The NCCN Order Template Profile is based upon the core FHIR PlanDefinition Resource and designed to improve the safety and effectiveness of cancer treatment protocols.

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

On the NCCN FHIR server, this will always be in a format like [external version].[internal version]. The external version number is incremented each time the template is duplicated into a new version. The internal version number will increment with each save. Only published versions will be available from the API.

This version number can be used for finding and retrieving specific versions of an OrderTemplate via the API. However, data consumers should use PlanDefinition.version as the primary source of version information because FHIR servers may override the Meta.versionId when a resource is copied.

When the resource last changed - e.g. when the version changed.

This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant.

A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

The security labels can be updated without changing the stated version of the resource The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element as much as possible.

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

An Extension

An Extension

An absolute URL that is used to identify this activity definition when it is referenced in a specification, model, design or an instance. This SHALL be a URL, SHOULD be globally unique, and SHOULD be an address at which this activity definition is (or will be) published. The URL SHOULD include the major version of the activity definition. For more information see Technical and Business Versions.

Allows the activity definition to be referenced by a single globally unique identifier.

Can be a urn:uuid: or a urn:oid:, but real http: addresses are preferred.

A formal identifier that is used to identify this activity definition when it is represented in other formats, or referenced in a specification, model, design or an instance.

Allows externally provided and/or useable business identifiers to be easily associated with the module.

Typically, this is used for identifiers that can go in an HL7 v3 II data type - e.g. to identify this activity definition outside of FHIR, where the logical URL is not possible to use.

The identifier that is used to identify this version of the activity definition when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the activity definition author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions are orderable. To provide a version consistent with the Decision Support Service specification, use the format Major.Minor.Revision (e.g. 1.0.0). For more information on versioning knowledge assets, refer to the Decision Support Service specification. Note that a version is required for non-experimental active assets.

There may be multiple different instances of a activity definition that have the same identifier but different versions.

A natural language name identifying the activity definition. This name should be usable as an identifier for the module by machine processing applications such as code generation.

Support human navigation & code generation.

The name is not expected to be globally unique. The name should be a simple alpha-numeric type name to ensure it is computable friendly.

A short, descriptive, user-friendly title for the activity definition.

The status of this activity definition. Enables tracking the life-cycle of the content.

Allows filtering of activity definition that are appropriate for use vs. not.

A flag to indicate that this activity definition is authored for testing purposes (or education/evaluation/marketing), and is not intended to be used for genuine usage.

Enables experimental content to be developed following the same life-cycle as a production-level activity definition would.

Allows filtering of activity definition that are appropriate for use vs. not.

The date (and optionally time) when the activity definition was published. The date must change when the business version changes, if it does, and it must change if the status code changes. In addition, it should change when the substantive content of the activity definition changes.

Note that this is not the same as the resource last-modified-date, since the resource may be a secondary representation of the activity definition. Additional specific dates may be added as extensions.

The name of the individual or organization that published the activity definition.

Helps establish the "authority/credibility" of the activity definition. May also allow for contact.

Usually an organization, but may be an individual. The publisher (or steward) of the activity definition is the organization or individual primarily responsible for the maintenance and upkeep of the activity definition. This is not necessarily the same individual or organization that developed and initially authored the content. The publisher is the primary point of contact for questions or issues with the activity definition. This item SHOULD be populated unless the information is available from context.

A free text natural language description of the activity definition from the consumer's perspective.

This description can be used to capture details such as why the activity definition was built, comments about misuse, instructions for clinical use and interpretation, literature references, examples from the paper world, etc. It is not a rendering of the activity definition as conveyed in the text field of the resource itself. This item SHOULD be populated unless the information is available from context (e.g. the language of the profile is presumed to be the predominant language in the place the profile was created).

Explains why this activity definition is needed and why it has been designed as it has.

This element does not describe the usage of the activity definition (See, e.g, the comments element, or relatedArtifacts), rather it's for traceability of ''why'' the resource is either needed or ''why'' it is defined as it is. This may be used to point to source materials or specifications that drove the structure of this activity definition.

A detailed description of how the asset is used from a clinical perspective.

The date on which the asset content was approved by the publisher. Approval happens once when the content is officially approved for usage.

The date may be more recent than the approval date because of minor changes / editorial corrections.

The date on which the asset content was last reviewed. Review happens periodically after approval, but doesn't change the original approval date.

If specified, this is usually after the approval date.

The period during which the activity definition content was or is planned to be effective.

The effective period for a activity definition determines when the content is applicable for usage and is independent of publication and review dates. For example, a measure intended to be used for the year 2016 would be published in 2015.

The content was developed with a focus and intent of supporting the contexts that are listed. These terms may be used to assist with indexing and searching of code system definitions.

Assist in searching for appropriate content.

When multiple usageContexts are specified, there is no expectation for whether all or any of the contexts apply.

A jurisdiction in which the activity definition is intended to be used.

Descriptive topics related to the content of the activity. Topics provide a high-level categorization of the activity that can be useful for filtering and searching.

Repositories must be able to determine how to categorize the asset so that it can be found by topical searches.

A contributor to the content of the asset, including authors, editors, reviewers, and endorsers.

Consumers of the content must be able to quickly determine who contributed to the content of the knowledge asset.

Contact details to assist a user in finding and communicating with the publisher.

May be a web site, an email address, a telephone number, etc.

A copyright statement relating to the activity definition and/or its contents. Copyright statements are generally legal restrictions on the use and publishing of the activity definition.

Consumers of the library must be able to determine any legal restrictions on the use of the activity definition and/or its content.

Related artifacts such as additional documentation, justification, or bibliographic references.

Assets must be able to provide enough information for consumers of the content (and/or interventions or results produced by the content) to be able to determine and understand the justification for and evidence in support of the content.

Each related artifact is either an attachment, or a reference to another resource, but not both.

A reference to a Library resource containing any formal logic used by the asset.

A description of the kind of resource the activity definition is representing. For example, a MedicationRequest, a ProcedureRequest, or a CommunicationRequest. Typically, but not always, this is a Request resource.

May determine what types of extensions are permitted.

Detailed description of the type of activity; e.g. What lab test, what procedure, what kind of encounter.

Allows matching performed to planned as well as validation against protocols.

Tends to be less relevant for activities involving particular products.

The period, timing or frequency upon which the described activity is to occur.

Allows prompting for activities and detection of missed planned activities.

Identifies the facility where the activity will occur; e.g. home, hospital, specific clinic, etc.

Helps in planning of activity.

May reference a specific clinical location or may just identify a type of location.

Indicates who should participate in performing the action described.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

The type of participant in the action.

The role the participant should play in performing the described action.

Identifies the food, drug or other product being consumed or supplied in the activity.

Identifies the quantity expected to be consumed at once (per dose, per meal, etc.).

Provides detailed dosage instructions in the same way that they are described for MedicationRequest resources.

In the current version of the NCCN Chemotherapy Order Template Tool, if the recommended dosing changes over time (e.g. dose titration), each dosage will be listed in its own ActivityDefinition.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Whether the cycle definition is fully represented in the structured data (including extensions).

Indicates the order in which the dosage instructions should be applied or interpreted.

If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.

Free text dosage instructions e.g. SIG.

Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing.

Supplemental instruction - e.g. "with meals".

Additional instruction such as "Swallow with plenty of water" which may or may not be coded.

Instructions in terms that are understood by the patient or consumer.

When medication should be administered.

The timing schedule for giving the medication to the patient. The Schedule data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

This attribute may not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Days of a possibly repeating cycle on which the agent is to be administered.

Identifies specific times when the event occurs.

In an MAR, for instance, you need to take a general specification, and turn it into a precise specification.

A set of rules that describe when the event is scheduled.

Many timing schedules are determined by regular repetitions.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Either a duration for the length of the timing schedule, a range of possible length, or outer bounds for start and/or end limits of the timing schedule.

A total count of the desired number of repetitions.

Repetitions may be limited by end time or total occurrences.

If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.

A maximum value for the count of the desired repetitions (e.g. do something 6-8 times).

How long this thing happens for when it happens.

Some activities are not instantaneous and need to be maintained for a period of time.

For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).

The upper limit of how long this thing happens for when it happens.

Some activities are not instantaneous and need to be maintained for a period of time.

For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).

The units of time for the duration, in UCUM units.

The number of times to repeat the action within the specified period / period range (i.e. both period and periodMax provided).

If present, indicates that the frequency is a range - so to repeat between [frequency] and [frequencyMax] times within the period or period range.

Indicates the duration of time over which repetitions are to occur; e.g. to express "3 times per day", 3 would be the frequency and "1 day" would be the period.

If present, indicates that the period is a range from [period] to [periodMax], allowing expressing concepts such as "do this once every 3-5 days.

The units of time for the period in UCUM units.

If one or more days of week is provided, then the action happens only on the specified day(s).

If no days are specified, the action is assumed to happen every day as otherwise specified. The elements frequency and period cannot be used as well as dayOfWeek.

Specified time of day for action to take place.

When time of day is specified, it is inferred that the action happens every day (as filtered by dayofWeek) on the specified times. The elements when, frequency and period cannot be used as well as timeOfDay.

Real world events that the occurrence of the event should be tied to.

Timings are frequently determined by occurrences such as waking, eating and sleep.

When more than one event is listed, the event is tied to the union of the specified events.

The number of minutes from the event. If the event code does not indicate whether the minutes is before or after the event, then the offset is assumed to be after the event.

A code for the timing schedule. Some codes such as BID are ubiquitous, but many institutions define their own additional codes. If a code is provided, the code is understood to be a complete statement of whatever is specified in the structured timing data, and either the code or the data may be used to interpret the Timing, with the exception that .repeat.bounds still applies over the code (and is not contained in the code).

BID etc are defined as 'at institutionally specified times'. For example, an institution may choose that BID is "always at 7am and 6pm". If it is inappropriate for this choice to be made, the code BID should not be used. Instead, a distinct organization-specific code should be used in place of the HL7-defined BID code and/or the a structured representation should be used (in this case, specifying the two event times).

Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).

Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".

Body site to administer to.

A coded specification of the anatomic site where the medication first enters the body.

If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension body-site-instance. May be a summary code, or a reference to a very precise definition of the location, or both.

How drug should enter body.

A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

Technique for administering medication.

A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.

Only populated for IV push and IV continuous infusion.

Amount of medication per dose.

The amount of therapeutic or other substance given at one administration event.

How to declare an extension that can appear on either doseQuanityt OR doseRange?

Upper limit on medication per unit of time.

The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.

This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

Upper limit on medication per administration.

The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.

This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.

Upper limit on medication per lifetime of the patient.

The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.

Amount of medication per unit of time.

Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.

Indicates the sites on the subject's body where the procedure should be performed (I.e. the target sites).

Knowing where the procedure is made is important for tracking if multiple sites are possible.

Only used if not implicit in the code found in ProcedureRequest.type.

A reference to a StructureMap resource that defines a transform that can be executed to produce the intent resource using the ActivityDefinition instance as the input.

Dynamic values that will be evaluated to produce values for elements of the resulting resource. For example, if the dosage of a medication must be computed based on the patient's weight, a dynamic value would be used to specify an expression that calculated the weight, and the path on the intent resource that would contain the result.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

A brief, natural language description of the intended semantics of the dynamic value.

The path to the element to be customized. This is the path on the resource that will hold the result of the calculation defined by the expression.

The media type of the language for the expression.

An expression specifying the value of the customized element.

The expression may be inlined, or may be a reference to a named expression within a logic library referenced by the library element.