observations (i.e. encapsulating both the nature of the observation and the finding). Thus the Read Code for "Diabetes melitus" is conveyed in this attribute and by default the value field is absent.
• However, if the value field is present it significantly affects the interpretation (as detailed in the description of the value field) and must not be ignored.

One of the CD (Concept Descriptor) datatype flavours is used to carry this information, whichever is most appropriate to the sending application.

Indicates whether the Observation Statement is complete (current), obsolete (replaced) or nullified (deleted).

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 EhrActState vocabulary.

The clinically relevant date/time or period.

• E.g. for a laboratory investigation the date/time of sampling (as opposed to the date/time of analysis or reporting).

In the case of a record of past history this is the date (to the accuracy recorded) of the original condition.

• E.g. If the history taken on 21 June 2002 notes a past history of appendectomy in 1965 then the effectiveTime is 1965.

If the originating system inherits an effective time from the surrounding context (e.g. from a compound or compound), the date/time derived from that context should be repeated explicitly in this attribute.

• E.g. For a finding or diagnosis within an dated encounter. If a precise time of the finding is not recorded the date of the enclosing EhrComposition or EhrCompound are repeated.

Only if the effective date is not known should the relevant null flavour be used.

• E.g. History of a condition with no stated date.

System date and time of recording this observation on the original system.

If no separate system date and time is recorded for this element in the originating system, the availabilityTime of the enclosing CompoundStatement or EhrComposition shall be repeated here.

An optional indication of the priority assigned to this observation.

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

• The code attribute will contain a value from the list of codes in the EhrPriority vocabulary;
• The codeSystem attribute will contain an OID with the value "2.16.840.1.113883.6.96";
• The displayName attribute will contain the text meaning of the code.

Indicates if the author indicated that the observation statement is in some way uncertain.

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

• The code attribute will contain a value from the list of codes in the ActUncertainty vocabulary;
• The codeSystem attribute will contain an OID with the value "2.16.840.1.113883.5.1053";
• The displayName attribute will contain the text meaning of the code.

The result value of an observation action. The following are the approved uses of the ANY datatype:

• Quantitative measurement
  PQ ::Physical quantity (real number with unit.)
• Titre (e.g., 1:64) and other ratios
  RTO :: A ratio of two integer numbers.
• Index (number without unit)
  PQ with a dimensionless unit (e.g., "1" or "%").
• Ranges (e.g., < 3; 12-20)
  IVL<PQ> :: Interval of physical quantity.
• Ordinals (e.g., stage "IIa","++")
  ST a string*.
• Nominal results (e.g. organism type)
  ST a string*
• Unstructured results (e.g. a text table representing outcome of a microbiology culture)
  ED using markup with limitation as specified for Narrative

NOTE:

• HL7v3 specifications indicate that codes should be used for Ordinal and Nominal results. However, in the UK such codes do not exist and the string data type is preferred to a fabricated code.

The xsi:type attribute is required to be present in order to indicate which of the above constraints in the ANY datatype is being used.

For example, with a quantitive measurement, the xsi:type attribute will have value "PQ".

Indication of whether an observation was interpreted as abnormal by the party responsible for the original observation.

NOTE:

• The primary intended use of this is for representation of laboratory investigation in line with current UK clinical EDI requirements.

Refers to a person (or kind of person) who is the subject of this information. This is only used where the subject of information is not the patient. For example, in the case of family history this refer to the family member to whom the observation applies.

The participation of the Specimen in the act, in the sense of it's receipt in the laboratory.

This participation should only be used when it is the child of a lone ObservationStatement, and not the grandchild of a CompoundStatement.

The participation of the specimen in the act, in the sense of its' involvement in the laboratory investigation.

This participation should only be used as part of a lone ObservationStatement, or where the corresponding participation on the grandparent CompoundStatement is in disagreement with the correct data for this element, or absent.

Represents textual information entered in or displayed on the originating system as part of a ObservationStatement, which is not derived from any of the structured information (e.g. text not derived from a code, date, participant, etc).

Up to three seperate pieces of text can be applied to an ObservationStatement. Each of these must have a different sequenceNumber. The sequenceNumber determines the position to the text annotation relative to the textual rendering applied to the code and value in the associated ObservationStatement.

• pertinentInformation[sequenceNumber= -1].Annotation.text
• code.originalText (displayText of no originalText)
• pertinentInformation[sequenceNumber= 0].Annotation.text
• value (representation including all elements within value)
• pertinentInformation[sequenceNumber= +1].Annotation.text

NOTE:

This structure is included for the benefit of those systems that allow text to be added before the code and between the code and the associated value. If a system does not support this it may combine the text in the order specified for the purposes of storage and display. In this situation, text from a systems supporting the multiple position text entry should be combined with the intervening rendering of the code and or value (which is thus duplicated) and treated as a post-fixed annotation (e.g. as though the single combined block of text had sequenceNumber= +1).

Refers to a reference range for an observation result.

NOTE:

• The primary intended use of this is for representation of laboratory investigation in line with current UK clinical EDI requirements.

A Plan statement represents an intention or planned action such as a recall for a particular intervention.

Indicates that the plan is for an observation or action.

• Fixed value

Although the classCode is an attribute of the PlanStatement element, it need not be included in message instances as its value is fixed in the schema.

Indicates that this is an intention to carry out a planned action

• Fixed value

Although the moodCode is an attribute of the PlanStatement element, it need not be included in message instances as its value is fixed in the schema.

To provide a unique identifier for this particular plan statement.

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

• The root attribute will contain a DCE UUID.

A code specifying a the nature of the plan.

• The code is taken from a clinical coding scheme approved for use in the realms in which the message is used.
• This will be a code or concept identifier from the Read Codes, CTV3 and in future SNOMED CT.

One of the CD (Concept Descriptor) datatype flavours is used to carry this information, whichever is most appropriate to the sending application.

The description of an act as a piece of free text or multimedia data.

NOTE:

• Where marked up text is used, the use of this field is restricted to a subset of XHTML specified in a separate document.
See EhrXhtml.htm

Indicates whether the Plan Statement is complete (current), obsolete (replaced) or nullified (deleted).

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 EhrActState vocabulary.

Intended date/time or period of the planned event.

For example a recall, diary or review date.

System date and time of recording this plan on the original system.

If no separate system date and time is recorded for this element in the originating system, the availabilityTime of the enclosing CompoundStatement or EhrComposition shall be repeated here.

An optional indication of the priority associated with this plan.

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

• The code attribute will contain a value from the list of codes in the EhrPriority vocabulary;
• The codeSystem attribute will contain an OID with the value "2.16.840.1.113883.6.96";
• The displayName attribute will contain the text meaning of the code.

A Registration statement represents information about a registered, formal or informal relationship between the patient and another party.

• The most common use of this here is to indicate the patient's registered GP. However, this statement can also indicate other relationships and affiliations including usual GP, other carers, etc.

Indicates that this is an observation.

• Fixed value

Although the classCode is an attribute of the RegistrationStatement element, it need not be included in message instances as its value is fixed in the schema.

Indicates that this records an actual event.

• Fixed value

Although the moodCode is an attribute of the RegistrationStatement element, it need not be included in message instances as its value is fixed in the schema.

To provide a unique identifier for this particular Registration Statement.

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

• The root attribute will contain a DCE UUID.

A code representing the type of registration statement.

One of the CE (Coded with Equivalents) datatype flavours is used to carry this information, whichever is most appropriate to the sending application.

Indicates whether the Registration Statement is complete (current), obsolete (replaced) or nullified (deleted).

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 EhrActState vocabulary.

Date/time or period to which the registration applies.

System date and time of recording this registration on the original system.

• If no separate system date and time is recorded for this element in the originating system, the availabilityTime of the enclosing CompoundStatement or EhrComposition shall be repeated here.

Refers to a party with whom the patient is registered or otherwise associated.

A Request statement is an entry that records the submission of a request for a service to be provided to the patient by another party.

Request statements may include records of referrals and investigation requests.

Indicates that the plan related to a requested observation or action.

• Fixed value

Although the classCode is an attribute of the RequestStatement element, it need not be included in message instances as its value is fixed in the schema.

Indicates that this is an order or request for an action

• Fixed value

Although the moodCode is an attribute of the RequestStatement element, it need not be included in message instances as its value is fixed in the schema.

One or two identifiers of the request statement:

1. Mandatory DCE UUID identifying the request statement. The DCE UUID should be generated by an originating system and may thereafter be reused to refer to the same statement.

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

• The root attribute will contain a DCE UUID.
2. Optional request or referral number as used in NHS PMIP or similar messaging projects. Number or other specific recognisable identifier for the request. A requestnumber is carried in the following way:

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

• The root attribute will contain an OID with the value "2.16.840.1.113883.2.1.4.5.3";
• The extension attribute will contain the request number itself.

A code specifying a the nature of the requested action.

• The code is taken from a clinical coding scheme approved for use in the realms in which the message is used.
• This will be a code or concept identifier from the Read Codes, CTV3 and in future SNOMED CT.

One of the CD (Concept Descriptor) datatype flavours is used to carry this information, whichever is most appropriate to the sending application.

A textual description of the request. This may include the text of a referral request. The text may include markup.

NOTE:

• Where marked up text is used, the use of this field is restricted to a subset of XHTML specified in a separate document.
See EhrXhtml.htm

Indicates whether the Request Statement is complete (current), obsolete (replaced) or nullified (deleted).

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 EhrActState vocabulary.

Intended date/time or period of the requested event.

System date and time of recording this request on the original system.

If no separate system date and time is recorded for this element in the originating system, the availabilityTime of the enclosing CompoundStatement or EhrComposition shall be repeated here.

An optional indicator of the priority of a request or referral.

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

• The code attribute will contain a value from the list of codes in the EhrReferralPriority vocabulary;
• The codeSystem attribute will contain an OID with the value "2.16.840.1.113883.6.96";
• The displayName attribute will contain the text meaning of the code.

Refers to the person or organisation from whom the service was requested.

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

Indicates that this is a reference to an agent.

• Fixed value

Although the classCode is an attribute of the AgentRef element, it need not be included in message instances as its value is fixed in the schema.

To provide a reference to the unique identifier of the agent as specified in the agent directory.

• If a message contains several Folders, the agent is in the same Folder as the component that refers to it.

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

• The root attribute will contain the DCE UUID of the agent.

Identifies and provides details about the entity (person, organisation or device) which plays this role.

Identifies and provides details about the entity (person, organisation or device) which plays this role.

Identifies and provides details about the entity (person, organisation or device) which plays this role.

Identifies and provides details about the entity (person, organisation or device) which plays this role.

Identifies and provides details about the entity (person, organisation or device) which plays this role.

Identifies and provides details about the entity (person, organisation or device) which plays this role.

Identifies and provides details about the entity (person, organisation or device) which plays this role.

Identifies and provides details about the entity (person, organisation or device) which plays this role.

Identifies and provides details about the entity (person, organisation or device) which plays this role.

Identifies and provides details about the entity (person, organisation or device) which plays this role.

Identifies and provides details about the entity (person, organisation or device) which plays this role.

Identifies and provides details about the entity (person, organisation or device) which plays this role.

Information about the person who provided information about the clinical statement where it is not the patient and not a healthcare party. For example, another member of the patient's family.

Indicates that this is an informant role.

• Fixed value

Although the classCode is an attribute of the informantRole element, it need not be included in message instances as its value is fixed in the schema.

A code representing the relationship of the informant to the patient.

For example:

• Family member
• Parent
• Child
• Contact
• Carer

One of the CE (Coded with Equivalents) datatype flavours is used to carry this information, whichever is most appropriate to the sending application.

A reference to another clinical statement.

Indicates the type of clinical statement that is being referenced.

NOTE: this reference to another statement should have the same classCode as the statement being referenced.

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

• The classCode attribute of the StatementRef element will contain a value from the x_ClinicalStatement vocabulary.

Indicates whether the referenced clinical statement is an intention (INT), recommendation (RMD), order (ORD) or an actual event (EVN).

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

• The moodCode attribute of the StatementRef element will contain a value from the list of codes in the x_StatementMood vocabulary.

To provide a reference to the unique identifier of the referenced Clinical Statement.

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

• The root attribute will contain the DCE UUID of the referenced statement.

An attached or referenced resource or file. The data within an attachment is associated with an application that renders or processes it but is not available for direct semantic interpretation by the EHR application.

Indicates that this is a document.

• Fixed value

Although the classCode is an attribute of the referredToExternalDocument element, it need not be included in message instances as its value is fixed in the schema.

Indicates that this is an actual event.

• Fixed value

Although the moodCode is an attribute of the referredToExternalDocument element, it need not be included in message instances as its value is fixed in the schema.

To provide a unique identifier for this particular External Document.

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

• The root attribute will contain a DCE UUID.

A code representing the nature of the attachment. For example "letter", "report", "message"). In the case of an attached message the message type is identified within this code.

NOTE:

• This attribute is not used to represent the format of the attachment as that is represented within the text attribute

One of the CD (Concept Descriptor) datatype flavours is used to carry this information, whichever is most appropriate to the sending application.

An attachment consisting of a coded indication of the data type (represented using MIME types as specified in the HL7 data type specification) and one of the following:

• Encapsulated binary data;
• A reference to binary data available of shared server;
• A reference to binary data present elsewhere in the message.

Within the UK, the url reference is to be represented as follows:

• file:[dce uuid]_[filename]
• [dce uuid] is the standard string representation of a DCE UUID. To allow the same document to be referenced from multiple places in the record this is a unique identifier assigned to the document not the same DCE UUID as ExternalDocument.id.
• [filename] is the filename on the sending system without a preceding path.

The associated attached or separately conveyed file is given the name [dce uuid]_[filename] when communicated ensuring uniqueness with the DCE UUID and providing a "sane" local file name with the [filename] element.

The clinically relevant date and time or period.

A report identifier that remains constant across all document revisions that derive from a common original document.

An integer starting at '1' and incrementing by 1. The first instance or original report should always be valued as '1'.

Information about the author of the external document.

Information about the organisation maintaining the EHR application.

Indicates that this is an organisation.

• Fixed value

Although the classCode is an attribute of the maintainingOrganization element, it need not be included in message instances as its value is fixed in the schema.

Indicates that this is a specific instance of an organisation not a general kind of organisation.

• Fixed value

Although the determinerCode is an attribute of the maintainingOrganization element, it need not be included in message instances as its value is fixed in the schema.

To optionally provide a national code for the organization.

A national organization code is carried in the following way:

• the root attribute shall contain an with the value "2.16.840.1.113883.2.1.4.3";
• the extension attribute shall contain the national organization code itself.

Indicates the type of organisation.

The name of the organisation.

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

Telecommunication numbers for the organisation.

• Includes email or web addresses where appropriate.

The address of the organisation.

Information about the organisation maintaining the EHR application.

Indicates that this is an organisation.

• Fixed value

Although the classCode is an attribute of the maintainingOrganization element, it need not be included in message instances as its value is fixed in the schema.

Indicates that this is a specific instance of an organisation not a general kind of organisation.

• Fixed value

Although the determinerCode is an attribute of the maintainingOrganization element, it need not be included in message instances as its value is fixed in the schema.

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 itself

Details about a person who is related to the patient.

Indicates that this is a person.

• Fixed value

Although the classCode is an attribute of the player element, it need not be included in message instances as its value is fixed in the schema.

Indicates that this refers to a specific person.

• Fixed value

Although the determinerCode is an attribute of the player element, it need not be included in message instances as its value is fixed in the schema.

To optionally provide one or more names of the person.

Indicates whether or not the subject has died.

Provides information about a material specimen collected for laboratory investigation.

Where this is the first instance of a particular specimen in a message, SpecimenRole should be used.

In subsequent instances, SpecimenRoleRef should be used.

Provides information about a specimen.

Provides a reference to information about a specimen.

Information about a manufactured medicinal product.

Indicates that this is a manufactured product.

• Fixed value

Although the classCode is an attribute of the manufacturedProduct element, it need not be included in message instances as its value is fixed in the schema.

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

Represents a choice of one or more types of supply action associated with a medication statement. The types of supply action supported are discontinuation, authorisation, prescription and dispensing.

Refers to the agent involved in performing the associated supply action.

Information about a consumable associated with the supply act.

Information pertinent to the supply. This refers to textual annotations.

Represents an authorisation for one or more issues of prescriptions for this medication.

Represents a record of a discontinuation or a previously authorised or issued prescription for this medication.

Represents the action of dispensing or supplying a medication item for personal administration.

Represents an issued prescription for this medication.

The dosage details.

Indicates that this is a substance administration action.

• Fixed value

Although the classCode is an attribute of the pertinentMedicationDosage element, it need not be included in message instances as its value is fixed in the schema.

Indicates whether this is:

• a dosage instruction (RMD);
• an actual event of administering the specified dosage (EVN).

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

• The moodCode attribute of the pertinentMedicationDosage element will contain a value from the x_DosageMood vocabulary.

A text description of the dosage instructions.

Information about a person (or kind of person) who is the subject of this information. This is only used where the subject of information is not the patient. For example, in the case of family history this refer to the family member to whom the observation applies.

NOTE:

• Usually this will not refer to an individual person but to an unidentified person in the role of "Family member" or possibly more specifically "Parent", "Father" etc.
• Whenever an instance of subject is present the presumption of a recipient should be that the observation does not apply directly to the patient.

Indicates that this is a personal relationship.

• Fixed value

Although the classCode is an attribute of the personalRelationship element, it need not be included in message instances as its value is fixed in the schema.

A code representing the relationship of the subject to the patient.

For example:

• Family member
• Parent
• Child
• Contact
• Carer

One of the CE (Coded with Equivalents) datatype flavours is used to carry this information, whichever is most appropriate to the sending application.

Text associated with an Observation Statement. Up to three instances can be attached to each Observation Statement each having a different position relative to the code and value elements of that statement. The position is indicated by the sequenceNumber of the pertinentInformation relationship from the statement.

Indicates that this is an Observation.

• Fixed value

Although the classCode is an attribute of the pertinentAnnotation element, it need not be included in message instances as its value is fixed in the schema.

Indicates that this is an actual event.

• Fixed value

Although the moodCode is an attribute of the pertinentAnnotation element, it need not be included in message instances as its value is fixed in the schema.

Plain text of the annotation.

Details of the reference range.

Indicates that this is an Observation.

• Fixed value

Although the classCode is an attribute of the referenceInterpretationRange element, it need not be included in message instances as its value is fixed in the schema.

Indicates that this represents criteria applied to an observation event.

• Fixed value

Although the moodCode is an attribute of the referenceInterpretationRange element, it need not be included in message instances as its value is fixed in the schema.

This is used for textual reference ranges.

This is used for structured numeric ranges.

Details about a person who is related to the patient.

Indicates that this is a person.

• Fixed value

Although the classCode is an attribute of the player element, it need not be included in message instances as its value is fixed in the schema.

Indicates that this refers to a specific person.

• Fixed value

Although the determinerCode is an attribute of the player element, it need not be included in message instances as its value is fixed in the schema.

An identifier for the person.

In the GP2GP Project

• The NHS number is used for patients
• The GP number used in GP-HA link is used to identify GPs
• The OCS issued number is used for other health professionals (where available)
• Other profession identification schemes may be usable by future agreement.
• If no national code is available a GUID should be used to identify instances of the same person within a single message so that these are clearly recognisable as referring to the same real world instance.

Details about a person who is related to the patient.

Indicates that this is a person.

• Fixed value

Although the classCode is an attribute of the player element, it need not be included in message instances as its value is fixed in the schema.

Indicates that this refers to a specific person.

• Fixed value

Although the determinerCode is an attribute of the player element, it need not be included in message instances as its value is fixed in the schema.

To optionally provide one or more names of the person.

The sex of the person (e.g., female, male).

• This code is for administrative purposes only and does not imply a particular genetic or physical sex. Therefore, were gender is indeterminate the value should be as registered with the health provider.

Information about a specimen or sample associated with a battery or observation.

Indicates that this is a specimen.

• Fixed value

Although the classCode is an attribute of the specimenRole element, it need not be included in message instances as its value is fixed in the schema.

One or two identifiers of the specimen:

1. Mandatory DCE UUID identifying the specimen. The DCE UUID should be generated by an originating system and may thereafter be reused to refer to the same specimen.

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

• The root attribute will contain a DCE UUID.
2. Optional specimen number as used in NHS PMIP or similar messaging projects. Number or other specific recognisable identifier for the specimen.

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

A specimen number is carried in the following way:

• The root attribute will contain an OID with the value "2.16.840.1.113883.2.1.4.5.2";
• The extension attribute will contain the specimen number itself.

The clinically significant date and time or period related to the specimen, i.e. the date and time or period of collection.

Information describing the specimen.

A reference to an instance of SpecimenRole

Indicates that the target is a Specimen

• Fixed Value

A DCE UUID corresponding to the first id attribute value for a SpecimenRole instance previously quoted in this message.

The details of a therapeutic product.

Indicates that this is a manufactured material.

• Fixed value

Although the classCode is an attribute of the manufacturedMaterial element, it need not be included in message instances as its value is fixed in the schema.

Indicates whether this represents a kind of material or a specific instance of a material.

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

• Where the material is associated directly with a MedicationStatement, the determinerCode attribute of the manufacturedMaterial element will contain value "KIND" from the Determiner vocabulary.
• Where the material is associated directly with an EhrSupply (Discontinue, Authorise, Supply or Dispense), the determinerCode attribute of the manufacturedMaterial element will contain value "INSTANCE" from the Determiner vocabulary.

A code representing the nature of the product.

• In the case of a prescription or authorisation this represents any of the following a virtual medicinal product, a virtual medicinal product pack, an actual medicinal product or an actual medicinal product pack.
• In the case of a supply action this represents either an actual medicinal product or an actual medicinal product pack.
• The source of these codes should eventually be an agreed UK medicinal product dictionary. However, interim solutions using other coding systems with appropriate mapping to an equivalent in an agreed coding system are also permitted.

One of the CE (Coded with Equivalents) datatype flavours is used to carry this information, whichever is most appropriate to the sending application.

The quantity of the manufactured material.

The batch number of a supplied or administered substance.

The date and time or period when the manufactured material will or was to expire.

Details of the supply authorisation.

Indicates that this is a supply act.

• Fixed value

Although the classCode is an attribute of the Authorise element, it need not be included in message instances as its value is fixed in the schema.

Indicates that this is an authorisation or intention (INT) to prescribe.

• Fixed value

Although the moodCode is an attribute of the Authorise element, it need not be included in message instances as its value is fixed in the schema.

To provide a unique identifier for this particular authorisation.

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

• The root attribute will contain a DCE UUID.

A code representing the type of supply or type of prescription authorised. These may include:

• Standard NHS Prescription
• ACBS
• Private Prescription

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

• The code attribute will contain a value from the list of codes in the EhrSupplyType vocabulary;
• The codeSystem attribute will contain an OID with the value "2.16.840.1.113883.6.96";
• The displayName attribute will contain the text meaning of the code.

Indicates whether the Authorisation is complete (current), obsolete (replaced) or nullified (deleted).

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 EhrSupplyState vocabulary.

Period of authorisation. This should be omitted for a single acute prescription issued at the same time as authorisation.

• If repeatNumber is omitted effectiveTime is MANDATORY.
• By default the end point of the effective time is the review date for this authorisation. If the originating system supports a separate concept of medication review date (not co-terminus with the end of authorisation) then this should be conveyed in a PlanStatement.