ATTACHMENT 25 - Opioid NonCancer Pain Mgt Order Set Conceptual Structure_2018-05-28.pdf

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R405--Clinical Decision Support CO: Matthew Klempay CS: Sharif Shabaz Ra-El
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This is a pre-solicitation notice for an indefinite delivery indefinite quantity multiple award contract to provide clinical decision support services to the Veterans Health Administration. The scope includes subject matter expertise, policy guidance, and strategic recommendations regarding clinical decision support standards implementation for VA IT systems. The solicitation will be issued as a request for proposal on August 11, 2018 for a 28-day response window. The IDIQ ordering period is ten years with a fifteen-year effective period. The NAICS code is 541611 with a $16.5 million size standard. The contracting office is the VA Program Contract Activity Central in Independence, Ohio. All inquiries must be directed to the named contract specialist and contracting officer by email only.

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Mental Health: Chronic Noncancer Pain Order Set Order Set: Conceptual Structure

Contract: VA118-16-D-1008, Task Order (TO): VA-118-16-F-1008-0007, CLIN0008BA

Department of Veterans Affairs (VA)

Knowledge Based Systems (KBS) Office of Informatics and Information Governance (OIIG)

Clinical Decision Support (CDS)

Publication date 05/29/2018

Version: 1.0

Mental Health: Chronic Noncancer Pain Order Set: Order Set: Con-ceptual Structure by Knowledge Based Systems (KBS), Office of Informatics and Information Governance (OIIG), and Clinical Decision Support (CDS)

Publication date 05/29/2018

Table of Contents Preface .............................................................................................................................. v Artifact Applicability ......................................................................................................... vii Models ........................................................................................................................... viii

1. External Data Definitions

2. Expression Definitions

3. Medications

4. Laboratory Tests

5. Consults and Referrals

6. Patient and Caregiver Education

7. Tabular List

8. Behavior Symbols A. References iii

List of Tables

1. Revision History ............................................................................................................. v

2. Clinical White Paper Contributors ...................................................................................... v

3. Artifact Identifier ........................................................................................................... vi

4. Applicability Foci, Description and Codes ......................................................................... vii

5. Model References ......................................................................................................... viii

7.1. Terminology Versions

7.2. Terminology References

8.1. Group Organizational Behavior

8.2. Group Selection Behavior

8.3. Required Behavior

8.4. Precheck Behavior

8.5. Cardinality Behavior

8.6. Item Flags

8.7. Read Only Behavior

iv

Preface Table 1. Revision History

Date Life Cycle Event May 29, 2018 Published May 29, 2018 Reviewed March 1, 2018 Pre-published August 10, 2017 Created

Table 2. Clinical White Paper Contributors

Name Role Affiliation

Ilene Robeck Author Physician, Richmond VA Medical Center (VAMC), Rich-mond, VA

Jodie Trafton Author Director, VA Program Evaluation and Resource Center, VA Palo Alto Health Care System, Menlo Park, CA

Friedhelm Sand-brink

Author Acting Director of Pain Management Program Office, De-partment of VA, Washington, DC

Elizabeth Oliva Author VA National Opioid Overdose Education and Naloxone Dis-tribution (OEND) Coordinator, VA Palo Alto Health Care System, Menlo Park, CA

Eleanor Lewis Author Research Health Science Specialist, VA Palo Alto Health Care System, Menlo Park, CA

Kendall Browne Author Clinical Psychologist, Seattle Puget Sound Health Care Sys-tem, Seattle, WA

Alicia Heapy Author Mental Health, VA New England Healthcare System, West Haven, CT

Karen Drexler Author National Mental Health Program Director, Substance Use Disorders, VA Central Office, Atlanta, GA

Andrew Saxon Author Physician, Seattle Health Care System, Seattle, WA

Melissa Christo-pher

Author National Director, Academic Detailing VACO Pharmacy Benefits Management (PBM), Mission Valley Annex VISN 22, San Diego, CA

Daina Wells Author United States

Lucille Burgo Author Firm Chief, Primary Care, VA New England Healthcare Sys-tem, West Haven, CT v

Preface

Name Role Affiliation

Julianne Himstreet Author Pharmacist, Eugene, OR

Table 3. Artifact Identifier

Domain Artifact ID Name urn:va.gov:kbs:knart:artifact:r1 495c933d-52a6-5e02-98fd-9813222014cf O21 vi

Artifact Applicability Table 4. Applicability Foci, Description and Codes

Focus Description Code Sys-tem

Code Value Set Value Set Version

TargetUser Primary Care Provider (PCP)

SNOMED

CT

453231000124104 |Primary care provider (occupa-tion)|

N/A N/A

PatientAgeGroup Adult SNOMED

CT

133936004 |Adult (person)|

N/A N/A

WorkflowSetting Primary Care N/A N/A

ClinicalVenue Outpatient SNOMED

CT

33022008 |Hospi-tal-based outpatient department (envi-ronment)|

N/A N/A vii

Models Table 5. Model References

Referenced Model Description urn:solor.io:anf-model:1.0 VA Analysis Normal Form Model viii

Chapter 1. External Data Definitions No external data expression definitions and no trigger definitions are present.

Chapter 2. Expression Definitions No expression definitions are present.

Chapter 3. Medications Oral Medications

☐ Ibuprofen 200 mg tablet oral every 4 to 6 hours as needed for pain 100 tablets 2 refills actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Postcoordinated Expression [416118004 |Administration

(procedure)] ->(260686004 |Method (attribute))->[129445006 |Administration - action (qualifier value)] ->(363701004 | Direct substance (attribute))->[Rx;310965 Ibuprofen 200 MG Oral Tablet] ->(410675002 |Route of administration (at-tribute))->[26643006 |Oral route (qualifier value)] unstructured[0]: 100 tablets 2 refills unstructured[1]: as needed purpose[0]: Postcoordinated Expression [277132007 |Thera-peutic procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[22253000 |Pain (finding)] requestedResult.lowerBound: 1 requestedResult.upperBound: 1 requestedResult.includeLowerBound: TRUE requestedResult.includeUpperBound: TRUE requestedResult.measureSemantic: Precoordinated Expression

421026006 |Oral tablet (qualifier value)| repetition[0].periodDuration.lowerBound: 1 repetition[0].periodDuration.upperBound: 75 repetition[0].periodDuration.includeLowerBound: TRUE repetition[0].periodDuration.includeUpperBound: TRUE repetition[0].periodDuration.measureSemantic: Precoordinated

Expression 258703001 |day (qualifier value)| repetition[0].eventFrequency.lowerBound: 4 repetition[0].eventFrequency.upperBound: 6 repetition[0].eventFrequency.includeLowerBound: TRUE repetition[0].eventFrequency.includeUpperBound: TRUE repetition[0].eventFrequency.measureSemantic: Precoordinat-ed Expression 258702006 |hour (qualifier value)| ☐ Naproxen 250 mg tablet oral 2 times daily as needed for pain 100 tablets 2 refills actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Postcoordinated Expression [416118004 |Administration (procedure)] ->(260686004 |Method (attribute))->[129445006

Medications

|Administration - action (qualifier value)] ->(363701004 | Direct substance (attribute))->[Rx;198013 Naproxen 250 MG Oral Tablet] ->(410675002 |Route of administration (at-tribute))->[26643006 |Oral route (qualifier value)] unstructured[0]: 100 tablets 2 refills unstructured[1]: as needed purpose[0]: Postcoordinated Expression [277132007 |Thera-peutic procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[22253000 |Pain (finding)] requestedResult.lowerBound: 1 requestedResult.upperBound: 1 requestedResult.includeLowerBound: TRUE requestedResult.includeUpperBound: TRUE requestedResult.measureSemantic: Precoordinated Expression

421026006 |Oral tablet (qualifier value)| repetition[0].periodDuration.lowerBound: 1 repetition[0].periodDuration.upperBound: 150 repetition[0].periodDuration.includeLowerBound: TRUE repetition[0].periodDuration.includeUpperBound: TRUE repetition[0].periodDuration.measureSemantic: Precoordinated

Expression 258703001 |day (qualifier value)| repetition[0].eventFrequency.lowerBound: 2 repetition[0].eventFrequency.upperBound: 2 repetition[0].eventFrequency.includeLowerBound: TRUE repetition[0].eventFrequency.includeUpperBound: TRUE repetition[0].eventFrequency.measureSemantic: Precoordinat-ed Expression 258703001 |day (qualifier value)| ☐ Acetaminophen 325 mg tablet oral 2 tablets every 6 hours as needed for pain; may increase dose frequency to 2 tablets every 4 hours; do not take more than 10 tablets per day 100 tablets 2 refills actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Postcoordinated Expression [416118004 |Administration

(procedure)] ->(260686004 |Method (attribute))->[129445006 |Administration - action (qualifier value)] ->(363701004 |Di-rect substance (attribute))->[Rx;313782 Acetaminophen 325 MG Oral Tablet] ->(410675002 |Route of administration (at-tribute))->[26643006 |Oral route (qualifier value)] unstructured[0]: 100 tablets 2 refills unstructured[1]: as needed; may increase dose frequency to 2 tablets every 4 hours; do not take more than 10 tablets per day purpose[0]: Postcoordinated Expression [277132007 |Thera-peutic procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[22253000 |Pain (finding)] requestedResult.lowerBound: 2 requestedResult.upperBound: 2 requestedResult.includeLowerBound: TRUE requestedResult.includeUpperBound: TRUE requestedResult.measureSemantic: Precoordinated Expression

421026006 |Oral tablet (qualifier value)| repetition[0].periodDuration.lowerBound: 1 repetition[0].periodDuration.upperBound: 37.5 repetition[0].periodDuration.includeLowerBound: TRUE repetition[0].periodDuration.includeUpperBound: TRUE repetition[0].periodDuration.measureSemantic: Precoordinated

Expression 258703001 |day (qualifier value)| repetition[0].eventFrequency.lowerBound: 4 repetition[0].eventFrequency.upperBound: 4 repetition[0].eventFrequency.includeLowerBound: TRUE repetition[0].eventFrequency.includeUpperBound: TRUE repetition[0].eventFrequency.measureSemantic: Precoordinat-ed Expression 258703001 |day (qualifier value)| ☐ Celecoxib 100 mg capsule oral 2 times a day 60 capsules 2 refills actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Postcoordinated Expression [416118004 |Administration

(procedure)] ->(260686004 |Method (attribute))->[129445006 |Administration - action (qualifier value)] ->(363701004 |Di-rect substance (attribute))->[Rx;205322 celecoxib 100 MG Oral Capsule] ->(410675002 |Route of administration (at-tribute))->[26643006 |Oral route (qualifier value)] unstructured[0]: 60 capsules 2 refills requestedResult.lowerBound: 1 requestedResult.upperBound: 1 requestedResult.includeLowerBound: TRUE requestedResult.includeUpperBound: TRUE requestedResult.measureSemantic: Precoordinated Expression

420692007 |Conventional release oral capsule (dose form)| repetition[0].periodDuration.lowerBound: 90 repetition[0].periodDuration.upperBound: 90 repetition[0].periodDuration.includeLowerBound: TRUE repetition[0].periodDuration.includeUpperBound: TRUE repetition[0].periodDuration.measureSemantic: Precoordinated

Expression 258703001 |day (qualifier value)| repetition[0].eventFrequency.lowerBound: 2 repetition[0].eventFrequency.upperBound: 2 repetition[0].eventFrequency.includeLowerBound: TRUE repetition[0].eventFrequency.includeUpperBound: TRUE repetition[0].eventFrequency.measureSemantic: Precoordinat-ed Expression 258703001 |day (qualifier value)| The following orders may be considered for patients who tolerate lower doses but whose pain control remains inadequate on lower doses

☐ Ibuprofen 400 mg tablet oral every 4 to 6 hours as needed for pain 100 tablets 2 refills actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Postcoordinated Expression [416118004 |Administration

(procedure)] ->(260686004 |Method (attribute))->[129445006 |Administration - action (qualifier value)] ->(363701004 | Direct substance (attribute))->[Rx;197805 Ibuprofen 400 MG Oral Tablet] ->(410675002 |Route of administration (at-tribute))->[26643006 |Oral route (qualifier value)] unstructured[0]: 100 tablets 2 refills unstructured[1]: as needed purpose[0]: Postcoordinated Expression [277132007 |Thera-peutic procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[22253000 |Pain (finding)] requestedResult.lowerBound: 1 requestedResult.upperBound: 1 requestedResult.includeLowerBound: TRUE requestedResult.includeUpperBound: TRUE requestedResult.measureSemantic: Precoordinated Expression

421026006 |Oral tablet (qualifier value)| repetition[0].periodDuration.lowerBound: 1 repetition[0].periodDuration.upperBound: 75 repetition[0].periodDuration.includeLowerBound: TRUE repetition[0].periodDuration.includeUpperBound: TRUE repetition[0].periodDuration.measureSemantic: Precoordinated

Expression 258703001 |day (qualifier value)| repetition[0].eventFrequency.lowerBound: 4 repetition[0].eventFrequency.upperBound: 6 repetition[0].eventFrequency.includeLowerBound: TRUE repetition[0].eventFrequency.includeUpperBound: TRUE repetition[0].eventFrequency.measureSemantic: Precoordinat-ed Expression 258702006 |hour (qualifier value)| ☐ Naproxen 375 mg tablet oral 2 times daily as needed for pain 100 tablets 2 refills topic: Postcoordinated Expression [416118004 |Administration (procedure)] ->(260686004 |Method (attribute))->[129445006 |Administration - action (qualifier value)] ->(363701004 | Direct substance (attribute))->[Rx;198012 Naproxen 375 MG Oral Tablet] ->(410675002 |Route of administration (at-tribute))->[26643006 |Oral route (qualifier value)] unstructured[0]: 100 tablets 2 refills unstructured[1]: as needed purpose[0]: Postcoordinated Expression [277132007 |Thera-peutic procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[22253000 |Pain (finding)] requestedResult.lowerBound: 1 requestedResult.upperBound: 1 requestedResult.includeLowerBound: TRUE requestedResult.includeUpperBound: TRUE requestedResult.measureSemantic: Precoordinated Expression

421026006 |Oral tablet (qualifier value)| repetition[0].periodDuration.lowerBound: 1 repetition[0].periodDuration.upperBound: 150 repetition[0].periodDuration.includeLowerBound: TRUE repetition[0].periodDuration.includeUpperBound: TRUE repetition[0].periodDuration.measureSemantic: Precoordinated

Expression 258703001 |day (qualifier value)| repetition[0].eventFrequency.lowerBound: 2 repetition[0].eventFrequency.upperBound: 2 repetition[0].eventFrequency.includeLowerBound: TRUE repetition[0].eventFrequency.includeUpperBound: TRUE repetition[0].eventFrequency.measureSemantic: Precoordinat-ed Expression 258703001 |day (qualifier value)| ☐ Celecoxib 200 mg capsule oral 2 times a day 60 capsules 2 refills actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Postcoordinated Expression [416118004 |Administration

(procedure)] ->(260686004 |Method (attribute))->[129445006 |Administration - action (qualifier value)] ->(363701004 |Di-rect substance (attribute))->[Rx;205323 celecoxib 200 MG Oral Capsule] ->(410675002 |Route of administration (at-tribute))->[26643006 |Oral route (qualifier value)] unstructured[0]: 100 tablets 2 refills requestedResult.lowerBound: 1 requestedResult.upperBound: 1 requestedResult.includeLowerBound: TRUE requestedResult.includeUpperBound: TRUE requestedResult.measureSemantic: Precoordinated Expression 420692007 |Conventional release oral capsule (dose form)| repetition[0].periodDuration.lowerBound: 90 repetition[0].periodDuration.upperBound: 90 repetition[0].periodDuration.includeLowerBound: TRUE repetition[0].periodDuration.includeUpperBound: TRUE repetition[0].periodDuration.measureSemantic: Precoordinated

Expression 258703001 |day (qualifier value)| repetition[0].eventFrequency.lowerBound: 2 repetition[0].eventFrequency.upperBound: 2 repetition[0].eventFrequency.includeLowerBound: TRUE repetition[0].eventFrequency.includeUpperBound: TRUE repetition[0].eventFrequency.measureSemantic: Precoordinat-ed Expression 258703001 |day (qualifier value)| The following orders may be considered for patients who tolerate lower doses but whose pain control remains inadequate on lower doses

☐ Ibuprofen 600 mg tablet oral every 6 hours as needed for pain 100 tablets 2 refills actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Postcoordinated Expression [416118004 |Administration

(procedure)] ->(260686004 |Method (attribute))->[129445006 |Administration - action (qualifier value)] ->(363701004 | Direct substance (attribute))->[Rx;197806 Ibuprofen 600 MG Oral Tablet] ->(410675002 |Route of administration (at-tribute))->[26643006 |Oral route (qualifier value)] unstructured[0]: 100 tablets 2 refills unstructured[1]: as needed purpose[0]: Postcoordinated Expression [277132007 |Thera-peutic procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[22253000 |Pain (finding)] requestedResult.lowerBound: 1 requestedResult.upperBound: 1 requestedResult.includeLowerBound: TRUE requestedResult.includeUpperBound: TRUE requestedResult.measureSemantic: Precoordinated Expression

421026006 |Oral tablet (qualifier value)| repetition[0].periodDuration.lowerBound: 1 repetition[0].periodDuration.upperBound: 75 repetition[0].periodDuration.includeLowerBound: TRUE repetition[0].periodDuration.includeUpperBound: TRUE repetition[0].periodDuration.measureSemantic: Precoordinated Expression 258703001 |day (qualifier value)| repetition[0].eventFrequency.lowerBound: 6 repetition[0].eventFrequency.upperBound: 6 repetition[0].eventFrequency.includeLowerBound: TRUE repetition[0].eventFrequency.includeUpperBound: TRUE repetition[0].eventFrequency.measureSemantic: Precoordinat-ed Expression 258702006 |hour (qualifier value)| ☐ Naproxen 500 mg tablet oral 2 times daily as needed for pain 100 tablets 2 refills actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Postcoordinated Expression [416118004 |Administration

(procedure)] ->(260686004 |Method (attribute))->[129445006 |Administration - action (qualifier value)] ->(363701004 | Direct substance (attribute))->[Rx;198014 Naproxen 500 MG Oral Tablet] ->(410675002 |Route of administration (at-tribute))->[26643006 |Oral route (qualifier value)] unstructured[0]: 100 tablets 2 refills unstructured[1]: as needed purpose[0]: Postcoordinated Expression [277132007 |Thera-peutic procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[22253000 |Pain (finding)] requestedResult.lowerBound: 1 requestedResult.upperBound: 1 requestedResult.includeLowerBound: TRUE requestedResult.includeUpperBound: TRUE requestedResult.measureSemantic: Precoordinated Expression

421026006 |Oral tablet (qualifier value)| repetition[0].periodDuration.lowerBound: 1 repetition[0].periodDuration.upperBound: 150 repetition[0].periodDuration.includeLowerBound: TRUE repetition[0].periodDuration.includeUpperBound: TRUE repetition[0].periodDuration.measureSemantic: Precoordinated

Expression 258703001 |day (qualifier value)| repetition[0].eventFrequency.lowerBound: 2 repetition[0].eventFrequency.upperBound: 2 repetition[0].eventFrequency.includeLowerBound: TRUE repetition[0].eventFrequency.includeUpperBound: TRUE repetition[0].eventFrequency.measureSemantic: Precoordinat-ed Expression 258703001 |day (qualifier value)| Topical Medications

☐ Capsaicin 0.1% cream topical 3 times a day apply to affected area 1 tube 0 refills routine quested (qualifier value)| topic: Postcoordinated Expression [416118004 |Administration (procedure)] ->(260686004 |Method (attribute))->[129445006 |Administration - action (qualifier value)] ->(363701004 |Di-rect substance (attribute))->[Rx;646333 Capsaicin 1 MG/ML Topical Cream] ->(410675002 |Route of administration (at-tribute))->[6064005 |Topical route (qualifier value)] unstructured[0]: 1 tube, 0 refills unstructured[1]: apply to affected area requestedResult.lowerBound: 1 requestedResult.upperBound: 1 requestedResult.includeLowerBound: TRUE requestedResult.includeUpperBound: TRUE requestedResult.measureSemantic: Precoordinated Expression

425753008 |Conventional release cutaneous ointment (dose form)| priority: Precoordinated Expression 50811001 |Routine (quali-fier value)| repetition[0].eventFrequency.lowerBound: 3 repetition[0].eventFrequency.upperBound: 3 repetition[0].eventFrequency.includeLowerBound: TRUE repetition[0].eventFrequency.includeUpperBound: TRUE repetition[0].eventFrequency.measureSemantic: Precoordinat-ed Expression 258703001 |day (qualifier value)| ☐ Diclofenac sodium 1% 2 g gel topical 4 times a day apply to affected area 1 tube 0 refills routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Postcoordinated Expression [416118004 |Administration

(procedure)] ->(260686004 |Method (attribute))->[129445006 |Administration - action (qualifier value)] ->(363701004 |Di-rect substance (attribute))->[Rx;1043479 Diclofenac Sodium 10 MG/ML Topical Cream] ->(410675002 |Route of adminis-tration (attribute))->[6064005 |Topical route (qualifier value)] unstructured[0]: 1 tube, 0 refills unstructured[1]: apply to affected area requestedResult.lowerBound: 1 requestedResult.upperBound: 1 requestedResult.includeLowerBound: TRUE requestedResult.includeUpperBound: TRUE requestedResult.measureSemantic: Precoordinated Expression

425753008 |Conventional release cutaneous ointment (dose form)| priority: Precoordinated Expression 50811001 |Routine (quali-fier value)| repetition[0].eventFrequency.lowerBound: 4 repetition[0].eventFrequency.upperBound: 4 repetition[0].eventFrequency.includeLowerBound: TRUE repetition[0].eventFrequency.includeUpperBound: TRUE repetition[0].eventFrequency.measureSemantic: Precoordinat-ed Expression 258703001 |day (qualifier value)| ☐ Lidocaine 5% patch topical apply to intact skin to cover most painful area; apply prescribed number of patches (maximum of 3); apply only 1 time for a maximum of 12 hours within a 24-hour period 30 patches 0 refills routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Postcoordinated Expression [416118004 |Administration

(procedure)] ->(260686004 |Method (attribute))->[129445006 | Administration - action (qualifier value)] ->(363701004 |Direct substance (attribute))->[Rx;1745091 Lidocaine 0.05 MG/MG Medicated Patch] ->(410675002 |Route of administration (at-tribute))->[6064005 |Topical route (qualifier value)] unstructured[0]: 30 patches, 0 refills unstructured[1]: apply to intact skin to cover most painful area;

apply prescribed number of patches (maximum of 3); apply on-ly 1 time for a maximum of 12 hours within a 24-hour period requestedResult.lowerBound: 1 requestedResult.upperBound: 3 requestedResult.includeLowerBound: TRUE requestedResult.includeUpperBound: TRUE requestedResult.measureSemantic: Precoordinated Expression

739003001 |Patch (basic dose form)| priority: Precoordinated Expression 50811001 |Routine (quali-fier value)| repetition[0].eventFrequency.lowerBound: 24 repetition[0].eventFrequency.upperBound: 24 repetition[0].eventFrequency.includeLowerBound: TRUE repetition[0].eventFrequency.includeUpperBound: TRUE repetition[0].eventFrequency.measureSemantic: Precoordinat-ed Expression 258702006 |hour (qualifier value)| ☐ Menthol 10%/methyl salicylate 15% cream topical 3 times a day apply to affected area 1 tube 0 refills routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Postcoordinated Expression [416118004 |Administration

(procedure)] ->(260686004 |Method (attribute))->[129445006

|Administration - action (qualifier value)] ->(363701004 |Di-rect substance (attribute))->[Rx;311498 Menthol 100 MG/ML / methyl salicylate 150 MG/ML Topical Cream] ->(410675002 |Route of administration (attribute))->[6064005 |Topical route (qualifier value)] unstructured[0]: 1 tube, 0 refills unstructured[1]: apply to affected area requestedResult.lowerBound: 1 requestedResult.upperBound: 1 requestedResult.includeLowerBound: TRUE requestedResult.includeUpperBound: TRUE requestedResult.measureSemantic: Precoordinated Expression

425753008 |Conventional release cutaneous ointment (dose form)| priority: Precoordinated Expression 50811001 |Routine (quali-fier value)| repetition[0].eventFrequency.lowerBound: 3 repetition[0].eventFrequency.upperBound: 3 repetition[0].eventFrequency.includeLowerBound: TRUE repetition[0].eventFrequency.includeUpperBound: TRUE repetition[0].eventFrequency.measureSemantic: Precoordinat-ed Expression 258703001 |day (qualifier value)|

Chapter 4. Laboratory Tests ☐ Complete blood count 1 time routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Requested (qualifier value)| topic: Precoordinated Expression 26604007 |Complete blood count (procedure)| ☐ Comprehensive metabolic panel 1 time routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Requested (qualifier value)| topic: Precoordinated Expression 85acf077-d744-48bc-b57a-fa3b5ce12d97 |Comprehensive metabolic panel (procedure)| ☐ Hemoglobin A1c 1 time routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Requested (qualifier value)| topic: Precoordinated Expression 43396009 |Hemoglobin A1c measurement (procedure)| ☐ Toxicology screen 1 time routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Requested (qualifier value)| topic: Precoordinated Expression 314076009 |Toxicology screening test (procedure)| ☐ 25-hydroxyvitamin D 1 time routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Requested (qualifier value)| topic: Precoordinated Expression 12199005 |Vitamin D, 25-hydroxy measurement (proce-dure)| ☐ Erythrocyte sedimentation rate 1 time routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Requested (qualifier value)| topic: Precoordinated Expression 416838001 |Erythrocyte sedimentation rate measurement

(procedure)| ☐ C-reactive protein 1 time routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Requested (qualifier value)| topic: Postcoordinated Expression [3457005 |Patient referral (procedure)] ->(363702006 |

Has focus (attribute))->[392134007 |Care regimes management (procedure)]

Chapter 5. Consults and Referrals Specify consults required for this patient

☐ Referral care management services evaluate needs related to chronic pain routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Precoordinated Expression 306238000 |Referral to So-cial Services (procedure)| purpose[0]: Postcoordinated Expression [386053000 |Eval-uation procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[408954001 |Chronic pain control (procedure)]

☐ Referral social services evaluate for needs related to chronic pain routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Precoordinated Expression 306238000 |Referral to So-cial Services (procedure)| purpose[0]: Postcoordinated Expression [386053000 |Eval-uation procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[408954001 |Chronic pain control (procedure)]

☐ Referral clinical nurse specialist evaluate for chronic pain routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Precoordinated Expression 306320001 |Referral to clini-cal nurse specialist (procedure)| purpose[0]: Postcoordinated Expression [386053000 |Eval-uation procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[408954001 |Chronic pain control (procedure)]

☐ Referral mental health evaluate for mental health interventions related to chronic pain routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Precoordinated Expression 390866009 |Referral to men-tal health team (procedure)| purpose[0]: Postcoordinated Expression [386053000 |Eval-uation procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[408954001 |Chronic pain control (procedure)]

☐ Referral mental health evaluate for psychotherapy related to chronic pain routine

Consults and Referrals topic: Postcoordinated Expression [390866009 |Referral to mental health team (procedure)] ->(363702006 |Has focus (at-tribute))->[45392008 |Psychologic evaluation or test procedure (procedure)] purpose[0]: Postcoordinated Expression [386053000 |Eval-uation procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[408954001 |Chronic pain control (procedure)]

☐ Referral mental health evaluate for cognitive behavioral therapy related to chronic pain rou-tine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Postcoordinated Expression [390866009 |Referral to mental health team (procedure)] ->(363702006 |Has focus (at-tribute))->[704072009 |Cognitive behavior therapy care man-agement (procedure)] purpose[0]: Postcoordinated Expression [386053000 |Eval-uation procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[408954001 |Chronic pain control (procedure)]

☐ Referral mental health evaluate for acceptance and commitment therapy related to chronic pain routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Postcoordinated Expression [390866009 |Referral to mental health team (procedure)] ->(363702006 |Has focus (at-tribute))->[710137005 |Promotion of acceptance of health sta-tus (procedure)] purpose[0]: Postcoordinated Expression [386053000 |Eval-uation procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[408954001 |Chronic pain control (procedure)]

☐ Referral addiction evaluate for substance use disorder with chronic pain routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Postcoordinated Expression [3457005 |Patient referral (procedure)] ->(363702006 |Has focus (at-tribute))->[266707007 |Drug addiction therapy (regime/thera-py)] purpose[0]: Postcoordinated Expression [386053000 |Eval-uation procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[408954001 |Chronic pain control (procedure)]

☐ Referral addiction evaluate for tobacco cessation with chronic pain routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-topic: Precoordinated Expression 449861000124107 |Referral to tobacco use cessation counseling program (procedure)| purpose[0]: Postcoordinated Expression [386053000 |Eval-uation procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[408954001 |Chronic pain control (procedure)]

☐ Referral pain management evaluate for chronic pain routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Precoordinated Expression 306109009 |Referral to pain management service (procedure)| purpose[0]: Postcoordinated Expression [386053000 |Eval-uation procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[408954001 |Chronic pain control (procedure)]

☐ Referral pain management evaluate for opioid management with chronic pain routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Postcoordinated Expression [306109009 |Referral to pain management service (procedure)] ->(363702006 |Has fo-cus (attribute))->[b6216dfc-5b5f-4823-9bc8-ce9c79d67709 | Management of opioid therapy (procedure)] purpose[0]: Postcoordinated Expression [386053000 |Eval-uation procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[408954001 |Chronic pain control (procedure)]

☐ Referral pharmacy evaluate for needs related to chronic pain routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Precoordinated Expression 306179008 |Referral to phar-macy service (procedure)| purpose[0]: Postcoordinated Expression [386053000 |Eval-uation procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[408954001 |Chronic pain control (procedure)]

☐ Referral physical therapy evaluate for chronic pain routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Precoordinated Expression 444831000124102 |Referral for physical therapy (procedure)| purpose[0]: Postcoordinated Expression [386053000 |Eval-uation procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[408954001 |Chronic pain control (procedure)]

☐ Referral acupuncture evaluate for chronic pain routine quested (qualifier value)| topic: Postcoordinated Expression [3457005 |Patient referral (procedure)] ->(363702006 |Has focus (attribute))->[44868003 |Acupuncture (procedure)] purpose[0]: Postcoordinated Expression [386053000 |Eval-uation procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[408954001 |Chronic pain control (procedure)]

☐ Referral tai chi evaluate for chronic pain routine ☐ Referral yoga evaluate for chronic pain routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Postcoordinated Expression [3457005 |Patient referral (procedure)] ->(363702006 |Has focus (at-tribute))->[229223006 |Participation in Tai Chi (regime/thera-py)] purpose[0]: Postcoordinated Expression [386053000 |Eval-uation procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[408954001 |Chronic pain control (procedure)]

☐ Referral mindfulness evaluate for chronic pain routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Postcoordinated Expression [3457005 |Patient referral (procedure)] ->(363702006 |Has focus (at-tribute))->[05257e84-e247-4f2e-bb83-dccd395d56a8 |Mindful-ness therapy (procedure)] purpose[0]: Postcoordinated Expression [386053000 |Eval-uation procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[408954001 |Chronic pain control (procedure)]

☐ Referral meditation evaluate for chronic pain routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Postcoordinated Expression [3457005 |Patient referral (procedure)] ->(363702006 |Has focus (at-tribute))->[386365008 |Meditation facilitation (procedure)] purpose[0]: Postcoordinated Expression [386053000 |Eval-uation procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[408954001 |Chronic pain control (procedure)]

☐ Referral guided imagery evaluate for chronic pain routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-topic: Postcoordinated Expression [3457005 |Patient referral (procedure)] ->(363702006 |Has focus (at-tribute))->[228565006 |Imagery technique (regime/therapy)] purpose[0]: Postcoordinated Expression [386053000 |Eval-uation procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[408954001 |Chronic pain control (procedure)]

☐ Referral hypnotherapy evaluate for chronic pain routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Postcoordinated Expression [3457005 |Patient referral

(procedure)] ->(363702006 |Has focus (attribute))->[19997007 |Hypnotherapy (regime/therapy)] purpose[0]: Postcoordinated Expression [386053000 |Eval-uation procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[408954001 |Chronic pain control (procedure)]

☐ Referral biofeedback evaluate for chronic pain routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Re-quested (qualifier value)| topic: Postcoordinated Expression [3457005 |Patient referral

(procedure)] ->(363702006 |Has focus (attribute))->[28150003 |Biofeedback procedure (regime/therapy)] purpose[0]: Postcoordinated Expression [386053000 |Eval-uation procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[408954001 |Chronic pain control (procedure)]

Only applicable if referring to an outside facility. To inform appropriate opioid and chronic non-cancer pain treatment for this patient, please provide the following information

☐ prompt: Goal of Consult response: String (Single) ☐ prompt: Clinical FIndings response: String (Single) ☐ prompt: Priority (specify Routine or otherwise response: String (Single) ☐ prompt: Referring Physician Name response: String (Single) ☐ prompt: Referring Physician Contact Details response: String (Single)

Chapter 6. Patient and Caregiver Education

☐ Chronic pain management education routine actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Requested (qualifier value)| topic: Precoordinated Expression 408956004 |Chronic pain control education (procedure)|

Chapter 7. Tabular List Terminology Service Request (TSR) Mappings

Table 7.1. Terminology Versions

Name Identifer Version

SNOMED CT 2.16.840.1.113883.6.96 United States Edition 20180301

Table 7.2. Terminology References

System Code Display Texta Referencesb

SNOMED CT 12199005 |Vitamin D, 25-hydroxy measurement (procedure)|

Precoordinated Expression 1

SNOMED CT 133936004 |Adult (per-son)|

Adult 1

SNOMED CT 258702006 |hour (qualifier value)|

Precoordinated Expression 4

SNOMED CT 258703001 |day (qualifier value)|

Precoordinated Expression 18

SNOMED CT 26604007 |Complete blood count (procedure)|

Precoordinated Expression 1

SNOMED CT 306109009 |Referral to pain management service (procedure)|

Precoordinated Expression 1

SNOMED CT 306179008 |Referral to pharmacy service (proce-dure)|

Precoordinated Expression 1

SNOMED CT 306238000 |Referral to So-cial Services (procedure)|

Precoordinated Expression 2

SNOMED CT 306320001 |Referral to clinical nurse specialist (procedure)|

Precoordinated Expression 1

SNOMED CT 314076009 |Toxicology screening test (procedure)|

Precoordinated Expression 1

SNOMED CT 33022008 |Hospital-based outpatient department (en-vironment)|

Outpatient 1

SNOMED CT 385644000 |Requested (qualifier value)|

Precoordinated Expression 41

SNOMED CT 390866009 |Referral to mental health team (proce-dure)|

Precoordinated Expression 1

SNOMED CT 408956004 |Chronic pain control education (proce-dure)|

Precoordinated Expression 1

Tabular List

System Code Display Texta Referencesb

SNOMED CT 416838001 |Erythrocyte sedimentation rate mea-surement (procedure)|

Precoordinated Expression 1

SNOMED CT 420692007 |Conventional release oral capsule (dose form)|

Precoordinated Expression 2

SNOMED CT 421026006 |Oral tablet (qualifier value)|

Precoordinated Expression 7

SNOMED CT 425753008 |Conventional release cutaneous ointment (dose form)|

Precoordinated Expression 3

SNOMED CT 43396009 |Hemoglobin A1c measurement (proce-dure)|

Precoordinated Expression 1

SNOMED CT 444831000124102 |Re-ferral for physical therapy (procedure)|

Precoordinated Expression 1

SNOMED CT 449861000124107 |Refer-ral to tobacco use cessation counseling program (pro-cedure)|

Precoordinated Expression 1

SNOMED CT 453231000124104 |Prima-ry care provider (occupa-tion)|

Primary Care Provider (PCP) 1

SNOMED CT 50811001 |Routine (quali-fier value)|

Precoordinated Expression 4

SNOMED CT 739003001 |Patch (basic dose form)|

Precoordinated Expression 1

SNOMED CT 85acf077-d744-48bc-b57a-fa3b5ce12d97 |Compre-hensive metabolic panel (procedure)|

Precoordinated Expression 1

SNOMED CT [277132007 |Therapeutic procedure (procedure)] - >(363702006 |Has focus (attribute))->[22253000 | Pain (finding)]

Postcoordinated Expression 7

SNOMED CT [306109009 |Referral to pain management service (procedure)] - >(363702006 |Has focus (attribute))->[b6216d-fc-5b5f-4823-9bc8-ce9c79d67709 |Management of opioid therapy (procedure)]

Postcoordinated Expression 1

SNOMED CT [3457005 |Patient re-ferral (procedure)] -

Postcoordinated Expression 1

>(363702006 |Has focus (attribute))->[05257e84-e247-4f2e-bb83-dc-cd395d56a8 |Mindfulness therapy (procedure)]

SNOMED CT [3457005 |Patient re-ferral (procedure)] - >(363702006 |Has focus (attribute))->[19997007 |Hypnotherapy (regime/ therapy)]

Postcoordinated Expression 1

SNOMED CT [3457005 |Patient re-ferral (procedure)] - >(363702006 |Has focus (attribute))->[228565006 |Imagery technique (regime/therapy)]

Postcoordinated Expression 1

SNOMED CT [3457005 |Patient re-ferral (procedure)] - >(363702006 |Has focus (attribute))->[229223006 |Participation in Tai Chi (regime/therapy)]

Postcoordinated Expression 1

SNOMED CT [3457005 |Patient re-ferral (procedure)] - >(363702006 |Has focus (attribute))->[266707007 |Drug addiction therapy (regime/therapy)]

Postcoordinated Expression 1

SNOMED CT [3457005 |Patient re-ferral (procedure)] - >(363702006 |Has focus (attribute))->[28150003 |Biofeedback procedure (regime/therapy)]

Postcoordinated Expression 1

SNOMED CT [3457005 |Patient re-ferral (procedure)] - >(363702006 |Has focus (attribute))->[386365008 |Meditation facilitation (procedure)]

Postcoordinated Expression 1

SNOMED CT [3457005 |Patient re-ferral (procedure)] - >(363702006 |Has focus (attribute))->[392134007 | Care regimes management (procedure)]

Postcoordinated Expression 1

SNOMED CT [3457005 |Patient re-ferral (procedure)] -

>(363702006 |Has focus (attribute))->[44868003 | Acupuncture (procedure)]

SNOMED CT [386053000 |Evaluation procedure (procedure)] - >(363702006 |Has focus (attribute))->[408954001 | Chronic pain control (pro-cedure)]

Postcoordinated Expression 20

SNOMED CT [390866009 |Refer-ral to mental health team (procedure)] - >(363702006 |Has focus (attribute))->[45392008 | Psychologic evaluation or test procedure (procedure)]

Postcoordinated Expression 1

SNOMED CT [390866009 |Refer-ral to mental health team (procedure)] - >(363702006 |Has focus (attribute))->[704072009 | Cognitive behavior thera-py care management (pro-cedure)]

Postcoordinated Expression 1

SNOMED CT [390866009 |Refer-ral to mental health team (procedure)] - >(363702006 |Has focus (attribute))->[710137005 |Promotion of acceptance of health status (proce-dure)]

Postcoordinated Expression 1

SNOMED CT [416118004 |Adminis-tration (procedure)] - >(260686004 |Method (at-tribute))->[129445006 |Administration - ac-tion (qualifier val-ue)] ->(363701004 | Direct substance (at-tribute))->[Rx;1043479 Diclofenac Sodium 10 MG/ML Topical Cream] ->(410675002 |Route of administration (at-tribute))->[6064005 |Topi-cal route (qualifier value)]

Postcoordinated Expression 1

SNOMED CT [416118004 |Adminis-tration (procedure)] - >(260686004 |Method (at-tribute))->[129445006 |Administration - ac-tion (qualifier val-ue)] ->(363701004 | Direct substance (at-tribute))->[Rx;1745091 Lidocaine 0.05 MG/ MG Medicated Patch] ->(410675002 |Route of administration (at-tribute))->[6064005 |Topi-cal route (qualifier value)]

SNOMED CT [416118004 |Adminis-tration (procedure)] - >(260686004 |Method (at-tribute))->[129445006 |Administration - ac-tion (qualifier val-ue)] ->(363701004 | Direct substance (at-tribute))->[Rx;197805 Ibuprofen 400 MG Oral Tablet] ->(410675002 | Route of administration (attribute))->[26643006 | Oral route (qualifier val-ue)]

Postcoordinated Expression 1

SNOMED CT [416118004 |Adminis-tration (procedure)] - >(260686004 |Method (at-tribute))->[129445006 |Administration - ac-tion (qualifier val-ue)] ->(363701004 | Direct substance (at-tribute))->[Rx;197806 Ibuprofen 600 MG Oral Tablet] ->(410675002 | Route of administration (attribute))->[26643006 | Oral route (qualifier val-ue)]

Postcoordinated Expression 1

SNOMED CT [416118004 |Adminis-tration (procedure)] - >(260686004 |Method (at-tribute))->[129445006 |Administration - ac-tion (qualifier val-ue)] ->(363701004 | Direct substance (at-tribute))->[Rx;198012

Naproxen 375 MG Oral Tablet] ->(410675002 | Route of administration (attribute))->[26643006 | Oral route (qualifier val-ue)]

SNOMED CT [416118004 |Adminis-tration (procedure)] - >(260686004 |Method (at-tribute))->[129445006 |Administration - ac-tion (qualifier val-ue)] ->(363701004 | Direct substance (at-tribute))->[Rx;198013 Naproxen 250 MG Oral Tablet] ->(410675002 | Route of administration (attribute))->[26643006 | Oral route (qualifier val-ue)]

Postcoordinated Expression 1

SNOMED CT [416118004 |Adminis-tration (procedure)] - >(260686004 |Method (at-tribute))->[129445006 |Administration - ac-tion (qualifier val-ue)] ->(363701004 | Direct substance (at-tribute))->[Rx;198014 Naproxen 500 MG Oral Tablet] ->(410675002 | Route of administration (attribute))->[26643006 | Oral route (qualifier val-ue)]

Postcoordinated Expression 1

SNOMED CT [416118004 |Adminis-tration (procedure)] - >(260686004 |Method (at-tribute))->[129445006 |Administration - ac-tion (qualifier val-ue)] ->(363701004 | Direct substance (at-tribute))->[Rx;205322 celecoxib 100 MG Oral Capsule] ->(410675002 | Route of administration (attribute))->[26643006 | Oral route (qualifier val-ue)]

SNOMED CT [416118004 |Adminis-tration (procedure)] - >(260686004 |Method (at-tribute))->[129445006 |Administration - ac-tion (qualifier val-ue)] ->(363701004 | Direct substance (at-tribute))->[Rx;205323 celecoxib 200 MG Oral Capsule] ->(410675002 | Route of administration (attribute))->[26643006 | Oral route (qualifier val-ue)]

Postcoordinated Expression 1

SNOMED CT [416118004 |Adminis-tration (procedure)] - >(260686004 |Method (at-tribute))->[129445006 |Administration - ac-tion (qualifier val-ue)] ->(363701004 | Direct substance (at-tribute))->[Rx;310965 Ibuprofen 200 MG Oral Tablet] ->(410675002 | Route of administration (attribute))->[26643006 | Oral route (qualifier val-ue)]

Postcoordinated Expression 1

SNOMED CT [416118004 |Adminis-tration (procedure)] - >(260686004 |Method (at-tribute))->[129445006 |Administration - ac-tion (qualifier val-ue)] ->(363701004 | Direct substance (at-tribute))->[Rx;311498 Menthol 100 MG/ML / methyl salicylate 150 MG/ML Topical Cream] ->(410675002 |Route of administration (at-tribute))->[6064005 |Topi-cal route (qualifier value)]

Postcoordinated Expression 1

SNOMED CT [416118004 |Adminis-tration (procedure)] - >(260686004 |Method (at-tribute))->[129445006 |Administration - ac-tion (qualifier val-ue)] ->(363701004 | Direct substance (at-tribute))->[Rx;313782 Ac-etaminophen 325 MG Oral Tablet] ->(410675002 | Route of administration (attribute))->[26643006 | Oral route (qualifier val-ue)]

SNOMED CT [416118004 |Adminis-tration (procedure)] - >(260686004 |Method (at-tribute))->[129445006 |Administration - ac-tion (qualifier val-ue)] ->(363701004 | Direct substance (at-tribute))->[Rx;646333 Capsaicin 1 MG/ML Topi-cal Cream] ->(410675002 |Route of administration (attribute))->[6064005 | Topical route (qualifier value)]

Postcoordinated Expression 1 aIf a code is used multiple times in the KNART, only the display text of the first instance is shown.

bCount of the number of times the given code system and code pair is used in the KNART.

Chapter 8. Behavior Symbols Table 8.1. Group Organizational Behavior

Sym-bol

Name Definition

▶ Sentence Group A group of related alternative actions is a sentence group if the item referenced by the action is the same in all the actions, and each action simply constitutes a different variation on how to specify the details for that item. For example, two actions that could be in a SentenceGroup are "aspirin, 500 mg, 2 times per day" and "aspirin, 300 mg, 3 times per day". In both cases, as-pirin is the item referenced by the action, and the two actions represent two different options for how aspirin might be or-dered for the patient. Note that a SentenceGroup would almost always have an associated selection behavior of "AtMostOne", unless it's a required action, in which case, it would be "Exact-lyOne".

▷ Logical Group A group with this behavior logically groups its sub-elements, and may be shown as a visual group to the end user, but it is not required to do so.

➤ Visual Group Any group marked with this behavior should be displayed as a visual group to the end user.

Table 8.2. Group Selection Behavior

Sym-bol

Name Definition

☐ Any Any number of the items in the group may be chosen, from ze-ro to all.

◉ All All the items in the group must be selected as a single unit.

◎ AllOrNone All the items in the group are meant to be chosen as a single unit: either all must be selected by the end user, or none may be selected.

○ ExactlyOne The end user must choose one and only one of the selectable items in the group. The user may not choose none of the items in the group.

✪ AtMostOne The end user may choose zero or at most one of the items in the group.

❂ OneOrMore The end user must choose a minimum of one, and as many ad-ditional as desired.

Table 8.3. Required Behavior

Sym-bol

Name Definition

✦ Must An action with this behavior must be included in the actions processed by the end user; the end user may not choose not to include this action.

Behavior Symbols

Sym-bol

Name Definition

✧ Could An action with this behavior may be included in the set of ac-tions processed by…

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