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Initial Assessment:

Standards Compatibility in Medication Reconciliation

August 31, 2011

Prepared by 1st American Systems and Services LLC

for 

National Institute of Standards and Technology

1

st American Systems and Services LLC
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1st American Systems and Services LLC

469 Township Road 1535

Proctorville, OH 45669 

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Authors

Frank McKinney

fm@frankmckinney.com

Melva Peters 

melva.peters@gpinformatics.com
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21 1

st American Systems and Services LLC | NIST NCPDP Analysis

NIST NCPDP Analysis – Initial Assessment: Standards Compatibility in Medication 

Reconciliation

Final, August 31, 2011

Contents

A. Introduction.........................................................................................................................................5

B. Background on Assessed Standards .....................................................................................................6

NCPDPD SCRIPT .......................................................................................................................................6

- Medication History (NCPDP SCRIPT RXHREQ, RXHRES) .....................................................................6

- New Prescription (NCPDP SCRIPT NEWRX) .......................................................................................6

- Cancel Prescription (NCPDP SCRIPT CANRX) .....................................................................................7

- Census Update (NCPDP SCRIPT CENSUS) ..........................................................................................7

- Prescription Fill Status (NCPDP SCRIPT RXFILL) .................................................................................7

Continuity of Care Record (ASTM CCR).....................................................................................................7

Continuity of Care Document (HL7 CCD) ..................................................................................................8

C. Integrating multiple source standards into medication reconciliation...................................................8

Where the source standards are used......................................................................................................8

Sources’ points of view reflected in the standards ...................................................................................9

Aligning medications from different sources..........................................................................................10

- Coded drug identifiers are not always present................................................................................11

- Different drug identifiers are used..................................................................................................11

- Prescribed versus dispensed medications.......................................................................................11

- Active versus inactive medications.................................................................................................12

- Over the counter (OTC) products, inpatient medications, and patient-reported drugs....................12

Incorporating other clinical information from the CCD, CCR or medication history into the process.......13

- Diagnosis or indication ...................................................................................................................13

- Patient allergies .............................................................................................................................14

D. Output flow: Conveying the results of med rec to other parties .........................................................14

- New Prescription............................................................................................................................15
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- Cancel Prescription ........................................................................................................................15

- Census ...........................................................................................................................................15

E. High-Level Illustration of Content Differences....................................................................................16

F. Assessed Scenario Overview ..............................................................................................................18

G. Scenario Content Summary................................................................................................................20

H. Medication Content Excerpts.............................................................................................................27

I. Adverse Reaction Excerpts.................................................................................................................30

J. Problem Excerpts...............................................................................................................................32

K. Detailed Comparison: Compatibility of Coded Values and Terminology..............................................34

L. Comparison Findings – Compatibility of Coded Content and Terminology ..........................................44

Appendix A: Standards Sources..................................................................................................................51

C32 CCD.................................................................................................................................................51

ASTM CCR..............................................................................................................................................51

NCPDP Medication History.....................................................................................................................51

NCIt Subset for NCPDP...........................................................................................................................51

Appendix B: Coded Content and Terminology Guidance from Source Standards........................................53

NCPDP SCRIPT Terminology References.................................................................................................53

CCR Terminology References.................................................................................................................64

C32 CCD Medication-Related Terminology References...........................................................................74
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A. Introduction

The goal of this document is to provide an initial assessment of the potential use and compatibility of the 

NCPDP SCRIPT, C32 CCD, and ASTM CCR standards in the medication reconciliation process. Included is an 

identification of points during medication reconciliation where related information is gathered or passed on 

using multiple standards, and a comparison of how each standard represents these common pieces of 

information. 

The document identifies gaps between the standards and translation points where information is 

represented differently in the standards. In addition, the analysis looks at how clinical information used 

during medication reconciliation is represented in the different message types within the SCRIPT standard 

itself, identifying issues and noting opportunities.

Document sections:

Background on Assessed Standards. Overview of the standards and particular messages/documents 

reviewed in this analysis. 

Standards Interaction Overview. Identification of points during the sample medication reconciliation

scenarios where information is exchanged using the different standards and used together in the 

care of the patient or transferred from one standard to another as part of the information flow. This 

section also gives a high-level comparison of how each standard represents common pieces of 

information.

Assessed Scenarios. This analysis focuses on a limited number of medication reconciliation scenarios 

in which the three standards might all be used in the care of a patient. This section describes these 

scenarios.

Standards Comparison. This section provides a more detailed comparison of concepts shared 

between the NCPDP, HL7 and ASTM standards focusing on the key aspects of medication vocabulary, 

administration directions, dispensing status and dates that come into play in the medication 

reconciliation process. This part of the document includes analysis of how information is represented 

between the standards (data types, lengths, etc.), vocabularies used, identification of gaps—such as 

information that can be conveyed in one standard but not the other, and identification of translation 

points, where two standards represent the same information, but in different ways.

Standards Comparison. This section compares how clinical content related to medication 

reconciliation—such as diagnoses, observations and allergies—is represented across different 

message types in the SCRIPT. Where there are differences or issues, the section recommends ways 

for NCPDP to address them.

Summary of Findings. Summary of compatibility and conflicts between the analyzed standards and 

representation of clinical concepts within the SCRIPT standard itself.
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B. Background on Assessed Standards

This analysis focuses on three electronic data exchange standards in which information about patient 

medications and other related clinical information can be used during a medication reconciliation process to:

- gather patient medications and other clinical information from other providers, insurance 

companies, pharmacies, or other sources such as state-based health information organizations 

(HIOs) 

- electronically transmit prescriptions resulting from medication reconciliation to the patient’s 

pharmacy

- include pertinent observations and clinical alerts such as allergies an potential drug conflicts in 

prescriptions transmitted to the pharmacy, 

- enable a nursing home or other long-term or post-acute care facility to electronically share a new 

resident patient’s allergies and problems discovered during medication reconciliation with the 

facility’s partner institutional pharmacy.

These standards are... 

- the NCPDP SCRIPT standard, including the Medication History, New Prescription, Cancel 

Prescription and Census messages

- the HITSP C32 CCD document, and

- the ASTM CCR message

... and are described further below.

NCPDPD SCRIPT

SCRIPT is a standard that includes several messages supporting medication management. This analysis 

focuses on those most closely associated with a medication reconciliation process—either providing patient 

clinical information to the process, or transmitting prescriptions and related information resulting from the 

process to the patient’s pharmacy. Those messages are briefly described below.

- Medication History (NCPDP SCRIPT RXHREQ, RXHRES)

The NCPDP SCRIPT Medication History message is the most common means by which medication 

history information is shared between a patient’s pharmacy benefit insurer and their physician or 

other practitioner. The SCRIPT Medication History format is named by CMS for use in the care of 

Medicare Part D recipients, and is required for participation in the federal MIPPA e-prescribing 

incentive program for practitioners. Medication History is not, however, included in currently defined

Meaningful Use criteria.

- New Prescription (NCPDP SCRIPT NEWRX)

The NCPDP SCRIPT New Prescription message is used to transmit prescriptions electronically to the 

patient’s pharmacy. 

The New Prescription message is named by CMS for use in the care of Medicare Part D recipients, 

and is required for participation in the federal MIPPA e-prescribing incentive program for 
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practitioners. Use of the New Prescription message is also required of prescribing systems wishing to 

meet current Meaningful Use certification.

- Cancel Prescription (NCPDP SCRIPT CANRX)

The NCPDP SCRIPT Cancel Prescription message is used to electronically cancel a prescription 

previously sent to the patient’s pharmacy. The use of Census is very limited today, and only in the 

long-term and post-acute care (LTPAC) setting. However, the message is mentioned here because of 

its current role in medication reconciliation in LTPAC settings today, and its potential to be adopted in 

ambulatory settings in the future.

- Census Update (NCPDP SCRIPT CENSUS)

The NCPDP SCRIPT Census message is used by long-term and post-acute care (LTPAC) facilities to 

notify partner institutional pharmacies of resident patient admissions, discharges and other census 

events, and can also be used to convey a profile of patient allergies and diagnoses. 

The use of Census is very limited today, and only in the LTPAC setting. However, the message is 

included in this analysis because of its potential role in medication reconciliation in LTPAC settings, 

and because it is the only SCRIPT message that contains the standard’s Allergy and Diagnosis 

segments. The Census message is not currently included in Meaningful Use criteria.

- Prescription Fill Status (NCPDP SCRIPT RXFILL)

The NCPDP SCRIPT Fill Status message enables the dispensing pharmacy to notify the prescriber 

when a prescription is dispensed and picked up by (or delivered to) the patient. The message also 

enables the prescriber to be notified if the order can’t be dispensed or if the patient does not take 

possession of the medication.

The standard is not in wide use today—with initial usage primarily in the long-term and post-acute 

care settings. However, the standard is named for optional use by CMS for Medicare Part D patients, 

and its potential value in the ambulatory setting to alert prescribers of non-compliance by their 

patients has been noted. 

Similar to dispense-based medication history provided by healthcare payers, the Fill Status can 

augment EMR-based medication information, which typically reflects medication orders which may 

or may not have actually been filled and picked up by the patient.

SCRIPT Versions

The 8.1 version of the SCRIPT standard is in most common use today, though where SCRIPT is named for 

federal programs, the 10.6 version is also allowed to be used. The industry is expected to implement the 10.6 

version over the course of the upcoming 2-4 years. This analysis will focus on the 10.6 version of the 

standard.

Continuity of Care Record (ASTM CCR)

The Continuity of Care Record, or CCR, is a patient medical summary format managed by ASTM International. 

It represents a core data set of the most relevant facts about a patient’s health care. The CCR standard predates, and provided the clinical content model, for the Continuity of Care Document—which was created in 
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conjunction with HL7. The CCR has continued to evolve since the creation of the CCD, though the content of 

the two formats remains very similar. 

Medication content in the CCR is held in its Medications section, which is used to list and describe the 

patient’s current medications and pertinent medication history. According to the CCR implementation guide, 

“at a minimum, the currently active medications should be listed, with an entire Medication History as an 

option, particularly when the CCR is used for comprehensive data export.”

CCR Version

Meaningful Use rules allow use of the ASTM E2369 Standard Specification for Continuity of Care Record.

Continuity of Care Document (HL7 CCD)

The CCD is a patient summary format based on the clinical information contained in the Continuity of Care 

Record and the HL7 Clinical Document Architecture (CDA) electronic document structure. As such, it’s 

content is very similar to that of the CCR, though not identical—as the two standards have evolved since the 

creation of the CCD. 

CCR Version

Meaningful Use rules identify the following as the CCD version and implementation guidance: HITSP 

(Healthcare Information Technology Standards Panel) Summary Documents Using HL7 CCD Component 

HITSP/C32.

C. Integrating multiple source standards into medication reconciliation

Where the source standards are used

Each information source standard included in this review has the potential to be used in a range of clinical 

systems and to be available through multiple networks or other means. However, in today’s environment...

 the NCPDP Medication History transaction is typically used by insurance companies to share claimsbased medication information, and to a lesser extent, also used to retrieve dispensed drug 

information from pharmacies. It typically contains prescription medications dispensed by retail and 

mail service pharmacies for ambulatory patients, as well as a portion of medications dispensed for 

patients residing in long-term and post-acute care facilities (specifically, those medications paid by 

the patient’s Medicare Part D coverage or other commercial coverage)

 CCDs and CCRs are commonly used by electronic medical record systems to publish and receive 

patient clinical summaries, and CCRs have been commonly implemented by personal health record 

(PHR) systems. Depending on the source system, content may can reflect both inpatient and 

ambulatory care, and is not limited by the insurance or other means by which treatment was covered

 the Fill Status and Cancel messages used primarily in long-term and post-acute care settings today, 

exchanged between institutional pharmacies and facility electronic medical record systems. In the 

future, these may be adopted in ambulatory settings as well.

 the Census message is designed to be used only in long-term and post-acute care settings, sent by 

facilities to their partner long-term care pharmacies to notify them of patient admissions, changes, 

etc.
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Gathering source material for the medication reconciliation process

The graphic below illustrates electronic sources of information used during medication reconciliation, and the 

standards typically employed today.

Patient’s clinics, caregivers

Pharmacy network Long-term, post acute care Patient’s insurance / payers Hospital

PHR Medication History CCR or CCD

Clinician at the point of care

Pharmacy

Fill Status

Source information for medication reconciliation

Sources’ points of view reflected in the standards

The medication details conveyed by different sources may vary due to the source’s role and its relationship 

with the patient as well as the use of differing data exchange standards. For example, the clinic’s record may 

reflect the prescriber’s directions for use of the medication:

 Current medication started June 2010: Inderal (brand) 80mg by mouth daily for migraines

whereas the medication history will reflect the specific product dispensing events that were paid-for by the 

patient’s insurance plan:

 Propranolol (generic) 80mg tablet. Qty: 30. Dispensed Sep 30, July 30, June 15...

and a summary received from a hospital whose emergency department was visited by the patient may 

include only partial information gathered as part of a patient history:

 Current medication: propranolol.
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The resulting challenge for the clinician performing medication reconciliation using information received 

from multiple electronic sources is to align the various reports, “de-duplicating” where the same medication 

is reported in different ways, yet capturing aspects present in one source but not others. In the example 

above, for instance, once the receiving system associates the prescribed Inderal to the dispensed generic 

propranolol, the clinician might note that the patient isn’t getting their prescription filled as directed (as 

evidenced by the non-regular dispensing dates received from the patient’s insurance company). 

The illustration below reflects the perspectives typically reflected by users of the CCD, CCR, and claims-based 

Medication History standard.

Medications Dispensed per this clinician’s previous Rx’s only

Partial view... Problems Allergies Labs, Results Medications - Prescribed (prescription, samples, OTC) ...

CCR or CCD

Partial view... Problems Allergies Medications - Prescribed (prescription, samples, OTC) ...

CCR or CCD Medications - Dispensed (prescription, OTC? ) * May reflect generic / brand substitutions * Each dispensing event listed

Medication History

Local view... Problems Allergies Labs, Results Procedures Medications - Prescribed (prescription, samples, OTC) ...

Consolidated medication list Local med 1 : Dispense/claim (generic sub) Jan, Feb ... Local med 2 : [no dispensing reported] Local med 3 : Dispense/claim (w/gaps) Nov, Dec, Feb... Multivitamin : No claim info (not covered by insurance) Drug Allergies : From local chart and reported in CCD/CCR Emer. Dept med A : Dispensed Dec C Specialist med X : Dispenses/claims .... linician at the point of care Incorporate into local records

Fill Status

Consolidating medication information during med rec

Aligning medications from different sources

The first step in utilizing medication data from multiple sources is to determine which records in Source A

represent the same prescriptions reported in Source B. For example, clinical summaries from two 

practitioners that care for a patient may contain the same five medications, but might report them using 

different brand names or identifiers. And a claims-based medication history message might report those 

same five medications—but in the form of sixty separate dispensing events occurring during the year, using 

another set of identifiers.
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Key challenges when aligning information received via different standards are identified below.

- Coded drug identifiers are not always present

Not all standards require that a coded drug identifier accompany each drug’s textual description. Of 

the three standards reviewed here, only one—the C32 CCD—strictly requires coded drug identifiers, 

though even in that case it is allowable to use a coded form of “unknown” rather than an actual 

medication code.

While not required in the NCPDP Medication History, data sources typically include NDC codes for 

dispensed medications (but note that the Medication History message is not covered under current 

Meaningful Use rules and its RxNorm requirement). Drug codes are optional in the ASTM CCR.

- Different drug identifiers are used

Even if two sources both include coded drug identifiers, they may not be from the same code system.

For example, the clinician may receive a Medication History containing NDC codes but no RxNorm 

identifiers, and a CCD containing the opposite: RxNorm IDs but no NDCs. When no identifiers are

present in one or more sources, matching must rely on text string comparisons (typically with manual 

actions by the clinician using the system). If different code systems are used, translation may be 

possible, though results will be less reliable due to gaps and “shading differences” between code 

systems, and human review will be more critical. Below are the drug coding systems required or most 

typically used in the three standards being reviewed here.

NCPDP Medication History. Traditionally, implementers of the NCPDP medication history have used 

the NDC 11 code of the dispensed product as the sole drug identifier in the message, and today that 

is still the case. However, it is expected that the RxNorm terminology will start to be used as 

implementers move to the 10.6 version of the standard and take steps to support federal Meaningful 

Use requirements for use of RxNorm in the New Prescription message. NDC 11 codes will likely 

continue to be included while the industry moves to add RxNorm to the messages, and potentially 

even after RxNorm is adopted—for the purpose of identifying the particular packaged products 

dispensed.

C32 CCD. The C32 CCD specification requires that medication references include a coded value. When 

the reference is to a prescribing-level brand or generic drug, RxNorm is to be used. Meaningful Use 

rules further require a RxNorm code to be present. If also specifying a particular packaged product 

(e.g., 30 tablet bottle of drug A), the NDC is to be used. 

ASTM CCR. Use of coded drug identifiers is optional, with RxNorm recommended, and NDC codes 

allowed.

- Prescribed versus dispensed medications

As noted above, one challenge in integrating medication information from the three formats 

discussed above is that the SCRIPT Medication History reflects medication products that have been 

dispensed by a pharmacy, while the CCD and CCR primarily represent current medications ordered by 

a clinician, and optionally historical medications reported by the patient or another provider. 
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When integrating information from a Medication History and a CCD or CCR, the receiver matches the 

ordered medications to the related dispensing event(s), and must be careful not to “double count” 

medications present in both sources. In addition, there may be differences in how a given medication 

is reported between the order and dispensing event, including:

 brand versus generic—for example if a branded medication is ordered but fulfilled using a 

generic substitute

 strength / quantity—for example if the order specifies “30 tablets. Take 1 20mg tablet daily” 

and the pharmacy dispenses 60 10mg tablets instead, with patient instructions to take 2 

10mg tablets daily

 multiple dispensing events for a single order—for example where a maintenance medication 

is dispensed twelve times per year based on a single order, potentially with generic/brand 

differences or strength/quantity differences between dispensing events.

- Active versus inactive medications

A reference to a patient medication in any of the standards does not by itself indicate whether the 

patient is actually taking the drug in compliance with the prescriber’s directions. However, the CCD 

and CCR both enable a source to indicate whether a medication is currently being taken, whereas the 

NCPDP Medication History does not.

 A claims-based Medication History message as implemented by industry stakeholders today 

does not contain any direct indication of whether the patient is still taking a medication, 

though information about the patient’s compliance may be surmised by the presence or 

absence of dispensing records for a medication. For example, if a daily medication has been 

dispensed on an irregular basis, it may indicate that the patient isn’t taking it as directed.

 The C32 CCD requires start and stop dates for medications, indicating whether the patient is 

currently taking the medication.

 While not required, the CCR enables a medication’s status to be specified (Active, On Hold, 

Prior History No Longer Active) as well as start and stop dates.

- Over the counter (OTC) products, inpatient medications, and patient-reported drugs

The three standards differ in the types of medications they report—based on the roles of the entities 

that use each standard. In addition, the underlying sources differ as well, with clinic-based summaries 

and personal health records containing patient-reported medications.

 Medications reported in NCPDP Medication History messages consist typically include only

prescription drugs covered by the patient’s insurance drug plan. Over the counter products, 

which are ordinarily paid for by the patient, are rarely included. And medications 

administered during inpatient care (including the initial period of nursing home or post-acute 

facility care) are not included either—as they are paid for by the patient’s medical benefit 

rather than the pharmaceutical aspect of their health plan.

 CCD or CCR clinical summaries sourced from care providers may contain over the counter 

products and medications associated with inpatient care. Patient-reported medications (e.g., 
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taken as part of a patient history) may also be included. The amount and reliability of coded 

content for such information may vary in specificity and accuracy.

 Personal health records may contain products not included in either clinic-based or claimsbased sources, such as vitamins, herbals, or other over the counter products not prescribed 

by a clinician. Coded identifiers for such content is unlikely to be present.

Incorporating other clinical information from the CCD, CCR or medication history into the process

In addition to the drugs themselves, the CCD and CCR have the ability to convey additional clinical 

information critical during medication reconciliation—such as the diagnosis or indication for which the 

medication was prescribed, other patient conditions, and patient allergies or other alerts. In comparison, the 

NCPDP Medication History message has very limited support for other clinical information, which is rarely 

used today.

Using this information effectively in drug interaction checks such as for...

- Drug allergies 

- Drug to drug interactions

- Duplicate therapy

depends in large part on whether the information is codified in a manner understandable to the e-prescribing 

system or other system being use for medication reconciliation. Each of the three standards supports 

codification of drug and allergy content, but with some differences in the coded terminologies used and the 

extent to which that codification is required. Required vocabulary standards in Meaningful Use apply in some 

but not cases—for example, the Medication History message is not covered by current MU rules—and so the 

system supporting med rec will typically need to deal with content that has no coded representation as well 

as cases where sources both provide coded content, but reflecting different code sets.

Below is a brief summary of how clinical content is represented in the analyzed standards. Additional 

examples and comparisons will follow in other sections.

- Diagnosis or indication

While diagnosis / indication information can be conveyed in all three standards, today it is typically 

only included in the CCD and CCR clinical summaries. 

 The clinical summary standards, CCD and CCR, typically contain patient conditions. However, 

coded diagnoses are optional. The CCD specifies that SNOMED codes should be used, but 

allows other terminologies through translation code. The CCR recommends SNOMED and 

ICD-9 codes.

 The NCPDP Medication History includes elements for identification of a primary and 

secondary diagnosis related to each medication using ICD-9, ICD-10, SNOMED, First 

Databank, Micromedex or Medispan codes. This content is rarely included in the message, 

however. (Note that when diagnoses are included in the NCPDP New Prescription message, 

the ICD-9 code set is typically used.)
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- Patient allergies

The three standards differ in the level of support for patient allergies and intolerances, and the codes 

used to identify them.

 The NCPDP Medication History has no support for patient allergies.

 The NCPDP New Prescription message can include an allergy-related interaction considered 

while prescribing the medication. 

 The C32 CCD requires start and stop dates for medications, indicating whether the patient is 

currently taking the medication.

 While not required, the CCR enables a medication’s status to be specified (Active, On Hold, 

Prior History No Longer Active) as well as start and stop dates.

D. Output flow: Conveying the results of med rec to other parties

The process of medication reconciliation doesn’t stop after the clinician learns of the patient’s current 

medications and other clinical information, but instead continues into the prescribing of continued or new 

medications and the canceling of medications no longer needed. In addition, the patient information gained 

during medication reconciliation may be forwarded to other providers who will take part in the patient’s 

care.

Below are messages from the SCRIPT 10.6 standard into which medication and related clinical information 

gained from medication reconciliation may be conveyed to other parties. Following the graphic is a brief 

identification of the types of information supported by each message, and a later section analyzes more fully 

how clinical information is represented in the SCRIPT standard.
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Med Rec Process

Medication History

Retail Pharmacy

Mail Pharmacy

LTPAC Pharmacy

New Prescription

Fill Status *

CCR

CCD Census

Cancel Prescription *

* Note: Adoption of Fill Status and Cancel Prescription is currently limited to the long-term and post-acute care settings - New Prescription

In addition to carrying prescribed medication details, the NEWRX can also convey related clinical 

information to the pharmacy, including:

 the diagnosis for which the prescription was written

 one or more clinical observations related to the prescription or dosing

 clinical alerts that arose and were considered by the prescriber, including relevant allergies or 

intolerances, or potential drug conflicts.

Also, the Structured Sig segment in the message allows for an indication to be incorporated into the 

coded directions—for example to indicate that the medication should be taken when an observation 

reading exceeds a particular value.

- Cancel Prescription

The Cancel Prescription message serves the single purpose of canceling a previously-transmitted 

prescription. As such, it simply “echoes” the medication, prescriber and pharmacy information 

previously included in the New Prescription, with direction to either discontinue refills on an active 

prescription, or to cancel a prescription that has not yet been dispensed. 

- Census

The Census message is used in long-term and post-acute settings to notify partner pharmacies of 

resident patient admissions, discharges and other census events. It also contains sections in which 

patient problem and allergy profiles can be shared.
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E. High-Level Illustration of Content Differences

The graphic below provides a very high-level comparison of medication, adverse reaction and diagnosis 

content in the reviewed standards. As the picture illustrates, there are areas of both consistency and 

inconsistency between the standards, with regard to the types of information conveyed, the level of coded 

information, and the terminology used.

These comparisons are detailed further in later sections of the analysis.
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High-level illustration of content in CCR, CCD, and related NCPDP messages

 

Medication History

Problem Opt: Indication for Rx: ICD-9, 10

Adverse reaction

Prescribed Med

Opt: Prescriber Name, IDs Med details

Dispensed Med

Text: Name, strength, form Dispense dates

Pharmacy ID, Opt: name Qty dispensed

Text: Directions Opt: Coded directions

Opt med code: NDC, RxNorm

Opt coded strength, dose form, units: NCI FDA

Observations Alerts

New Prescription

Problem Opt: Indication for Rx: ICD-9, 10

Adverse 

reaction

Opt: Alerts (interaction or 

intolerance, severity, response): 

text and proprietary codes

Prescribed Med

Prescriber Name, NPI Prescribed date

Text: Name, strength, form Qty, num refills

Text: Directions Coded qty units: NCIt

Opt: Coded directions (SNOMED CT, NCI FDA)

Opt med code: NDC, RxNorm

Opt coded strength, dose form: NCI FDA

Opt: Observations (SNOMED CT, LOINC, NCI)

Problem Observation

Rx 

Conflict

Adverse 

Reaction

Prescribed 

Medication Directions

Dispensed 

Medication Directions

Text Code Text Code Txt/Cd Text Code Text Code Text Code Text Code Text Code

CCD

S,I S, 

R,D,U

R, 

N,U,D SFP~

R 

SFP

CCR

S,I,P,~ S,R,P,~ R,N,~ SF~ R,N,~ SF~

Med 

History I

N,R S,F Indication for Rx

NewRx

I

S,L,F

R,P

N,R,F S,F

n/a n/a n/a n/a

 Related to this Rx only

Census

S,I

S,R,D,U

Req’d Req’d w/ 

exceptions

Opt. / industry 

requires Opt. Opt. / rare Not supported

S=SNOMED CT, I=ICD9/10, L=LOINC, F= NCI FDA, D=NDF-RT, U=UNII, N=NDC, R=RxNorm, P=Proprietary, ~=Unspecified

 C32 CCD

Problem

Diagnosis and related info: SNOMED, ICD-9/10

Adverse reaction

Alert and related: SNOMED, RxNorm, other

Prescribed Med

Text medication name, 

strength, form, directions

RxNorm, opt 

NDC 

Opt: Prescriber

Name, IDs

Opt coded med, direction: 

SNOMED, NCI FDA

Dispensed Med

Opt pharmacy name, dates, qty, med details

Results Procedures Other Clinical

 CCR

Problem

Diagnosis and related info: SNOMED, ICD-9/10

Adverse reaction

Alert and related: SNOMED, RxNorm, other

Prescribed Med

Text medication name, 

strength, form, directions

RxNorm, opt 

NDC 

Opt: Prescriber

Name, IDs

Opt coded med, direction: 

SNOMED, NCI FDA

Dispensed Med

Opt pharmacy name, dates, qty, med details

Results Procedures Other Clinical
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F. Assessed Scenario Overview

This analysis uses the following scenarios as a basis for comparing the three standards. While somewhat 

unlikely given the current level of adoption of electronic health records, each of these scenarios include 

exchange of the NCPDP Medication History, C32 CCD, and ASTM CCR standards—in order to enable 

comparison between them. 

The first scenario is the basis for comparing historical medication information as it might be conveyed in the 

three reviewed standards. An example Medication History, CCD and CCR were created based on the same 

real-world information, but using the elements and codes of each standard. The examples include optional 

content included in the standards but not necessarily commonly used. This applies especially to the 

Medication History message, for which the example message contains coded content rarely populated today.

The second scenario illustrates the similarities and differences in representation of diagnosis and adverse 

event information between the CCD, CCR, and NCPDP Census message. This scenario also points out that is 

can be problematic for the receiver of an NCPDP Medication History message to infer the condition for which 

a drug has been dispensed; diagnosis information from a CCD or CCR coming from the patient’s physician or 

other provider is needed to clarify the reason the patient is taking a medication that has multiple clinical 

uses.

Scenario Description

Standards 

Used Topics

1 New patient 

with 

inconsistent 

compliance 

with 

maintenance 

medication

A patient is seen a physician office complaining of 

headaches. The patient is new to this physician so he 

reviews her clinical summary as received from her 

referring physician, and also orders a medication 

history from her payer. He assesses the profile and 

notes that the patient is hypertensive and appears to 

be non-compliant with her medications--her 

medication has not been picked up on a regular 30-

day basis. The patient indicates that she has a hard 

time in remembering to take her medication. 

The prescriber orders a prescription for the patient’s 

medication, but changes the dose to a single daily 

dose in the morning.

Patient 

profile from 

the referring 

physician (for 

analysis, in 

both CCD 

and CCR 

forms)

Medication 

History 

New 

Prescription 

Fill Status

EMR-based CCD 

contains 

prescribed 

information only, 

while NCPDP 

Medication 

History contains 

only dispensed 

drug information. 

Differences in 

terminology and 

element details
© 1st American Systems and Services LLC Page 19 of 93 Standards Compatibility in Medication Reconciliation

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Scenario Description

Standards 

Used Topics

2 Patient taking 

medications 

that can 

prescribed for 

different 

medical 

conditions—

increasing the 

need for 

diagnosis / 

indication 

information 

A patient arrives at an emergency department in a 

semi-conscious state. Claims-based medication 

history is retrieved from the patient’s insurance 

company—but the indications for the patient’s 

medications is not apparent, since the drugs are used 

to treat several different conditions, and the 

Medication History message typically does not 

include diagnosis information. However, staff are 

able to retrieve clinical summary information from 

the patient’s primary care physician through a statebased health information exchange (in a CCD) and the 

patient’s companion also provides access to a 

patient-maintained personal health record, which is 

retrieved as a CCR. 

CCD from 

primary care 

physician, 

CCR from 

PHR, 

Medication 

History from 

payer, 

Census 

message 

containing 

allergies sent 

to LTC 

pharmacy

Claims-based 

Medication 

History does not 

contain diagnosis 

information 

needed to 

determine the 

clinical purpose 

for medications it 

contains. 

Information from 

other clinical 

summaries is 

needed to create 

the full picture

Key content from these example messages / documents is compared in the next section. The full contents are 

included in the appendices and attached as separate files.

 Scenario One:

o Scen_1_Med_Hist_Response.xml

 Claims based medication history retrieved from the patient’s insurance company

o Scen_1_CCD.xml

 Clinical summary from a provider

o Scen_1_CCR.xml

 Clinical summary from a provider

o Scen_1_NewRx.xml

 Continued medication, with a change to once-daily administration based on a 

recognition that the patient was not compliant with the previous twice-daily regime

o Scen_1_FillStatus.xml

 Fill status sent by the pharmacy, indicating that the patient didn’t pick up the 

continued medication order and that it was returned to stock

 Scenario Two:

o Scen_2_Med_Hist_Response.xml

 Claims based medication history, which lacks the diagnosis information needed to 

determine the conditions being treated with the medications dispensed

o Scen_2_CCD.xml

 Clinical summary from a provider

o Scen_2_CCR.xml

 Clinical summary from a provider

o Scen_2_Census.xml

 Forwards the adverse event and diagnosis information to a long-term care pharmacy
© 1st American Systems and Services LLC Page 20 of 93 Standards Compatibility in Medication Reconciliation

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G. Scenario Content Summary

The table below highlights which content is supported and typically available in each standard, with required content bolded, content typically included set in 

plain text, and optional content in grey italics. Code values and terminology is also compared. (A more thorough review of terminologies follows in a later 

section.) 

Standards Compatibility Scenarios

NCPDP Med. History (RxHistoryResponse) C32 CCD ASTM CCR

Claims-based medication history from the 

patient’s insurance company

Clinical summary from 

thereferring physician

Clinical summary from 

thereferring physician 

(alternative format--

for comparison)

Patient profile

Problems, diagnoses Hypertension. 

9/27/2010 to 

present

Type: Disorder: 

SNOMED 64572001

Hypertension

SNOMED: 59621000

ICD9: 401.9

not supported

Type: Disorder: 

SNOMED 64572001 

HYPERTENSION 

[OPT: SNOMED: 

59621000

| ICD9: 401.9

[OPT: Type: Disorder | 

CCR code: 'Condition ']

HYPERTENSION 

[OPT: SNOMED: 

59621000

| ICD9: 401.9

Headaches 

1/1/2010 to 

10/31/2010. ICD9: 

784.0 Headache

SNOMED: 230461009 

Headache

Reduced severity after 

once-daily treatment 

started

not supported

Type: Disorder: 

SNOMED 64572001

HEADACHE 

[OPT: SNOMED: 

230461009

| ICD9: 784.0] 

[OPT: Type: Disorder | 

CCR code: 'Condition ']

HEADACHE 

[OPT: SNOMED: 

230461009

| ICD9: 784.0] 

Adverse Reactions Diarrhea 

associated with 

use of ACE 

inhibitor. Minor 

and deemed 

tolerable. Agent: 

Angiotensinconverting 

Enzyme Inhibitors 

(NDF-RT NUI: 

N0000000181)

Adverse Event: 

SNOMED: 59037007 

Intolerance to a drug. 

(NCPDP qualifier "LD")

Reaction: SNOMED: 

128333008 Diarrheal 

disorder

Severity: SNOMED 

371923003 Mild to 

Moderate

not supported

Type: INTOLERANCE TO 

A DRUG

| SNOMED 59037007

Agent: ndf-rt: 

N0000000181

Reaction: SNOMED: 

128333008 Diarrheal 

disorder

Severity: SNOMED 

371923003 Mild to 

moderate

Type: INTOLERANCE TO 

A DRUG

| SNOMED 59037007

Agent: ndf-rt: 

N0000000181

Reaction: SNOMED: 

128333008 Diarrheal 

disorder

Severity: SNOMED 

371923003 Mild to 

moderate

Scenario 1. New patient with inconsistent 

compliance with maintenance medication

SCRIPT message content in postreconciliation messagesStandard-specific clinical summary content

Raw information content

Key: BOLD CAPS= Always present

 Regular: Typically present. 

 Grey italic: Optional, not always or seldom present
© 1st American Systems and Services LLC Page 21 of 93 Standards Compatibility in Medication Reconciliation

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NCPDP Med. History (RxHistoryResponse) C32 CCD ASTM CCR

Medications

1. Vasotec (Enalapril Maleate)

Drug description Vasotec 5mg twice 

daily

If brand dispensed: VASOTEC 5 MG TABLET

If generic: ENALAPRIL MALEATE 5 MG 

TABLET

Product Name: 

ENALAPRIL MALEATE 5 

MG TABLET

Brand Name: Vasotec 5 

mg Tablet

Product Name: 

ENALAPRIL MALEATE 5 

MG TABLET

[OPT: Brand Name: 

Vasotec 5 mg Tablet]

Changed to once 

/ day 

ENALAPRIL MALEATE 10 MG 

TABLET

Coded medication Branded:

Enalapril Maleate 

5mg oral tablet 

(Vasotec name 

RxCUI = 224921)

RxN SBD: 858815

NDC: 00247057830

Generic:

Enalapril Maleate 5mg 

oral tablet 

RxN SBD: 858815

RxN SCD: 858813

NDC: 21695048730

NDC opt. but present by industry 

convention

BRAND: 00247057830 

OR GENERIC: 21695048730

[RxNorm optional, but rarely included 

today: SBD | 858815 or SCD | 858813]

RxNorm (required for 

MU): 

GENERIC: SCD | 858813

Brand: SBD | 858815

[Opt: NDC: 

21695048730 AND/OR 

00247057830]

RxNorm (required for 

MU): 

GENERIC: SCD | 858813

[OPT: Brand: SBD | 

858815]

[Opt: NDC: 

21695048730 AND/OR 

00247057830]

Enalapril 

Maleate 10mg 

oral tablet

SCD: 858817

NDC: 

21695048830

NDC | 21695048830

[OPT: SCD | 858817]

Coded strength NCI C28253 (mg) [OPT: NCI: C28253] [Strength units not 

codified]

[OPT: SNOMED: 

258684004 ]

[OPT: 

NCI: C28253]

Coded dose form NCI C42998 

(tablet)

[OPT: NCI: C42998] [OPT: NCI: C42998] [OPT: SNOMED: 

385055001 ]

[OPT: 

NCI: C42998]

Indication / diagnosis Hypertension

SNOMED: 

59621000 

Essential 

hypertension

ICD9: 401.9 

Hypertension, 

Unspecified

[OPT: ICD9 | 401.9 (rarely used)] [OPT: SNOMED 

59621000]

[OPT: 

SNOMED 59621000

ICD9 | 401.9 ]

[OPT: ICD9 401.9]

Secondary 

Indication / 

diagnosis

Headache

+A4 (disorder)

ICD9: 784.0 Headache [OPT: ICD9 | 784.0 (rarely used)] [OPT: SNOMED 

230461009]

[OPT: 

SNOMED 230461009

ICD9 | 784.0 ]

[OPT: ICD9 784.0]

TAKE 1 TABLET 

TWICE DAILY

TAKE 1 TABLET TWICE DAILY [OPT: take 1 tablet 

twice daily]

[OPT: take 1 tablet 

twice daily]

TAKE ONE TABLET DAILY

Delivery Method TAKE | SNOMED: 

419652001 

[OPT (rarely used): TAKE | SNOMED: 

419652001] not supported [OPT : TAKE | SNOMED: 419652001] 

[OPT: TAKE | SNOMED: 

419652001] 

Dose / Unit of 

Administration

NCI unit of 

presentation: 

C48542 (tablet)

NCI pharmaceutical 

dosage form: C42998 

(tablet)

[OPT (rarely used): TABLET | NCI NCPDP 

Strength Form (Pharmaceutical Dosage 

Form): C42998] 

[OPT: NCI unit of 

presentation - name 

only {Tablet}]

[OPT: TABLET | NCI: 

Pharmaceutical 

Dosage Form C42998] 

[OPT: NCI Unit of Presentation: 

C42998] 

Route of 

Administration

Swallow, oral NCI: 

C38288

BY MOUTH, 

SNOMED: 

26643006 

[OPT (rarely used): SNOMED: 26643006 ] [OPT: Oral 

NCI FDA: C38288]

[OPT: SNOMED: 

26643006 ] 

[OPT: SNOMED: 26643006 ] 

Administration 

Timing Time Period

2 per DAY | 

SNOMED: 

258703001

[OPT (rarely used): DAY | SNOMED: 

258703001] 

[OPT: DAY | 

PIVL_TS period: 'd']

[OPT: DAY | SNOMED: 

258703001] 

[OPT: DAY | SNOMED: 

258703001] 

NCPDP New Prescription (NewRx) 

Rx continued after med rec event... differs in 

Profile Medication some respects from profile med

Raw information content

Administration 

directions (sig)

Codified administration directions
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NCPDP Med. History (RxHistoryResponse) C32 CCD ASTM CCR

Medications

1. Vasotec (Enalapril Maleate)

Mild diarrhea; side 

effect of ACE 

inhibitors. Agent: 

Angiotensinconverting 

Enzyme Inhibitors 

(NDF-RT )

NUI: N0000000181

Adverse Event: 

SNOMED: 59037007 

Intolerance to a drug. 

(NCPDP qualifier "LD")

Reaction: SNOMED: 

128333008 Diarrheal 

disorder

Severity: SNOMED 

371923003 Mild to 

Moderate

[OPT (Rarely used):

AR (Adverse drug reaction);

MB (Overriding benefit - outweighs the 

risks);

4A (Prescribed anyway);

38 | 858817 (SCD for enalapril 10 mg);

3 (minor clinical significance)

"TOLERABLE DIARRHEA SIDE EFFECT OF ACE 

INHIBITOR"

not supported not supported

SCRIPT does not 

support NDF-RT 

in this element 

(options are 

RxNorm or 

NDC). 

Co-AgentID: 

SCD | 858817

Enalapril 

Maleate 10mg 

oral tablet

[OPT: 

AR (Adverse drug reaction);

MB (Overriding benefit - 

outweighs the risks);

4A (Prescribed anyway);

38 | 858817 (SCD for enalapril 

10 mg);

3 (minor clinical significance)

"TOLERABLE DIARRHEA SIDE 

EFFECT OF ACE INHIBITOR"

Quantity prescribed 60 not supported 60 [OPT: 60] 30

Coded quantity 

unit of measure

NCI unit of 

presentation: 

C48542 (tablet)

NCI pharmaceutical 

dosage form: C42998 

(tablet)

not supported

NCI pharmaceutical 

dosage form: C42998 

(tablet)

[OPT: NCI unit of 

presentation: C48542 

(tablet)]

NCI UNIT OF PRESENTATION: 

TABLET | C48542

Refills allowed 2 [OPT: 2] [OPT: 2] [OPT: 2] 1

Prescribed date 2010-09-27 and 

2010-12-29

[OPT: 2010-09-27 and 2010-12-29 (reported 

with associated dispense events]

[OPT: 2010-09-27+] [OPT: 2010-09-27+] 2011-03-24T16:01:20

Prescribing 

clinician

MICHAEL PETER 

BALZARY, 

NPI9999999, 

DEA999999, 

LIC99999

CORCORAN CLINIC, 500 

SEVENTEENTH ST NW, 

WASHINGTON DC

20006

PH: 2026391800

FAX: 2026391800

[OPT: MICHAEL PETER BALZARY | 

NPI9999999 | DEA999999 | LIC99999 

|CORCORAN CLINIC, 500 SEVENTEENTH ST 

NW, WASHINGTON DC

20006, PH | 2026391800,

FAX | 2026391800]

[OPT: MICHAEL PETER 

BALZARY ...]

[OPT: MICHAEL PETER 

BALZARY ...]

DR ANNA-KATHERINE HARTLEY

NPI1010101

[OPT: DEA101010, LIC101010, 

CORCORAN CLINIC] 

500 SEVENTEENTH ST NW, 

WASHINGTON DC 20006, PH | 

2026391800

[OPT: FAX | 2026391800]

2010-09-27 until 

instructed to stop not supported 2010-09+ [OPT: 2010-09+] N/A

Drug status (e.g., 

Active, on-hold...

Active

not supported

Active [OPT: Active]

N/A

Dispensed date 2010-09-30, 2010-

11-15, 2011-01-03, 

2011-02-01

[OPT: 2010-09-30, 2010-11-15, 2011-01-03, 

2011-02-01] 

[OPT: 2010-09-30, 2010-

11-15, 2011-01-03, 2011-

02-01] 

[OPT: 2010-09-30, 2010-

11-15, 2011-01-03, 2011-

02-01] 

N/A

Dispensing 

pharmacy

PHILLIPS 

PHARMACY

NCPDP03

NPI3300330

DEA330033

PHILLIPS PHARMACY

NCPDP03... (optional but included by 

industry convention)

[OPT: PHILLIPS 

PHARMACY]

[OPT: PHILLIPS 

PHARMACY] N/A

Quantity dispensed 30 [OPT: 60] [OPT: 60] not supported N/A

Coded quantity 

unit of measure

NCI: C48542 

(tablet)

[OPT: NCI: AC | C48542] [NCI pharmaceutical 

dosage form: C42998 

(tablet)]

not supported N/A

NCPDP New Prescription (NewRx) 

Rx continued after med rec event... differs in 

Profile Medication some respects from profile med

Raw information content

Administration start / 

end

Interactions or 

conflicts
© 1st American Systems and Services LLC Page 23 of 93 Standards Compatibility in Medication Reconciliation

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NCPDP Med. History (RxHistoryResponse) C32 CCD ASTM CCR

2. Multigen Plus (multivitamin)

Drug description Multigen Plus

Over-the-counter (non-prescription) 

products are typically not included in 

claims-based medication history

Product Name: 

CALCIUM ASCORBATE 

60 MG / CALCIUM 

THREONATE 0.8 MG / 

FERROUS ASPARTO 

GLYCINATE 50 MG / 

FERROUS FUMARATE 

101 MG / FOLIC ACID 1 

MG / SUCCINIC ACID 50 

MG / VITAMIN B 12 

0.01 MG ORAL TABLET

Brand Name: Multigen 

Plus

Product Name: 

CALCIUM ASCORBATE 

60 MG / CALCIUM 

THREONATE 0.8 MG / 

FERROUS ASPARTO 

GLYCINATE 50 MG / 

FERROUS FUMARATE 

101 MG / FOLIC ACID 1 

MG / SUCCINIC ACID 50 

MG / VITAMIN B 12 

0.01 MG ORAL TABLET

[OPT: Brand Name: 

Multigen Plus]

Multigen Plus

Coded medication RxNorm SCD: 

802503 

SBD: 802748

NDC: Brand: 

10267349400

RxNorm (required for 

MU): 

GENERIC: SCD | 802503

Brand: SBD | 802748

[Opt: NDC: Brand 

(generic not 

commercially avail.) 

10267349400]

RxNorm (required for 

MU): 

GENERIC: SCD | 802503

[OPT: Brand: SBD | 

802747]

[Opt: NDC: 

10267349400]

Continued with 

same product

NDC | 10267349400

[OPT: SBD | 802748]

Coded strength NCI: C28253 (mg) strength not stated for 

this multi-ingredient 

product

strength not stated for 

this multi-ingredient 

product

[OPT: AB | C28253 (mg)]

Coded dose form NCI: C42998 

(tablet)

[OPT: NCI: C42998] [OPT: SNOMED: 

385055001 ]

[OPT; AA | C42998 (tablet)]

Indication / diagnosis n/a [OPT: SNOMED 

59621000]

[OPT: 

SNOMED 59621000

ICD9 | 401.9 ]

N/A

Secondary 

Indication / 

diagnosis

n/a [OPT: SNOMED 

230461009]

[OPT: 

SNOMED 230461009

ICD9 | 784.0 ]

N/A

TAKE ONE TABLET 

DAILY

[OPT: take 1 tablet 

twice daily]

[OPT: take 1 tablet 

twice daily]

TAKE ONE TABLET DAILY

Delivery Method TAKE | SNOMED: 

419652001 

not supported [OPT : TAKE | 

SNOMED: 419652001] 

[OPT: TAKE | SNOMED: 

419652001] 

Dose / Unit of 

Administration

NCI Unit of 

Presentation: 

C48542 (tablet)

NCI Pharmaceutical 

Dosage Form: C42998 

(tablet)

[OPT: NCI unit of 

presentation - name 

only {Tablet}]

[OPT: TABLET | NCI: 

Pharmaceutical 

Dosage Form C42998] 

[OPT: NCI Pharmaceutical 

Dosage Form: C42998] 

Profile Medication Continued Medication

Raw information content

Administration 

directions (sig)

Codified administration directions
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NCPDP Med. History (RxHistoryResponse) C32 CCD ASTM CCR

2. Multigen Plus (multivitamin)

Route of 

Administration

Swallow, oral NCI: 

C38288

BY MOUTH, 

SNOMED: 

26643006 

[OPT: Oral 

NCI FDA: C38288]

[OPT: SNOMED: 

26643006 ] 

[OPT: SNOMED: 26643006 ] 

Administration 

Timing Time Period

1 per DAY | 

SNOMED: 

258703001

[OPT: DAY | 

PIVL_TS period: 'd']

[OPT: DAY | SNOMED: 

258703001] 

[OPT: DAY | SNOMED: 

258703001] 

None

not supported not supported

Quantity prescribed 120 120 [OPT: 120] 90

Coded quantity 

unit of measure

NCI Unit of 

Presentation: 

C48542 (tablet)

NCI Pharmaceutical 

Dosage Form: C42998 

(tablet)

NCI pharmaceutical 

dosage form: C42998 

(tablet)

[OPT: NCI unit of 

presentation: C48542 

(tablet)]

NCI Unit of Presentation: 

C448542

Refills allowed 12 [OPT: 1] [OPT: 1] 12

Prescribed date 4/1/2010 [OPT: 2010-09-27+] [OPT: 2010-09-27+] 2011-03-24T16:01:20

Prescribing 

clinician

MICHAEL PETER 

BALZARY, 

NPI9999999, 

DEA999999, 

LIC99999

CORCORAN CLINIC, 500 

SEVENTEENTH ST NW, 

WASHINGTON DC

20006

PH: 2026391800

FAX: 2026391800

[OPT: MICHAEL PETER 

BALZARY ...]

[OPT: MICHAEL PETER 

BALZARY ...]

DR ANNA-KATHERINE HARTLEY

NPI1010101

[OPT: DEA101010, LIC101010, 

CORCORAN CLINIC] 

500 SEVENTEENTH ST NW, 

WASHINGTON DC 20006, PH | 

2026391800

[OPT: FAX | 2026391800]

2010-04-01 until 

instructed to stop

2010-04+ [OPT: 2010-04+]

N/A

Drug status (e.g., 

Active, on-hold, 

prior history / no 

longer active)

Active Active [OPT: Active]

N/A

Dispensed date 2010-04-01, 2010-

08-01, 2010-12-01

[OPT: 2010-04-01, 2010-

08-01, 2010-12-01] 

[OPT: 2010-04-01, 2010-

08-01, 2010-12-01] N/A

Dispensing 

pharmacy

PHILLIPS 

PHARMACY

NCPDP03

NPI3300330

DEA330033

1600 21ST ST NW

WASHINGTON DC

20009-1090, PH: 

2023872151X238

FAX: 2023872436

[OPT: PHILLIPS 

PHARMACY]

[OPT: PHILLIPS 

PHARMACY]

N/A

Quantity dispensed 120 each dispense [OPT: 120] not supported N/A

Coded quantity 

unit of measure

NCI Unit of 

Presentation: 

C48542 (tablet)

NCI Pharmaceutical 

Dosage Form: C42998 

(tablet)

[NCI pharmaceutical 

dosage form: C42998 

(tablet)]

not supported N/A

Profile Medication Continued Medication

Raw information content

Administration start 

/ end

Interactions or 

conflicts
© 1st American Systems and Services LLC Page 25 of 93 Standards Compatibility in Medication Reconciliation

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NCPDP Med. History (RxHistoryResponse) C32 CCD ASTM CCR

Claims-based medication history from the 

patient’s insurance company

Patient’s primary care 

physician through a 

state-based Health 

Information Exchange

Patient-maintained 

personal health record 

(PHR)

Patient profile

Problems, diagnoses Migraine 

diagnosed 2009-12-

20

SNOMED PLS: 37796009 

Migraine

ICD9: 346.0 Migraine 

with aura not supported

Type: Disorder: 

SNOMED 64572001 

MIGRAINE 

[OPT: SNOMED: 

37796009

| ICD9: 346.0

[OPT: Type: Disorder | 

CCR code: 'Condition ']

MIGRAINE 

[OPT: SNOMED: 

37796009

| ICD9: 346.0

Depression 

diagnosed 2010-09-

10

SNOMED PLS: 18818009 

Moderate Recurrent 

Major Depression

ICD9: 296.3 Major 

Depression, recurrent 

episode

not supported

Type: Disorder: 

SNOMED 64572001

MODERATE 

RECURRENT MAJOR 

DEPRESSION 

[OPT: SNOMED: 

18818009

| ICD9: 296.3] 

[OPT: Type: Disorder | 

CCR code: 'Condition ']

MODERATE 

RECURRENT MAJOR 

DEPRESSION 

[OPT: SNOMED: 

18818009

| ICD9: 296.3] 

Adverse Reactions Food allergy. 

Agent: Peanut | 

UNII: QE1QX6B99R

Identified 1952-01-

02

Adverse Event: 

SNOMED: 414285001 

Allergy to a food. 

Reaction: ANAPHYLAXIS 

SNOMED: 91941002 

Severity: SNOMED 

371924009 Moderate to 

Severe

not supported

Type: INTOLERANCE TO 

A FOOD

| SNOMED 414285001

Agent: UNII: 

QE1QX6B99R

Reaction: SNOMED: 

91941002 Anaphylaxis

Severity: SNOMED 

371924009 Moderate to 

severe

Type: INTOLERANCE TO 

A FOOD

| SNOMED 414285001

Agent: UNII: 

QE1QX6B99R

Reaction: SNOMED: 

91941002 Anaphylaxis

Severity: SNOMED 

371924009 Moderate to 

severe

SNOMED PLS: 37796009 MIGRAINE

Effective Date: 2009-12-20

SNOMED: 18818009 MODERATE RECURRENT 

MAJOR DEPRESSION

Effective Date: 2010-09-10

SNOMED: 414285001 Allergy to a food. PEANUT | 

UNII Code: QE1QX6B99R

Reaction: ANAPHYLAXIS SNOMED: 91941002 

Severity: SNOMED 371924009 Moderate to 

Severe

Effective Date: 1952-01-02

Scenario 2. Patient taking medications that 

can prescribed for different medical 

conditions--increasing the need for diagnosis 

/ indication information

Raw information content

NCPDP Census (LTPAC settings only)

Information forwarded to a long-term care 

pharmacy upon subsequent admission to a 

nursing facility
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Medications

1. Bupropion (brand: Budeprion)

Drug description 12 HR Bupropion 

Hydrochloride 100 

MG Extended 

Release Tablet 

[Budeprion]

Note: Bupropion is used 

as an antidepressant as 

well as for smoking 

cessation. This patient 

takes the medication as 

an antidepressant.

2. Propranolol Hydrochloride (Inderal)

Drug description Inderal 40MG 

Tablet

Note: • Propranolol is 

used to treat 

hypertension, angina, 

tachycardia, migraines 

as well as some off label 

uses. This patient takes 

the medication as 

treatment for migraines

Profile Medication

Drug details not illustrated in this scenario

Profile Medication

Drug details not illustrated in this scenario

Drug details not illustrated in this scenario
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H. Medication Content Excerpts 

Below are excerpts showing the Scenario One drug, Vasotec (Enalapril Maleate) as represented in the Medication History, CCD, and CCR.

Medication History - Medication Content

<MedicationDispensed>

<DrugDescription>VASOTEC 5 MG TABLET 

 </DrugDescription>

<DrugCoded>

<ProductCode>00247057830</ProductCode>

<ProductCodeQualifier>ND</ProductCodeQualifier>

<Strength>5</Strength>

<DrugDBCode>858815</DrugDBCode>

<DrugDBCodeQualifier>SBD</DrugDBCodeQualifier>

<FormSourceCode>AA</FormSourceCode>

<FormCode>C42998</FormCode>

<StrengthSourceCode>AB</StrengthSourceCode>

<StrengthCode>C28253</StrengthCode>

</DrugCoded>

<Quantity>

<Value>60</Value>

<CodeListQualifier>87</CodeListQualifier>

<UnitSourceCode>AC</UnitSourceCode>

<PotencyUnitCode>C48542</PotencyUnitCode>

</Quantity>

<DaysSupply>30</DaysSupply>

<Directions>TAKE 1 TABLET TWICE DAILY</Directions>

<Refills>

<Qualifier>R</Qualifier>

<Value>2</Value>

</Refills>

<WrittenDate>

<Date>2010-09-27</Date>

</WrittenDate>

<LastFillDate>

<Date>2010-09-30</Date>

</LastFillDate>

<Diagnosis>

<ClinicalInformationQualifier>1</ClinicalInformationQualifier>

<Primary>

<Qualifier>DX</Qualifier>

<Value>401.9</Value>

</Primary>

</Diagnosis>

<DrugUseEvaluation>

<ServiceReasonCode>AR</ServiceReasonCode>

<ProfessionalServiceCode>MB</ProfessionalServiceCode>

<ServiceResultCode>4A</ServiceResultCode>

<CoAgent>

<CoAgentID>858817</CoAgentID>

<CoAgentQualifier>38</CoAgentQualifier>

</CoAgent>

<ClinicalSignificanceCode>3</ClinicalSignificanceCode>

<AcknowledgementReason>TOLERABLE DIARRHEA SIDE EFFECT OF ACE INHIBITOR

 </AcknowledgementReason>

</DrugUseEvaluation>

<StructuredSIG>

<RepeatingSIG>

<SigSequencePositionNumber>0</SigSequencePositionNumber>

</RepeatingSIG>

<CodeSystem>

<SNOMEDVersion>2010_07_31</SNOMEDVersion>

<FMTVersion>2011_04_01</FMTVersion>

</CodeSystem>

<FreeText>

<SigFreeTextStringIndicator>1</SigFreeTextStringIndicator>

<SigFreeText >TAKE ONE TABLET TWICE DAILY</SigFreeText >

</FreeText>

<Dose>

<DoseCompositeIndicator>1</DoseCompositeIndicator>

<DoseDeliveryMethodText>TAKE</DoseDeliveryMethodText>

<DoseDeliveryMethodCodeQualifier>1</DoseDeliveryMethodCodeQualifier>

<DoseDeliveryMethodCode>419652001</DoseDeliveryMethodCode>

<DoseQuantity>1</DoseQuantity>

<DoseFormText>TABLET</DoseFormText>

<DoseFormCodeQualifier>2</DoseFormCodeQualifier>

<DoseFormCode>C42998</DoseFormCode>

</Dose>

<RouteofAdministration>

<RouteofAdministrationText>BY MOUTH</RouteofAdministrationText>

<RouteofAdministrationCodeQualifier>1</RouteofAdministrationCodeQualifier>

<RouteofAdministrationCode>26643006</RouteofAdministrationCode>

</RouteofAdministration>

<Timing>

<FrequencyNumericValue>1</FrequencyNumericValue>

<FrequencyUnitsText>Day</FrequencyUnitsText>

<FrequencyUnitsCodeQualifier>1</FrequencyUnitsCodeQualifier>

<FrequencyUnitsCode>258703001</FrequencyUnitsCode>

</Timing>

</StructuredSIG>
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CCR - Medication Content

<Medication>

<CCRDataObjectID>eDGivm0RRrM-1</CCRDataObjectID>

<Status>

<Text>Active</Text>

</Status>

<Source>

<Actor>

<ActorID>ProviderID</ActorID>

<ActorRole>

<Text>Provider</Text>

</ActorRole>

</Actor>

</Source>

<Product>

<ProductName>

<Text>ENALAPRIL MALEATE 5 MG TABLET</Text>

<Code>

<Value>858813</Value>

<CodingSystem>RxNorm</CodingSystem>

</Code>

<Code>

<Value>00247057830</Value>

<CodingSystem>NDC</CodingSystem>

</Code>

</ProductName>

<BrandName>

<Text>VASOTEC 5 MG TABLET</Text>

<Code>

<Value>858813</Value>

<CodingSystem>RxNorm</CodingSystem>

</Code>

<Code>

<Value>00247057830</Value>

<CodingSystem>NDC</CodingSystem>

</Code>

</BrandName>

<Form>

<Text>Tablet</Text>

<Strength>

<Value>5</Value>

<Units>

<Unit>mg</Unit>

<Code>

<Value>258684004</Value>

<CodingSystem>SNOMED CT</CodingSystem>

<Version>20090701</Version>

</Code>

</Units>

</Strength>

<Code>

<Value>385055001</Value>

<CodingSystem>SNOMED CT</CodingSystem>

<Version>20090701</Version>

</Code>

</Form>

</Product>

<Quantity>

<Value>60</Value>

<Units>

<Unit>Tablet</Unit>

<Code>

<Value>C48542</Value>

<CodingSystem>FDA</CodingSystem>

<Version>20090701</Version>

</Code>

</Units>

</Quantity>

<Directions>

<Direction>

<Dose>

<Value>1</Value>

<Units>

<Unit>Tablet</Unit>

<Code>

<Value>C42998</Value>

<CodingSystem>FDA</CodingSystem>

<Version>20090701</Version>

</Code>

</Units>

</Dose>

<Route>

<Text>po</Text>

<Code>

<Value>26643006</Value>

<CodingSystem>SNOMED 

 CT</CodingSystem>

<Version>20090701</Version>

</Code>

</Route>

<Frequency>

<Value>2</Value>

<Units>

<Unit>Day</Unit>

<Code>

<Value>258703001</Value>

<CodingSystem>SNOMED 

 CT</CodingSystem>

<Version>20090701</Version>

</Code>

</Units>

</Frequency>

</Direction>

</Directions>

<FulfillmentHistory>

<Fulfillment>

<CCRDataObjectID>eDGivm0RRrM-0

 </CCRDataObjectID>

<Source>

<Actor>

<ActorID>ProviderID</ActorID>

<ActorRole>

<Text>Provider</Text>

</ActorRole>

</Actor>

</Source>

</Fulfillment>

</FulfillmentHistory>

</Medication>
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C32 CCD - Medication Content

<entry typeCode="DRIV">

<substanceAdministration classCode="SBADM" moodCode="EVN">

...

<!-- START / STOP DATES -->

<effectiveTime xsi:type="IVL_TS">

<low value="201009"/>

<high nullFlavor="UNK"/>

</effectiveTime>

<!-- DOSE TIMING -->

<effectiveTime xsi:type="PIVL_TS" institutionSpecified="false" operator="A">

<period value="12" unit="h"/>

</effectiveTime>

<!-- ROUTE -->

<routeCode code="C38288" displayName="Oral" codeSystem="2.16.840.1.113883.3.26.1.1"

codeSystemName="NCI - FDA RouteOfAdministration">

...

<translation code="PO" codeSystem="2.16.840.1.113883.5.112" codeSystemName="HL7 

RouteOfAdministration" displayName="Swallow, oral"/>

</routeCode>

<!-- DOSE, UNITS OF ADMINISTRATION -->

<doseQuantity value="1" unit="{TABLET}"/>

<!-- DOSAGE FORM -->

<administrationUnitCode code="C42998" displayName="Tablet"

codeSystem="2.16.840.1.113883.3.26.1.1" codeSystemName="NCI - FDA Dosage Forms">

...

</administrationUnitCode>

<consumable>

<manufacturedProduct>

...

<manufacturedMaterial>

<!-- GENERIC -->

<code code="858813" codeSystem="2.16.840.1.113883.6.88" displayName="Enalapril 

Maleate 5 Mg Tablet" codeSystemName="RxNorm">

...

<!-- BRAND NAME -->

<translation code="224921" codeSystem="2.16.840.1.113883.6.88"

displayName="Vasotec" codeSystemName="RxNorm"/>

<!—ORDER INFORMATION-->

<!-- BRAND PRODUCT -->

<translation code="00247057830" codeSystem="2.16.840.1.113883.6.69"

displayName="Vasotec 5 mg Tablet" codeSystemName="NDC"/>

</code>

</manufacturedMaterial>

</manufacturedProduct>

</consumable>

<entryRelationship typeCode="REFR">

<supply classCode="SPLY" moodCode="INT">

...

<!-- REFILLS-->

<repeatNumber value="2"/>

<!—QUANTITY -->

<quantity value="60" unit="{TABLET}"/>

<author>

 <!—PRESCRIBED DATE -->

<time value="20100927"/>

<assignedAuthor>

<id root="ProviderID"/>

<addr/>

<telecom/>

<assignedPerson>

<name>"MICHAEL PETER BALZARY"</name>

</assignedPerson>

</assignedAuthor>

</author>

</supply>

</entryRelationship>

<entryRelationship typeCode="REFR">

<!-- STATUS -->

<observation classCode="OBS" moodCode="EVN">

<templateId root="2.16.840.1.113883.10.20.1.47"/>

<code code="33999-4" displayName="Status" codeSystem="2.16.840.1.113883.6.1"

codeSystemName="LOINC"/>

<value xsi:type="CE" displayName="Active" code="55561003"

codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT">

...

</value>

</observation>

</entryRelationship>

</substanceAdministration>

</entry>
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I. Adverse Reaction Excerpts 

Below are excerpts showing the Scenario Two adverse reactions as represented in the NCPDP Census, CCD, and CCR.

Census - Adverse Reactions

<Allergy>

<NoKnownAllergies>N</NoKnownAllergies>

<SourceOfInformation>C</SourceOfInformation>

<EffectiveDate>

<Date>1991-01-02</Date>

</EffectiveDate>

<AdverseEvent>

<ItemDescriptionLong>FOOD ALLERGY</ItemDescriptionLong>

<ItemNumber>414285001</ItemNumber>

<CodeListQualifier>LD</CodeListQualifier>

</AdverseEvent>

<DrugProductCoded>

<ItemDescriptionLong>PEANUT</ItemDescriptionLong>

<ItemNumber>QE1QX6B99R</ItemNumber>

<CodeListQualifier>UN</CodeListQualifier>

</DrugProductCoded>

<ReactionCoded>

<ItemDescriptionLong>ANAPHYLAXIS</ItemDescriptionLong>

<ItemNumber>91941002</ItemNumber>

<CodeListQualifier>LD</CodeListQualifier>

</ReactionCoded>

<SeverityCoded>

<ItemDescriptionLong>MODERATE TO 

SEVERE</ItemDescriptionLong>

<ItemNumber>371924009</ItemNumber>

<CodeListQualifier>LD</CodeListQualifier>

</SeverityCoded>

</Allergy>

CCR - Adverse Reactions

<Alerts>

<Alert>

<CCRDataObjectID>HnVGINV2vpU-0</CCRDataObjectID>

<DateTime>

<Type>

<Text>Start date</Text>

</Type>

<ExactDateTime>1953</ExactDateTime>

</DateTime>

<Type>

<Text>Intolerance</Text>

</Type>

<Description>

<Text>Peanut</Text>

<Code>

<Value>QE1QX6B99R</Value>

<CodingSystem>UNII</CodingSystem>

</Code>

</Description>

<Status>

<Text>Active</Text>

</Status>

<Source>

<Actor>

<ActorID>ProviderID</ActorID>

<ActorRole>

<Text>Provider</Text>

</ActorRole>

</Actor>

</Source>

<Reaction>

<Description>

<ObjectAttribute>

<Attribute>Reaction</Attribute>

<AttributeValue>

<Value>Anaphylaxis</Value>

<Code>

<Value>91941002</Value>

<CodingSystem>SNOMED 

CT</CodingSystem>

<Version>20090701</Version>

</Code>

</AttributeValue>

</ObjectAttribute>

</Description>

<Severity>

<Text>MODERATE TO SEVERE</Text>

<Code>

<Value>371924009</Value>

<CodingSystem>SNOMED CT</CodingSystem>

<Version>20090701</Version>

</Code>

</Severity>

</Reaction>

</Alert>

</Alerts>
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C32 CCD - Adverse Reactions

<entry typeCode="DRIV">

<act classCode="ACT" moodCode="EVN">

...

<entryRelationship typeCode="SUBJ" inversionInd="false">

<observation classCode="OBS" moodCode="EVN">

<!-- TYPE OF ADVERSE REACTION -->

<code code="414285001" codeSystem="2.16.840.1.113883.6.96" displayName="allergy to a 

food" codeSystemName="SNOMED CT"/>

...

<!—DATES PRESENT -->

<effectiveTime>

<low value="1952"/>

<high nullFlavor="UNK"/>

</effectiveTime>

...

<!—CO-AGENT -->

<value xsi:type="CD" code="QE1QX6B99R" codeSystem="2.16.840.1.113883.4.9"

displayName="peanut" codeSystemName="UNII">

...

</value>

<participant typeCode="CSM">

<participantRole classCode="MANU">

...

<playingEntity classCode="MMAT">

<code code="QE1QX6B99R" codeSystem="2.16.840.1.113883.4.9"

displayName="peanut" codeSystemName="UNII">

...

</code>

<name>peanut</name>

</playingEntity>

</participantRole>

</participant>

<!—REACTION -->

<entryRelationship typeCode="MFST" inversionInd="true">

<observation classCode="OBS" moodCode="EVN">

<templateId root="2.16.840.1.113883.10.20.1.54"/>

<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>

<statusCode code="completed"/>

<value xsi:type="CD" code="91941002" codeSystem="2.16.840.1.113883.6.96"

displayName="anaphylaxis">

...

</value>

<!—SEVERITY -->

<entryRelationship typeCode="SUBJ">

<observation classCode="OBS" moodCode="EVN">

...

<code code="SEV" displayName="Severity" codeSystemName="HL7 ActCode"

codeSystem="2.16.840.1.113883.5.4"/>

...

<value xsi:type="CE" displayName="moderate to severe" code="371924009"

codeSystemName="SNOMED"

 codeSystem="2.16.840.1.113883.6.96"/>

</observation>

</entryRelationship>

</observation>

</entryRelationship>

<!—STATUS -->

<entryRelationship typeCode="REFR">

<observation classCode="OBS" moodCode="EVN">

...

<code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>

<statusCode code="completed"/>

<value xsi:type="CE" code="55561003" codeSystem="2.16.840.1.113883.6.96"

displayName="Active">

...

</value>

</observation>

</entryRelationship>

</observation>

</entryRelationship>

</act>

</entry>
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J. Problem Excerpts 

Below are excerpts showing the Scenario Two problems / conditions as represented in the NCPDP Census, CCD, and CCR.

Census - Problems

<DiagnosisGeneral>

<SourceOfInformation>C</SourceOfInformation>

<EffectiveDate>

<Date>2009-12-20</Date>

</EffectiveDate>

<ProblemType>

<ItemDescriptionLong>DIAGNOSIS</ItemDescriptionLong>

<ItemNumber>282291009</ItemNumber>

<CodeListQualifier>LD</CodeListQualifier>

</ProblemType>

<ProblemNameCoded>

<ItemDescriptionLong>MIGRAINE</ItemDescriptionLong>

<ItemNumber>37796009</ItemNumber>

<CodeListQualifier>LD</CodeListQualifier>

</ProblemNameCoded>

</DiagnosisGeneral>

<DiagnosisGeneral>

<SourceOfInformation>C</SourceOfInformation>

<EffectiveDate>

<Date>2010-09-10</Date>

</EffectiveDate>

<ProblemType>

<ItemDescriptionLong>DIAGNOSIS</ItemDescriptionLong>

<ItemNumber>282291009</ItemNumber>

<CodeListQualifier>LD</CodeListQualifier>

</ProblemType>

<ProblemNameCoded>

<ItemDescriptionLong>MODERATE RECURRENT MAJOR 

DEPRESSION</ItemDescriptionLong>

<ItemNumber>18818009</ItemNumber>

<CodeListQualifier>LD</CodeListQualifier>

</ProblemNameCoded>

</DiagnosisGeneral>

CCR - Problems

<Problems>

<Problem>

<CCRDataObjectID>QWP4gERwq.4-

0</CCRDataObjectID>

<DateTime>

<Type>

<Text>Start date</Text>

</Type>

<ExactDateTime>2009-12-20</ExactDateTime>

</DateTime>

<Description>

<Text>Migraine</Text>

<Code>

<Value>37796009</Value>

<CodingSystem>SNOMED CT</CodingSystem>

<Version>20090701</Version>

</Code>

<Code>

<Value>346.0</Value>

<CodingSystem>ICD9</CodingSystem>

</Code>

</Description>

<Status>

<Text>Active</Text>

</Status>

<Source>

<Actor>

<ActorID>ProviderID</ActorID>

<ActorRole>

<Text>Provider</Text>

</ActorRole>

</Actor>

</Source>

</Problem>

<Problem>

<CCRDataObjectID>Ev0tYUFXODA-0</CCRDataObjectID>

<DateTime>

<Type>

<Text>Start date</Text>

</Type>

<ExactDateTime>2010-09-10</ExactDateTime>

</DateTime>

<Type>

<Text>Condition</Text>

</Type>

<Description>

<Text>Moderate Recurrent Major Depression</Text>

<Code>

<Value>18818009</Value>

<CodingSystem>SNOMED CT</CodingSystem>

<Version>20090701</Version>

</Code>

<Code>

<Value>296.3</Value>

<CodingSystem>ICD9</CodingSystem>

</Code>

</Description>

<Status>

<Text>Active</Text>

</Status>

<Source>

<Actor>

<ActorID>ProviderID</ActorID>

<ActorRole>

<Text>Provider</Text>

</ActorRole>

</Actor>

</Source>

</Problem>

</Problems>
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C32 CCD - Problems

<entry typeCode="DRIV">

<act classCode="ACT" moodCode="EVN">

...

<!— PROBLEM TYPE -->

<entryRelationship typeCode="SUBJ" inversionInd="false">

<observation classCode="OBS" moodCode="EVN">

...

<code code="64572001" displayName="Condition" codeSystem="2.16.840.1.113883.6.96"

codeSystemName="SNOMED-CT"/>

...

 <!— DATES PRESENT -->

<statusCode code="completed"/>

<effectiveTime>

<low value="200912"/>

</effectiveTime>

 <!— NAME -->

<value xsi:type="CD" displayName="Migraine" code="37796009" codeSystemName="SNOMEDCT" codeSystem="2.16.840.1.113883.6.96">

<translation code="346.0" displayName="Migraine" codeSystem="2.16.840.1.113883.6.103"

codeSystemName="ICD-9-CM" />

</value>

<entryRelationship typeCode="REFR">

<observation classCode="OBS" moodCode="EVN">

<templateId root="2.16.840.1.113883.10.20.1.50"/>

 <!— STATUS -->

<code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>

<statusCode code="completed"/>

<value xsi:type="CE" code="55561003" codeSystem="2.16.840.1.113883.6.96"

displayName="Active">

...

</value>

</observation>

</entryRelationship>

</observation>

</entryRelationship>

</act>

</entry>

<entry typeCode="DRIV">

<act classCode="ACT" moodCode="EVN">

<!— PROBLEM TYPE -->

<entryRelationship typeCode="SUBJ" inversionInd="false">

<observation classCode="OBS" moodCode="EVN">

...

<code displayName="Condition" code="64572001" codeSystemName="SNOMED-CT"

codeSystem="2.16.840.1.113883.6.96" />

...

 <!— DATES PRESENT -->

<effectiveTime>

<low value="201009"/>

<high nullFlavor="UNK"/>

</effectiveTime>

 <!— NAME -->

<value xsi:type="CD" displayName="Moderate Recurrent Major Depression" code="18818009"

codeSystemName="SNOMED" codeSystem="2.16.840.1.113883.6.96">

<translation code="296.3" displayName="Major Depression, recurrent episode"

codeSystem="2.16.840.1.113883.6.103" codeSystemName="ICD-9-CM" />

</value>

<entryRelationship typeCode="REFR">

<observation classCode="OBS" moodCode="EVN">

<templateId root="2.16.840.1.113883.10.20.1.50"/>

 <!— STATUS -->

<code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>

<statusCode code="completed"/>

<value xsi:type="CE" code="55561003" codeSystem="2.16.840.1.113883.6.96"

displayName="Active">

...

</value>

</observation>

</entryRelationship>

</observation>

</entryRelationship>

</act>

</entry>
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K. Detailed Comparison: Compatibility of Coded Values and Terminology

Below is a detailed comparison of coded medication, adverse reaction, and problem content across the three 

standards reviewed. Findings are presented in the following section.
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Terminology comparison

SCRIPT CCD CCR

Concept Example Coded Term Element Opt Current Industry Use Terminology

Coded Term 

Element

Opt of 

code Terminology Coded Term Element

Opt of 

code Terminology

Medication 

Product

NDC, RxNorm 

code

DrugCoded: 

DrugDBCode / 

DrugDBCodeQualifie r O NewRx: Required for MU, 

containing RxNorm code

MedHistory, FillStatus: 

Uncommon to include drug 

codes beyond the 

dispensed NDC. RxNorm 

will be adopted over time 

but is not mandated by 

MU for these messages 

today

NewRx: RxNorm and 

RxNorm sources (per MU 

restrictions)

MedHistory, FillStatus: 

RxNorm and others 

including proprietary 

drug databases

Product name: 

[substanceAdminist

ration]...

cda:manufactured

Material/cda:code/

@code

R if 

known

RxNorm (and RxNorm 

sources per MU 

restrictions)

NDF-RT NUI if only the 

drug class is known 

(concept types of 

“Mechanism of Action - 

N0000000223”, 

“Physiologic Effect - 

N0000009802” or 

“Chemical Structure - 

N0000000002”)

UNII if only the 

ingredient is known

Medications: 

Medication: Product: 

ProductName: Code R RxNorm (and RxNorm 

sources per MU 

restrictions).

Products and agents should 

be coded with RxNorm to

as granular a level as 

possible+P7

Commercial 

Product, Brand 

Name

RxNorm code, 

NDC

DrugCoded: 

ProductCode / 

ProductCodeQualifier O MedHistory: Nearly 

always in dispensed med

NewRx: Always

FillStatus: Always in 

dispensed med

Census: n/a (drug info not 

in msg)

NDC11 of generic or 

brand product, as 

prescribed (NewRx, 

FillStatus) or dispensed 

(MedHistory, FillStatus)

Brand name:

[substanceAdminist

ration]...[manufact

uredMaterial]...

cda:translation/@c

ode

R if 

known

RxNorm, NDC (10-digit) Medications: 

Medication: Product: 

BrandName: Code O RxNorm, NDC (10-digit)In addition [to RxNorm, 

products] may be coded 

with another standard as 

applicable (NDC, for 

example) or

proprietary code, with the 

type of code and the source 

and version clearly defined. 

If any coding system is 

used, however, an RxNorm 

code must be included, if 

legally required.

Dosage Form Capsule, tablet, 

suspension, 

inhaler

FormSourceCode / 

FormCode

See also: 

Structured Sig:

DoseFormCodeQualif

ier / 

DoseFormCode O MedHistory, NewRx, 

FillStatus. To be seen. 

(Element is new in SCRIPT 

10.6)

NCI NCPDP StrengthForm 

(NCI subset code 

C89508). Subset of NCI 

FDA Pharmaceutical 

Dosage Form: C42636. 

Corresponds to the SPL 

Pharmaceutical Dosage 

Form (NCI subset 

C54456), with some 

omissions

[substanceAdminist

ration]...

cda:administration

UnitCode/@code O NCI concept code for 

pharmaceutical dosage 

form: C42636

Medications: 

Medication: Product: 

Form: Code O [No terminology cited 

specifically for this 

element. SNOMED cited 

generally as a preferred 

code source]

Medication and related concepts: 

NCPDP SCRIPT, C32 CCD, ASTM CCR

Drug Product and 

Prescribed / Dispensed Qty
© 1st American Systems and Services LLC Page 36 of 93 Standards Compatibility in Medication Reconciliation

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SCRIPT CCD CCR

Concept Example Coded Term Element Opt Current Industry Use Terminology

Coded Term 

Element

Opt of 

code Terminology Coded Term Element

Opt of 

code Terminology

Strength Unit of 

Measure

Milligram, gram, 

curie, milligram 

per 5 milliliters

StrengthSourceCode 

/ StrengthCode O MedHistory, NewRx, FillStatus. To be seen. 

(Element is new in SCRIPT 

10.6)

NCI NCPDP Strength Unit 

of Measure (NCI subset 

code 89509). 

Corresponds to the SPL 

Potency Terminology 

(NCI subset C54458) but 

lacking some SPL codes 

and containing codes not 

in SPL

None - not 

specified

n/a Product strength 

(Concentration) is 

inferred from the 

product code

[See Dose Unit of 

Administration below 

for administration units 

of measure]

Medications: 

Medication: Product: 

Strength: Code

OR 

Medications: 

Medication: Product: 

Concentration: Code

(e.g., 250mg/ml) O Product strength is optional. 

Can be inferred from the 

product code

[No terminology cited 

specifically for this 

element. SNOMED cited 

generally as a preferred 

code source]

Medication type Prescription, 

Over-thecounter

Not supported - In all SCRIPT messages, 

medication type 

(prescription versus overthe-counter) is derived 

from the drug name/code

n/a [substanceAdminist

ration]...

cda:entryRelationsh

ip[@typeCode='REF

R']/

cda:observation[cd

a:templateId/@root

='2.16.840.1.11388

3.10.20.1.47']/ 

cda:value/@code

R if 

known

Product strength 

(Concentration) is 

inferred from the 

product code

[See Dose Unit of 

Administration below 

for administration units 

of measure]

Not supported

(Note: The 

Medication: Type 

element suggested 

values are not Rx 

versus OTC, but 

instead: medication, 

IV fluid, parental 

nutrition, etc.)

 - Derived from the drug 

name/code

Ordered 

Quantity Unit of 

Measure

Capsule, 

package, 

packet, tablet, 

ounce

Quantity: 

UnitSourceCode / 

PotencyUnitCode R NewRx: Required by 

SCRIPT 10.6

MedHistory, FillStatus: To 

be seen (element is new in 

10.6)

NCI NCPDP Quantity Unit 

of Measure (NCI subset 

code 89510). 

Corresponds primarily to 

the SPL Unit of 

Presentation (NCI 

C87300) but lacks some 

of those values. Also 

includes terms in SPL 

Potency (subset C54458) 

and Unit Of Measure 

(subset C92951) 

terminologies. 

[substanceAdminist

ration]...

[REFR:supply]...

cda:quantity

R if 

known

Coded 

units 

if 

differ 

from 

admin 

units

NCI pharmaceutical 

dosage form: C42636 

If other (liquid, mass): 

UCUM

Inconsistency note: The 

C83 C83-[DE-8.26-CDA4] and C80 2.2.3.3.3 

constraints refer to 

“units of presentation”, 

but specify instead the 

NCI C42636 

pharmaceutical dosage 

form terminology

Medications: 

Medication: Quantity: 

Units: Code O [No terminology cited 

specifically for this 

element. SNOMED cited 

generally as a preferred 

code source]

Medication 

Status

Active Not supported - In the Medication History 

and Fill Status messages, 

status is inferred based on 

dispense dates for the 

medication.

n/a [substanceAdminist

ration]...

cda:entryRelationsh

ip[@typeCode='REF

R']/

cda:observation[cd

a:templateId/@root =

'2.16.840.1.113883.

10.20.1.47']/

cda:value/@code

R if 

known

No specific guidance on 

values / value set in 

C80, C83 IHE PCC 

Technical Framework 

Vol. 2 Rev 5.0 or CCD 

1.0 Imp Guide.

To be based on CCR 

values

Medications: 

Medication: Status: 

Text O From IG: Active, On Hold, 

Prior History No Longer

Active
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SCRIPT CCD CCR

Concept Example Coded Term Element Opt Current Industry Use Terminology

Coded Term 

Element

Opt of 

code Terminology Coded Term Element

Opt of 

code Terminology

Interactions 

considered

Drug/drug, 

drug/dose

Type of interaction: 

<Service 

ReasonCode>

Prescriber's 

response: 

<ProfessionalService

Code> / <Service 

ResultCode> / 

<Acknowledgment 

Reason>

CoAgent: 

<CoAgentID> / 

<CoAgentQualifier>

Severity: <Clinical 

SignificanceCode> O NewRx: Optional element 

new in SCRIPT 10.6. Future 

adoption level is unknown

CoAgent: RxNorm

Other: Proprietary NCPDP 

code values

Not suppported O It does not appear that 

the standard enables 

capturing of potential 

interactions considered 

during the prescribing 

process (drug/drug, 

drug/adverse reaction, 

drug/dose, etc.)

The HITSP Interaction 

(8.23 - templateID 

2.16.840.1.113883.10.2

0.1.54) conveys actual 

reactions occuring after 

patient started the 

medication 

Unknown. Appears to 

not be supported

 - n/a

Medication Administration

Free Text 

Directions

Take 1 tablet 

daily

Directions R MedHistory, NewRx, 

FillStatus: Required in 

SCRIPT 10.6

Recommended: SNOMED 

CT. No constraints 

specified.

Allowed: FMT (particular 

terminology not 

specified. Presume NCI)

[substanceAdminist

ration]...

cda:text O n/a Medications: 

Medication: 

Directions: Direction: 

Description: Text O n/a

Delivery Method Take, apply Structured Sig: 

DoseDeliveryMethod

Code / 

DoseDeliveryMethod

CodeQualifier O MedHistory, NewRx, 

FillStatus. See usage note 

above

Recommended: SNOMED 

CT. No constraints 

specified.

Allowed: FMT (particular 

terminology not 

specified. Presume NCI)

[substanceAdminist

ration]...

cda:code/@code O Vocabulary not defined 

pending completion of 

NCPDP Structured Sig 

piloting.

Medications: 

Medication: 

Directions: Direction: 

DeliveryMethod: Code O Per CCR IG: "codes and 

content to follow NCPCP 

Script SIG standard"

[Per SCRIPT Sig: 

Recommended: SNOMED; 

allowed: FMT]

Delivery Method 

Modifier

Gently, 

repeatedly

Structured Sig: 

DoseDeliveryMethod 

ModifierCode / 

DoseDeliveryMethod 

ModifierCodeQualifi

er O MedHistory, NewRx, 

FillStatus. See usage note 

above

Recommended: SNOMED 

CT. No constraints 

specified.

Allowed: FMT (particular 

terminology not 

specified. Presume NCI)

Concept not 

directly supported 

in C32 CCD. 

n/a Coded value: n/a

Potentially could 

include textual form in 

the free text description 

of delivery method.

Not supported - n/a

Usage note: The SCRIPT Structured Sig segment is in 

trial use. Future adoption level is unknown 
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SCRIPT CCD CCR

Concept Example Coded Term Element Opt Current Industry Use Terminology

Coded Term 

Element

Opt of 

code Terminology Coded Term Element

Opt of 

code Terminology

Dose Unit of 

Administration

Tablet, puff Structured Sig: 

DoseFormCode / 

DoseFormCodeQualif

ier O MedHistory, NewRx, 

FillStatus. See usage note 

above

Recommended: SNOMED 

CT. No constraints 

specified.

Allowed: FMT (particular 

terminology not 

specified. Presume NCI 

NCPDP StrengthForm, as 

specified for the 

FormCode element, 

above

[substanceAdminist

ration]...

cda:doseQuantity O If ordered in administration 

units: NCI Units of 

Presentation... name, rather 

than code value, in brackets--

e.g., {Tablet}.

If other (liquid, mass): UCUM

Medications: 

Medication: 

Directions: Direction: 

Dose: Units: Code O [Per SCRIPT Sig: 

Recommended: SNOMED; 

allowed: FMT]

Maximum Dose 

Unit of 

Administration

Tablet, puff Structured Sig: 

MaximumDoseRestri

ctionUnitsCode / 

MaximumDoseRestri

ctionCodeQualifier O MedHistory, NewRx, 

FillStatus. See usage note 

above

Recommended: SNOMED 

CT. No constraints 

specified.

Allowed: FMT (particular 

terminology not 

specified. Presume NCI 

NCPDP StrengthForm, as 

specified for the 

FormCode element, 

above

[substanceAdminist

ration]...

cda:maxDoseQuant

ity O see above Medications: 

Medication: 

Directions: Direction: 

DoseRestriction: 

Dose: Units: Code O [Per SCRIPT Sig: 

Recommended: SNOMED; 

allowed: FMT]

Route of 

Administration

Oral, topical Structured Sig: 

RouteOfAdministrati

onCode / 

RouteOfAdministrati

onCodeQualifier O MedHistory, NewRx, 

FillStatus. See usage note 

above

Recommended: SNOMED 

CT. No constraints 

specified.

Allowed: FMT (particular 

terminology not 

specified. Presume NCI 

FDA 

RouteOfAdministration 

terminology)

[substanceAdminist

ration]...

cda:routeCode/@co

de O NCI FDA RouteOfAdministration 

terminology. (NCI concept code 

for route of administration: 

C38114)

Medications: 

Medication: 

Directions: Direction: 

Route: Code O IG give latin abbreviations 

(e.g., "po" for "by mouth")

[Per SCRIPT Sig: 

Recommended: SNOMED; 

allowed: FMT]

Site of 

Administration

Each cheek, 

affected area

Structured Sig: 

SiteofAdministration

Code / 

SiteofAdministration

CodeQualifier O MedHistory, NewRx, 

FillStatus. See usage note 

above

Recommended: SNOMED 

CT. No constraints 

specified.

Allowed: FMT (particular 

terminology not 

specified. Presume NCI)

[substanceAdminist

ration]...

cda:approachSiteCo

de/@code O Value descending from the 

SNOMED CT® Anatomical 

Structure (91723000) hierarchy 

or Acquired body structure 

(body structure) (280115004) or 

Anatomical site notations for 

tumor staging (body structure) 

(258331007) or Body structure, 

altered from its original 

anatomical structure 

(morphologic abnormality) 

(118956008) or Physical 

anatomical entity (body 

structure) (91722005)

Medications: 

Medication: 

Directions: Direction: 

Site: Code O [Per SCRIPT Sig: 

Recommended: SNOMED; 

allowed: FMT]
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SCRIPT CCD CCR

Concept Example Coded Term Element Opt Current Industry Use Terminology

Coded Term 

Element

Opt of 

code Terminology Coded Term Element

Opt of 

code Terminology

Administration 

Timing 

(descriptive or 

based on 

activities of 

daily living)

Every morning, 

every evening

Structured Sig: 

AdministrationTiming

Code / 

AdministrationTiming

CodeQualifier O MedHistory, NewRx, 

FillStatus. See usage note 

above

Recommended: SNOMED 

CT. No constraints 

specified.

Allowed: FMT (particular 

terminology not 

specified. Presume NCI)

[substanceAdminist

ration]...

cda:effectiveTime 

[2] O HL7 TimingEvent 

vocabulary 

Medications: 

Medication: 

AdministrationTiming: 

ApproximateDateTime

: Code O Imp. Guide indicates that 

this element contains text 

only. However, a Code 

element is present. Intent is 

unclear. 

[Per SCRIPT Sig: 

Recommended: SNOMED; 

allowed: FMT]

Frequency Time 

Period

Day, week (e.g., 

"day" in 

frequency of "2 

times per day")

Structured Sig: 

FrequencyUnitsCode 

/ 

FrequencyUnitsCode

Qualifier O MedHistory, NewRx, 

FillStatus. See usage note 

above

Recommended: SNOMED 

CT. No constraints 

specified.

Allowed: FMT (particular 

terminology not 

specified. Presume NCI)

[substanceAdminist

ration]...

cda:effectiveTime 

[2] O PIVL_TS definition 

includes: “Legal values for 

the unit attribute of 

<period> are s, min, h, d, 

wk and mo.

Frequency admin timing 

has institutionSpecified 

attribute value of "true"

Medications: 

Medication: 

Directions: Direction: 

Frequency: Units: 

Code O [Per SCRIPT Sig: 

Recommended: SNOMED; 

allowed: FMT]

Interval Time 

Period

Day, hour (e.g., 

"hour" in 

interval of 

"every 3 hours")

Structured Sig: 

IntervalUnitsCode / 

IntervalUnitsCodeQu

alifier O MedHistory, NewRx, 

FillStatus. See usage note 

above

Recommended: SNOMED 

CT. No constraints 

specified.

Allowed: FMT (particular 

terminology not 

specified. Presume NCI)

[substanceAdminist

ration]...

cda:effectiveTime 

[2] O PIVL_TS definition 

includes: “Legal values for 

the unit attribute of 

<period> are s, min, h, d, 

wk and mo. 

Interval admin timing has 

institutionSpecified 

attribute value of "false"

Medications: 

Medication: 

Directions: Direction: 

Interval: Units: Code O [Per SCRIPT Sig: 

Recommended: SNOMED; 

allowed: FMT]

Duration Period Week, month 

(e.g., "week" in 

"apply to 

affected area as 

needed for up to 

one week then 

stop"

Structured Sig: 

DurationTextCode / 

DurationTextCodeQu

alifier O MedHistory, NewRx, 

FillStatus. See usage note 

above

Recommended: SNOMED 

CT. No constraints 

specified.

Allowed: FMT (particular 

terminology not 

specified. Presume NCI)

[substanceAdminist

ration]...

cda:effectiveTime 

[2] O The <width> element 

represents the duration of 

the dose administration 

(e.g., for IV 

administration). Utilizes 

the HL7 PIVL_TS data type 

/ code values

Medications: 

Medication: 

Directions: Direction: 

Duration: Units: Code O [Per SCRIPT Sig: 

Recommended: SNOMED; 

allowed: FMT]

Rate of 

Administration

Seconds, 

minutes, days

Structured Sig: 

RateUnitofMeasureC

ode / 

RateUnitofMeasureC

odeQualifier O MedHistory, NewRx, 

FillStatus. See usage note 

above

Recommended: SNOMED 

CT. No constraints 

specified.

Allowed: FMT (particular 

terminology not 

specified. Presume NCI)

[substanceAdminist

ration]...

cda:effectiveTime 

[2] O The rate is specified in the 

<rateQuantity> element. 

Time unit (s, min, h or d). 

(IHE Patient Care 

Coordination Technical 

Framework Volume 2 Rev 

5.0)

Medications: 

Medication: 

Directions: Direction: 

Dose: Rate: Units: 

Code O [Per SCRIPT Sig: 

Recommended: SNOMED; 

allowed: FMT]

Calculated Dose 

Time Period

Day, hour (e.g., 

"day" in a dose 

calculated as 

mg / kg / day)

Structured Sig: 

TimePeriodBasisCod

e / 

TimePeriodBasisCod

eQualifier O MedHistory, NewRx, 

FillStatus. See usage note 

above

Recommended: SNOMED 

CT.

Allowed: FMT (particular 

terminology not 

specified. Presume NCI)

Code set / values 

unknown

 - No specific guidance on 

time unit in C80, C83 IHE 

PCC Technical Framework 

Vol. 2 Rev 5.0. PIVL_TS 

limited to s, min, h, d, wk, 

mo... which is insufficient 

(e.g., omits Year, Lifetime)

Medications: 

Medication: 

Directions: Direction: 

DoseCalculation: 

Rate: Units: Code O [Per SCRIPT Sig: 

Recommended: SNOMED; 

allowed: FMT]
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SCRIPT CCD CCR

Concept Example Coded Term Element Opt Current Industry Use Terminology

Coded Term 

Element

Opt of 

code Terminology Coded Term Element

Opt of 

code Terminology

Maximum Dose 

Time Period

Day, week (e.g., 

"day" in "not to 

exceed 3 per 

day")

Structured Sig: 

MaximumDoseRestri

ctionVariableUnitsCo

de / 

MaximumDoseRestri

ctionVariableUnitsCo

deQualifier O MedHistory, NewRx, 

FillStatus. See usage note 

above

Recommended: SNOMED 

CT. No constraints 

specified.

Allowed: FMT (particular 

terminology not 

specified. Presume NCI)

Code set / values 

unknown

 - No specific guidance on 

time unit in C80, C83 IHE 

PCC Technical Framework 

Vol. 2 Rev 5.0. PIVL_TS 

limited to s, min, h, d, wk, 

mo... which is insufficient 

(e.g., omits Year, Lifetime)

Medications: 

Medication: 

DoseRestriction: 

Variable: Units: Code O [Per SCRIPT Sig: 

Recommended: SNOMED; 

allowed: FMT]

Indication for medication use

Indication 

Precursor Text 

"As needed for", 

"as directed 

for", "when"

Structured Sig: 

IndicationPrecursorC

ode / 

IndicationPrecursorC

odeQualifier O MedHistory, NewRx, 

FillStatus. See usage note 

above

Recommended: SNOMED 

CT. No constraints 

specified.

Allowed: FMT (particular 

terminology not 

specified. Presume NCI)

Unkown whether 

supported

 - No guidance in C80, C83 

IHE PCC Technical 

Framework Vol. 2 Rev 5.0

Not supported - n/a

Indication for 

medication 

administration 

(optionally in 

conjunction with 

an observation)

"headache", 

"blood 

pressure", 

"finger stick 

blood glucose", 

"after feeding"

Structured Sig: 

IndicationTextCode / 

IndicationTextCodeQ

ualifier O MedHistory, NewRx, 

FillStatus. See usage note 

above

Recommended: SNOMED 

CT. No constraints 

specified.

Allowed: FMT (particular 

terminology not 

specified. Presume NCI)

[substanceAdminist

ration]...

cda:entryRelationsh

ip[@typeCode='RS

ON']/

cda:observation[cd

a:templateId/@root

= 

'2.16.840.1.113883.

10.20.1.28'] O SNOMED CT, limited by 

HITSP to terms decending 

from the Clinical Findings 

(404684003) or Situation 

with Explicit Context 

(243796009) hierarchies

Medications: 

Medication: 

Directions: Direction: 

Indication: Problem: 

Description: Code O SNOMED CT recommended. 

ICD-9, 10 allowed. 

Recommended that, when

possible, all problems be 

coded (ICD-9CM, ICD-10, 

and/or SNOMED)...

Section A2.3.4.1 Problems 

should be coded at the highest level using SNOMED CT 

and the most recent ICD-9 

CM codes at the time the 

CCR is generated. ... It is 

recommended that 

problems be categorized 

with SNOMED CT codes to 

as granular a level as 

possible

Indication value 

unit of measure

blood glucose of 

___ mg/dL

Structured Sig: 

IndicationValueUnito

fMeasureCode / 

IndicationValueUnito

fMeasureCodeQualifi

er O MedHistory, NewRx, 

FillStatus. See usage note 

above

Recommended: SNOMED 

CT. No constraints 

specified.

Allowed: FMT

**Note: inconsistent 

with SCRIPT element, 

Observation 

MeasurementUnitCode, 

which only allows FMT / 

NCI MeasurementUnit 

terms

Unkown whether 

supported

 - No guidance in C80, C83 

IHE PCC Technical 

Framework Vol. 2 Rev 5.0

Medications: 

Medication: 

Directions: Direction: 

Indication: 

PhysiologicalParamet

er: Units: Code O [No terminology cited 

specifically for this 

element. SNOMED cited 

generally as a preferred 

code source]

Usage note: The SCRIPT Structured Sig segment is in 

trial use. Future adoption level is unknown 
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SCRIPT CCD CCR

Concept Example Coded Term Element Opt Current Industry Use Terminology

Coded Term 

Element

Opt of 

code Terminology Coded Term Element

Opt of 

code Terminology

Adverse Reaction

Type of allergy 

or adverse event

drug allergy, 

food intolerance

Allergy: 

AdverseEvent: 

ItemNumber

O * Census. See usage note 

above 

* Element required if "no 

known allergies" is not 

specified

Set of SNOMED CT 

values defined in HITSP 

C80 Table 2-86 Allergy / 

Adverse Event Type 

Value Set Definition

[allergy / drug 

sensitivity 

observation]...

cda:code/@code R Set of SNOMED CT 

values defined in HITSP 

C80 Table 2-86 Allergy / 

Adverse Event Type 

Value Set Definition

Alerts: Alert: Type: 

Text O Must be one of the defined structured text values: 

Allergy, Adverse Reaction, 

Alert, Critical Result

Medication 

product

penicillin Allergy: 

DrugProductCoded: 

ItemNumber O Census. See usage note 

above

RxNorm, representative 

NDC11, UPC, or Mfr. 

Code

[allergy / drug 

sensitivity 

observation]...

cda:participant[@t

ypeCode='CSM']/

cda:code/@code 

R if 

known

RxNorm (and RxNorm 

sources per MU 

restrictions)

Alerts: Alert: Agent: 

Products: Product: 

ProductName: Code O RxNorm. Optionally: NDC or 

other proprietary code. 

A2.3.4.3 Products and 

agents should be coded 

with RxNorm to as granular 

a level as possible. In

addition, they may be 

coded with another 

standard as applicable 

(NDC, for example) or 

proprietary code. .. If any 

coding system is used, 

however, an RxNorm code 

must be included, if legally 

required.

Drug class ACE inhibitors Allergy: 

DrugProductCoded: 

ItemNumber O Census. See usage note 

above

NDF-RT [allergy / drug 

sensitivity 

observation]...

cda:participant[@t

ypeCode='CSM']/

cda:code/@code 

R if 

known

NDF-RT NUI if only the 

drug class is known 

(concept types of 

“Mechanism of Action - 

N0000000223”, 

“Physiologic Effect - 

N0000009802” or 

“Chemical Structure - 

N0000000002”)

Alerts: Alert: Agent: 

Products: Product: 

ProductName: Code O [Terminology for drug class 

not specified. RxNorm cited 

for other medication 

concepts]

Food peanut Allergy: 

DrugProductCoded: 

ItemNumber O Census. See usage note 

above

UNII [allergy / drug 

sensitivity 

observation]...

cda:participant[@t

ypeCode='CSM']/

cda:code/@code 

R if 

known

UNII if only the 

ingredient is known

Alerts: Alert: Agent: 

EnvironmentalAgent: 

Description: Code O [Terminology for 

environmental agents not 

specified.]

Usage note: The SCRIPT Allergy segment is only in 

the Census message, which is in limited use in 

LTPAC settings only 
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SCRIPT CCD CCR

Concept Example Coded Term Element Opt Current Industry Use Terminology

Coded Term 

Element

Opt of 

code Terminology Coded Term Element

Opt of 

code Terminology

Reaction hives Allergy: 

ReactionCoded: 

ItemNumber O Census. See usage note 

above

Values are a subset of 

those defined in HITSP 

C80 (v2.01) 2.2.3.4.2 

Allergy / Adverse Event 

Type. Specifically, only 

Clinical Findings 

(concepts descending 

from 404684003) are 

allowed, and not 

concepts descending 

from Situation with 

Explicit Context 

(243796009). ** Note: 

variance due to SCRIPT's 

use of initial VA/KP 

problem list definition

[allergy / drug 

sensitivity 

observation]...

cda:entryRelationsh

ip[@typeCode='MF

ST']/ 

cda:observation[te

mplateId/@root= 

'2.16.840.1.113883.

10.20.1.54'] 

cda:value/@code

R if 

known

SNOMED CT limited by 

HITSP to terms 

descending from the 

Clinical Findings 

(404684003) or Situation 

with Explicit Context 

(243796009) hierarchies

Alerts: Alert: 

Reaction: Description: 

Code O Can be a string or can be 

used to encode the reaction

(recommended/preferred).

.. It is recommended

that, when possible, all 

instances of <Alert>

be coded with SNOMED CT

Reaction 

Severity

Severe, mild Allergy: 

SeverityCoded: 

ItemNumber O Census. See usage note 

above

Values conform to HITSP 

C80 2.2.3.1.6 Table 2-67 

Problem Severity set

[allergy / drug 

sensitivity 

observation]...

cda:entryRelationsh

ip[@typeCode='SU

BJ']/

cda:observation[te

mplateId/@root= 

'2.16.840.1.113883.

10.20.1.55']

cda:value/@code

R if 

known

SNOMED CT limited by 

HITSP to the value set in 

C80 2.2.3.1.6 Table 2-67 

Problem Severity Value 

Set Definition. These 

terms descend from the 

severities (272141005) 

concept

Alerts: Alert: 

Reaction: Severity: 

Text O Restricted content that 

must be one of the defined 

structured text values. 

Minimal, Mild, Moderate, 

Severe, Life Threatening,

Critical.
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SCRIPT CCD CCR

Concept Example Coded Term Element Opt Current Industry Use Terminology

Coded Term 

Element

Opt of 

code Terminology Coded Term Element

Opt of 

code Terminology

Problem

Problem type finding, 

symptom, 

problem

Diagnosis: 

ProblemType: 

ItemNumber O Census. See usage note 

above

Values conform to HITSP 

C80 2.2.3.1.2 Table 2-60 

Problem Type Value Set 

Definition

[Condition 

observation]...

cda:code/@code 

R if 

known

SNOMED CT limited by 

HITSP to the value set in 

C80 2.2.3.1.2 Table 2-60 

Problem Type Value Set 

Definition

Problems: Problem: 

Type: Text O Must be one of thedefined structured text 

values. Problem,

Condition, Diagnosis, 

Symptom, Finding,

Complaint, Functional 

Limitation

Problem name hypertension, 

migraine

Diagnosis: 

ProblemNameCoded: 

ItemNumber

O * Census. See usage note 

above 

* Element required if 

Diagnosis segment is used

Values are a subset of 

those defined in HITSP 

C80 (v2.01) 2.2.3.1.1 

Problem Value Set. 

Specifically, only Clinical 

Findings (concepts 

descending from 

404684003) are allowed, 

and not concepts 

descending from 

Situation with Explicit 

Context (243796009). ** 

Note: variance due to 

SCRIPT's use of initial 

VA/KP problem list 

definition

ICD-9 and ICD-10 also 

allowed.

[Condition 

observation]...

cda:value/@code O SNOMED CT limited by 

HITSP to terms 

decending from the 

Clinical Findings 

(404684003) or Situation 

with Explicit Context 

(243796009) 

hierarchies.

Meaningful Use rules 

also allow ICD-9 and ICD10.

Problems: Problem: 

Description: Code O SNOMED CT recommended. ICD-9, 10 allowed. 

Recommended that, when

possible, all problems be 

coded (ICD-9CM, ICD-10, 

and/or SNOMED)...

Section A2.3.4.1 Problems 

should be coded at the highest level using SNOMED CT 

and the most recent ICD-9 

CM codes at the time the 

CCR is generated. ... It is 

recommended that 

problems be categorized 

with SNOMED CT codes to 

as granular a level as 

possible

Problem status active, resolved Not supported - In the Census message, 

status is inferred from 

problem effectiveDate 

(start) and expirationDate 

(end) values

n/a [Condition 

observation]...

cda:entryRelationsh

ip/cda:observation

[cda:templateId/@r

oot =

'2.16.840.1.113883.

10.20.1.50']/ 

value/@code O SNOMED Code from C80 

2.2.3.1.8 Table 2-70 

Problem Status Value 

Set Definition (active, 

inactive, resolved)

Problems: Problem: 

Status: Text O Must be one of thedefined structured text 

values: Active, Inactive, 

Chronic, Intermittent,

Recurrent, Rule Out, Ruled 

Out, Resolved

Usage note: The SCRIPT Diagnosis segment is only 

in the Census message, which is in limited use in 

LTPAC settings only 
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L. Comparison Findings – Compatibility of Coded Content and Terminology

The analysis found points of consistency and difference in coded content and terminology used in the three 

standards. Below is a summary of those findings.

Drug Product and Prescribed / Dispensed Qty

Medication Product

E.g., NDC, RxNorm code

Compatibility: CCD and CCR same for drug products; Med History differs. CCD and CCR differ for drug classes and 

ingredients

Drug products: CCD, CCR and New Prescription: RxNorm required by Meaningful Use rules. Medication History 

is not covered by MU, however, and RxNorm is not typically used. Rather, the NDC of the dispensed medication 

is used.

Drug classes and ingredients: The CCD and CCR may include a drug class or ingredient rather than specific drug 

product in a patient's history (e.g., if the specific product isn't known). The CCD directs use of NDF-RT and UNII, 

respectively in such cases, whereas the CCR doesn't specify terminologies. (A drug class would not be reported 

in a Medication History, which only conveys specific dispensed products.)

Commercial Product, Brand Name

E.g., RxNorm code, NDC

Compatible (though implementers need to convert between NDC10 and NDC11 formats)

All reviewed standards enable particular commercial products to be identified using the National Drug Code 

(NDC). However, the NDC is a secondary identifier in the CCD and CCR after RxNorm, and then used to specify a 

particular brand as an addition attribute of a medication already specified using RxNorm. 

The NCPDP SCRIPT messages have traditionally used the NDC to represent both specific brand products as well 

commercially-available generic medication concepts. Where not required by MU to use RxNorm, the SCRIPT 

messages continue to use NDC to represent both concepts.

The NDC format differs between the SCRIPT, CCD and CCR standards (NDC11 for SCRIPT and NDC10 in the 

others). That difference can be resolved by converting between formats if segment dashes are included in the 

NDC10 values.

Dosage Form

E.g., Capsule, tablet, suspension, inhaler

CCD, Med History and CCR: When present, terminology is compatible

Both the CCD and SCRIPT standards use National Cancer Institute code sets to represent dosage forms, though 

with some differences. The C32 CCD limits values to the NCI pharmaceutical dosage form terminology (C42636), 

whereas NCI provides a subset of those terms for use in SCRIPT. However, NCPDP allows implementers to use 

additional NCI values not contained in the subset.
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The CCR does not specify a terminology, but supports the terms used in the CCD and Med History.

Strength Unit of Measure

E.g., Milligram, gram, curie, milligram per 5 milliliters

Not directly comparable between CCD, CCR, and Med History. Optional in all, with different coding

The strength or concentration of a medication can be conveyed in the drug description / code in combination 

with other medication attributes (drug name, dose form) in all standards. It can be stated separately in the 

SCRIPT and CCR standards, but is optional in both and a specific terminology is not cited for the CCR. 

Medication type

E.g., Prescription, Over-the-counter

Only supported by the CCD

Only the CCD has an element dedicated to specifying whether a product requires a prescription or is available 

over the counter. In the other standards, this characteristic of the medication product is determined based on 

the drug name and/or code, using third-party data sources.

Ordered Quantity Unit of Measure

E.g., Capsule, package, packet, tablet, ounce

C32 CCD and NCPDP Med History / CCR use different NCI FDA terminologies. CCD includes the Pharmaceutical Dosage 

Form name only (rather than the code value)

The Medication History (and CCR by reference) use a subset of the NCI Unit of Presentation terminology 

(C87300) whereas the C32 CCD uses the NCI Pharmaceutical Dosage Form terminology (C42636).

Note that for dose units of administration, the situation is reversed, with the C32 CCD using units of 

presentation and Medication History / CCR using pharmaceutical dosage form.

Medication Status

E.g., Active

Not supported by the Medication History message

The CCD and CCR enable a patient medication to be identified as active, inactive, etc. The CCR uses proprietary 

values for this element, and the CCD indicates an intent to base its value set on the CCR's. Recipients of the 

NCPDP Medication History must infer whether the patient is actively taking a medication based on its dispense 

history.

Interactions considered

E.g., Drug/drug, drug/dose

Only supported by the NCPDP SCRIPT New Prescription message

The SCRIPT New Prescription message can convey information about potential drug conflicts considered during 

the ordering process, as well as the practitioner's rationale for ultimately prescribing the drug. This information 

is to be used by the pharmacist when he/she performs their own drug utilization review prior to dispensing. 
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Medication Administration

Free Text Directions

E.g., Take 1 tablet daily

Free text directions (“sig”) are mandatory only in the SCRIPT messages

Free text directions are required in the SCRIPT Medication History, New Prescription, Fill Status and other 

messages. The individual administration components (dose, timing, etc.) are optional in all three standards 

reviewed.

Delivery Method

E.g., Take, apply

Optional in all reviewed standards. Consistent terminology

The terminology for this element in all reviewed standards is to be directed by the NCPDP Structured Sig 

standard. The current Structured Sig implementation guide (v1.1) cites SNOMED CT as the recommended 

terminology.

Delivery Method Modifier

E.g., Gently, repeatedly

Only supported in the SCRIPT standard

This element is only present in the SCRIPT standard's Structured Sig element. However, the CCR standard 

indicates an intent to be consistent with the Structured Sig standard (and the CCD would presumably reflect the 

CCR data elements). It can be presumed that this element will eventually be incorporated into future versions 

of the CCR and CCD standards.

Dose Unit of Administration

E.g., Tablet, puff

C32 CCD and NCPDP Med History / CCR use different NCI FDA terminologies. CCD includes the Unit of Presentation 

name only (rather than the code value)

The Medication History (and CCR by reference) use a subset of the NCI Pharmaceutical Dosage Form 

terminology (C42636), whereas the C32 CCD uses the NCI Unit of Presentation terminology (C87300). Note that 

for ordered quantity, the situation is reversed, with the C32 CCD using pharmaceutical dosage form and 

Medication History / CCR using units of presentation.

Maximum Dose Unit of Administration

E.g., Tablet, puff

C32 CCD and NCPDP Med History / CCR use different NCI FDA terminologies. CCD includes the Unit of Presentation 

name only (rather than the code value)

See Dose Unit of Administration comment, above.

Route of Administration

E.g., Oral, topical
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Different terminologies used

The NCPDP Medication History (and the CCR, which refers to NCPDP Structured Sig) use SNOMED CT, and the 

C32 CCD uses NCI FDA.

Site of Administration

E.g., Each cheek, affected area

Optional in all reviewed standards. Roughly consistent terminology

SNOMED CT is the terminology for this element in all reviewed standards; however, the allowed set of SNOMED 

CT codes is restricted further in the C32 CCD than in the NCPDP or CCR standards.

Administration Timing (descriptive or based on activities of daily living)

E.g., Every morning, every evening

Different terminologies used

The NCPDP standard (and the CCR, which refers to NCPDP Structured Sig) use SNOMED CT, and the C32 CCD 

uses a proprietary HL7 code set.

Frequency Time Period

E.g., Day, week (e.g., "day" in frequency of "2 times per day")

Different terminologies used

The NCPDP standard (and the CCR, which refers to NCPDP Structured Sig) use SNOMED CT, and the C32 CCD 

uses a proprietary HL7 code set.

Interval Time Period

E.g., Day, hour (e.g., "hour" in interval of "every 3 hours")

Different terminologies used

The NCPDP standard (and the CCR, which refers to NCPDP Structured Sig) use SNOMED CT, and the C32 CCD 

uses a proprietary HL7 code set.

Duration Period

E.g., Week, month (e.g., "week" in "apply to affected area as needed for up to one week then stop"

Different terminologies used

The NCPDP standard (and the CCR, which refers to NCPDP Structured Sig) use SNOMED CT, and the C32 CCD 

uses a proprietary HL7 code set.

Rate of Administration

E.g., Seconds, minutes, days

Different terminologies used

The NCPDP standard (and the CCR, which refers to NCPDP Structured Sig) use SNOMED CT, and the C32 CCD 

uses a proprietary HL7 code set.
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Calculated Dose Time Period

E.g., Day, hour (e.g., "day" in a dose calculated as mg / kg / day)

Different terminologies used

The NCPDP standard (and the CCR, which refers to NCPDP Structured Sig) use SNOMED CT, and the C32 CCD 

uses a proprietary HL7 code set.

Maximum Dose Time Period

E.g., Day, week (e.g., "day" in "not to exceed 3 per day")

Different terminologies used

The NCPDP standard (and the CCR, which refers to NCPDP Structured Sig) use SNOMED CT, and the C32 CCD 

uses a proprietary HL7 code set.

Indication for medication use

Indication Precursor Text 

E.g., "As needed for", "as directed for", "when"

Only supported in the SCRIPT standard

This element is only present in the SCRIPT standard's Structured Sig element. However, the CCR standard 

indicates an intent to be consistent with the Structured Sig standard (and the CCD would presumably reflect the 

CCR data elements). It can be presumed that this element will eventually be incorporated into future versions 

of the CCR and CCD standards.

Indication for medication administration (optionally in conjunction with an observation)

E.g., "headache", "blood pressure", "finger stick blood glucose", "after feeding"

Optional in all reviewed standards. Roughly consistent terminology

SNOMED CT is the recommended terminology for this element in all reviewed standards (with ICD-9 and ICD-10 

also allowed). However, the allowed set of SNOMED CT codes is restricted further in the C32 CCD than in the 

NCPDP or CCR standards.

Indication value unit of measure

E.g., blood glucose of ___ mg/dL

Optional in all reviewed standards. Non-specific guidance in all. Internal SCRIPT inconsistency

The guidance for terminology in this element is not specific in any of the reviewed standards. In addition, the 

SCRIPT standard contains terminology inconsistencies between elements in different parts of the standard that 

could represent this concept.

Adverse Reaction

Type of allergy or adverse event

E.g., drug allergy, food intolerance
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Differences in optionaity and terminology

This element is required in the CCD and SCRIPT Census message, but is optional in the CCR. The terminologies 

to be used in the SCRIPT message and CCD are the same (a HITSP-defined SNOMED CT subset), but the CCR 

uses a proprietary set of text values.

Medication product

E.g., penicillin

Optional in all reviewed standards. Roughly consistent terminology

The element is effectively optional in all reviewed standards ("required if known" in the CCD). RxNorm is the 

preferred terminology due to Meaningful Use rules (though not all SCRIPT messages are covered currently by 

MU). SCRIPT allows additional code sets--representative NDC, manufacturer code and UPC--though RxNorm is 

recommended, and the manufacturer code and UPC are not used in the industry.

Drug class

E.g., ACE inhibitors

Optional in all reviewed standards. Roughly consistent terminology

NDF-RT is the recommended terminology for this element in all reviewed standards. However, the allowed set 

of NDF-RT codes is restricted further in the C32 CCD than in the NCPDP or CCR standards.

Food

E.g., peanut

Optional in all reviewed standards. Roughly consistent terminology

UNII is the only allowed terminology in the SCRIPT and CCD standards. A terminology is not identified for the 

CCR.

Reaction

E.g. hives

Optional in all reviewed standards. Variance in terminology

Both the CCD and SCRIPT standards refer to the VA/KP SNOMED CT Problem List Subset. However, a variance 

has arisen due to a change to the original HITSP specification, on which the SCRIPT direction was based. The 

CCR does not specify a terminology for this element, but recommends SNOMED CT in general.

Reaction Severity

E.g., Severe, mild

Optional in all standards. Inconsistent terminology

There is consistency between terminology specified for SCRIPT and the CCR (a SNOMED CT subset identified by 

HITSP), but the CCR utilizes a proprietary textual value set.

Problem
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Problem type

E.g., finding, symptom, problem

Optional in all standards. Inconsistent terminology

There is consistency between terminology specified for SCRIPT and the CCR (a SNOMED CT subset identified by 

HITSP), but the CCR utilizes a proprietary textual value set.

Problem name

E.g., hypertension, migraine

Optional in all reviewed standards. Different terminologies.

Both the CCD and SCRIPT standards refer to the VA/KP SNOMED CT Problem List Subset. However, a variance 

has arisen due to a change to the original HITSP specification, on which the SCRIPT direction was based. The 

CCR recommends use of SNOMED CT, but does not specify restrictions on the range of codes.

Problem status

E.g., active, resolved

Not supported by SCRIPT. Different terminologies

The CCD specifies a subset of SNOMED CT codes, whereas the CCR uses a proprietary text value set. The 

element is not included in the SCRIPT standard; instead, status must be inferred from the problem's start and 

end dates.
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Appendix A: Standards Sources

C32 CCD

HITSP Summary Documents Using HL7 Continuity of Care Document (CCD) Component, HITSP/C32, July 8, 

2009, Version 2.5.

HITSP CDA Content Modules Component, HITSP/C83, January 31, 2010, Version 2.0.1

American National Standards Institute, Health Information Technology Standards Panel (HITSP) Secretariat, 

25 West 43rd Street – Fourth Floor, New York, NY 10036, http://www.hitsp.org

ASTM CCR

ASTM E2369-05: Standard Specification for Continuity of Care Record (CCR), year of adoption 2005, ASTM 

approved July 17, 2006. ASTM E2369-05 (Adjunct to E2369): Standard Specification Continuity of Care 

Record, - Final Version 1.0 (V1.0), November 7, 2005

ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA, 19428-2959 USA;

Telephone (610) 832-9585 or http://www.astm.org

NCPDP Medication History

SCRIPT Standard, Implementation Guide, Version 10.6, October, 2008, (Approval date for ANSI: November 12, 

2008)

National Council for Prescription Drug Programs, Incorporated, 9240 E. Raintree Drive, Scottsdale, AZ 85260–

7518; Telephone (480) 477–1000; and Facsimile (480) 767–1042 or http://www.ncpdp.org

NCIt Subset for NCPDP

National Cancer Institute Enterprise Vocabulary Services

ncicb@pop.nci.nih.gov

http://evs.nci.nih.gov/ftp1/NCPDP/About.html

NCIt Subset Name Subset Description Used in NCPDP SCRIPT Element(s)

NCPDP DEASchedule 

Terminology

A set of terminology for NCPDP that 

contains concepts within the Drug 

Enforcement Administration (DEA) 

Schedule of Controlled Substances.

DEASchedule

NCPDP 

MeasurementUnitCode 

Terminology

A set of terminology for NCPDP that 

contains concepts of various 

measurements of vital signs, 

particularly those pertaining to 

information about a patient that 

Observation: 

MeasurementUnitCode

(MeasurementSourceCode = “AD”)
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would be shared between the clinician 

and pharmacy in order to determine 

proper pharmaceutical care.

NCPDP 

QuantityUnitOfMeasure 

Terminology

A set of terminology for NCPDP that 

contains concepts of the intended or 

actual dispensed quantity unit of 

measure (e.g., 1 Pack, 1 Inhaler, 17 

grams, 30 tablets, 473 ML, 3 Eaches. 

Upon billing, this data is translated to 

Milliliters, Grams, for Eaches. Days 

supply is not allowed as a prescribed 

quantity for eRx. (Dispensed quantity 

from claims likely constrained to these 

values).

PotencyUnitCode

(UnitSourceCode qualifier = “AC”)

NCPDP StrengthForm 

Terminology

A set of terminology for NCPDP that 

contains concepts that qualify the 

strength and strength unit of measure 

associated with the prescribed product 

(e.g., Amoxicillin 250 mg Tablet, 

Allbuterol HFA 17 grams Inhaler, 

Cefaclor 250 MG/5ML Suspension, 

Fentanyl 12 mcg/hr Patch, Epinephrine 

0.3 mg [implied per dose] AutoInjector, Timolol 0.25% Ophthalmic 

Drops, Sprintec 28 Day Pack, 

Hydrocortisone 1% Ointment). 

FormCode 

(FormSourceCode qualifier = “AA”)

NCPDP 

StrengthUnitOfMeasure 

Terminology

A set of terminology for NCPDP that 

contains concepts of dosage form 

strength (e.g., 250 mg, 250 MG/5ML), 

a delivery rate (e.g., 12 mcg/hr, a 

dosage form concentration (e.g., 

0.05%, 1%), the dosage released from 

a single delivery device actuation (e.g., 

90 mcg [implied as per inhalation], 5 

grams), the days supply or quantity in 

a package (e.g., 28 day, 60 grams). 

StrengthCode

(StrengthSourceCode qualifier = 

“AB”)
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Appendix B: Coded Content and Terminology Guidance from Source Standards

A challenge encountered when attempting to determine the compatibility of standards is collecting and 

aligning the definitions and directions for use each concept, including optionality, structure and terminology 

constraints. This section gathers direction from the source standard implementation guides and related 

documents—arranging it by standard and concept.

NCPDP SCRIPT Terminology References

Excerpts from the:

 NCPDP SCRIPT 10.6 Implementation Guide

 Structured Sig Implementation Guide 1.1

 NCPDP External Code List, April 2011 version

Note: The NCPDP SCRIPT 10.6 Implementation Guide describes the structure and data element contents of 

the SCRIPT standard, but typically refers to the Extended Code List document (ECL) to identify allowed code 

values and terminologies. In addition, SCRIPT 10.6 incorporates the NCPDP Structured Sig standard into its 

SIG segment. While the 10.6 guide doesn’t refer to the Structured Sig Implementation Guide, the Sig guide 

provides additional direction on the terminology recommended for use in Structured Sig.

Below are excerpts from those three documents related to terminology for medications, adverse reactions 

and diagnoses. The material focuses on the message types most pertinent to medication reconciliation.
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Excerpts from the SCRIPT 10.6 IG, Structured Sig 1.1 IG, and April 2011 ECL document

Medication

Generic 

Medication 

Name

- OR -

Brand Name

(R)

Text (Required)

<DrugDescription>

Per 10.6 IG: Must include: full drug name, strength, and form. May be abbreviated to fit the 

information in 35 or less bytes. In the SCRIPT new prescription message, either the generic or 

branded medication is included—but not both—along with the associated identifier(s).

---

Coded (Optional, but populated by industry convention)

<ProductCode>: NDC11, included in both message types.

 In the New Prescription, the NDC is representative of the prescribed medication, 

strength, and dosage form. However, the package information contained in the NDC 

(bottle size, etc.) is ignored by the receiving pharmacy. While specified as optional in the 

SCRIPT 10.6 implementation guide, the ProductCode is nearly always included in the 

NewRx message by industry convention, containing an NDC 11-digit identifier.

 In the Medication History or Fill Status message, the element conveys the NDC of the 

dispensed product.

o The NDC is nearly always included in the Fill Status message

o The NDC is typically, but not always, included in Medication History message

External Code List: ProductQualifierCode (3Ø55)

CODE DESCRIPTION 

Note: NDC used by industry convention:

ND NDC 

Note: Other types allowed by the standard, but not used in the industry:

UP UPC 

MF MFG 

RT NDF-RT – National Drug File Reference Terminology 

NH HRI – Health Related Item 

UN UNII - Unique Ingredient Identifier

<DrugDBCode>: RxNorm (Optional, but required in NewRx per Meaningful Use rules).

The DrugDBCode element holds the RxNorm code associated with the prescribed or dispensed 

medication identified in the DrugDescription element. The RxNorm code (or code from another 

information source to RxNorm) is required to be present in New Prescription messages. Other 

messages including the Medication History response are not included in current MU rules, and 

the RxNorm code is optional.

External Code List: DrugDBCodeQualifier (1153)

Note: RxNorm codes recommended by SCRIPT:

BPK: RxNorm BPCK, GPK: RxNorm GPCK, SBD: RxNorm SBD, SCD: RxNorm SCD

Note: Other types allowed by the standard, but not used in the industry:

FG: FDB GCN SEQNO, FM: FDB MedID, FI: FDB MedID, FS: FDB Smartkey, FN: FDB 

Medication Name ID, FL: FDB Ingredient List ID (HICL_SEQNO), FD: FDB Routed Dosage 

Form Med ID, MG: Medi-Span Generic Product Indicator (GPI), MM: Multum MMDC, 

MD: Medi-Span Product Line (DDID), MC: Multum Drug ID, AF: American Hospital 

Formulary Serice (AHFS), G: Medical Economics Generic Master (GM), E: Medical 

Economics Generic Formulation Code (GFC)
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Excerpts from the SCRIPT 10.6 IG, Structured Sig 1.1 IG, and April 2011 ECL document

Dosage Form

(O)

Text (Required)

Required to be included in <DrugDescription>

Coded (Optional)

<FormCode>

Structured Sig: <DoseFormCodeQualifier> / <DoseFormCode>

ECL: Terminology: NCI Code - NCI Values - NCPDP Drug StrengthForm Terminology - available at 

http://www.cancer.gov/cancertopics/terminologyresources/page7 

For NCPDP Specific Terminology

Note: The NCI NCPDP StrengthForm (NCI subset code C89508) is a subset of NCI 

Pharmaceutical Dosage Form: C42636 and corresponds to the SPL Pharmaceutical 

Dosage Form (NCIt subset C54456), with some omissions

Strength, 

Strength Unit 

of Measure

(O)

Text (Required)

Required to be included in <DrugDescription>

Coded (Optional)

<StrengthCode>

ECL: NCICode - NCI Values - NCPDP Drug StrengthUnitOfMeasure Terminology - available at 

http://www.cancer.gov/cancertopics/terminologyresources/page7 

For NCPDP Specific Terminology

Note: The NCI NCPDP Strength Unit of Measure terminology (NCIt subset code 89509) 

corresponds to the SPL Potency Terminology (NCIt subset C54458) but lacks some SPL codes and 

contains other NCI codes not included in the SPL set.

Type of 

Medication

Not supported

Orders and Status

Quantity 

Ordered / Unit 

of Measure

(O)

Text (Required)

Required to be included in <DrugDescription>

Coded (Optional)

<PotencyUnitCode>

ECL: Terminology: NCI Code - NCI Values - NCPDP Drug StrengthForm Terminology - available at 

http://www.cancer.gov/cancertopics/terminologyresources/page7 

For NCPDP Specific Terminology

Note: The NCI NCPDP Quantity Unit of Measure (NCIt subset code 89510) corresponds primarily 

to the SPL Unit of Presentation (NCIt subset C87300) but lacks some of those values. Also 

includes terms in SPL Potency (subset C54458) and Unit Of Measure (subset C929510) 

terminologies.

Fills

(NewRx: R

MedHist: O)

(NewRx: Required, Medication History Response: Optional)

<Refills><Value> 
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Excerpts from the SCRIPT 10.6 IG, Structured Sig 1.1 IG, and April 2011 ECL document

Medication 

Status

Not supported

In the Medication History and Fill Status messages, status is inferred based on dispense dates for 

the medication.

Potential 

Interactions

Potential interaction: The following elements enable capturing of potential interactions 

considered by the prescriber, including drug/drug, drug/adverse reaction, drug/dose, and 

others.

Type of interaction: <Service ReasonCode>

Prescriber's response: <ProfessionalServiceCode> / <Service ResultCode> / 

<Acknowledgment Reason>

CoAgent: <CoAgentID> / <CoAgentQualifier>

Severity: <Clinical SignificanceCode>

Directions

Free Text Sig

(R)

(Required)

<Directions>

Delivery 

Method

(O)

(Optional)

Structured Sig: <DoseDeliveryMethodCode> / <DoseDeliveryMethodCodeQualifier>

Terminology

ECL: 

 SNOMED CT [No constraints specified]

 FMT [Particular terminology not specified in the ECL]

Structured Sig Implementation Guide: 

 Recommended: SNOMED CT

Delivery 

Method 

Modifier

(Optional)

Structured Sig: <DoseDeliveryMethod ModifierCode> / <DoseDeliveryMethod 

ModifierCodeQualifier>

Terminology

ECL: 

 SNOMED CT [No constraints specified]

 FMT [Particular terminology not specified in the ECL]

Structured Sig Implementation Guide: 

 Recommended: SNOMED CT
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Excerpts from the SCRIPT 10.6 IG, Structured Sig 1.1 IG, and April 2011 ECL document

Dose Unit of 

Administration

(O)

(Optional)

Structured Sig: <DoseFormCode> / <DoseFormCodeQualifier>

Terminology

ECL: 

 SNOMED CT (No constraints specified)

 FMT [Particular terminology not specified in the ECL, but NCI NCPDP StrengthForm 

terminology is assumed (see Dose Form, above)]

Structured Sig Implementation Guide: 

 Recommended: FMT

Maximum 

Dose Unit of 

Administration

(O)

(Optional)

Structured Sig: <MaximumDoseRestrictionUnitsCode> / <MaximumDoseRestrictionCodeQualifier 

Terminology>

ECL: 

 SNOMED CT [No constraints specified]

 FMT [Particular terminology not specified in the ECL]

Structured Sig Implementation Guide: 

 Recommended: SNOMED CT

Route of 

Administration

(O)

(Optional)

Structured Sig: <RouteOfAdministrationCode> / <RouteOfAdministrationCodeQualifier>

ECL: 

 SNOMED CT [No constraints specified]

 FMT [Particular terminology not specified in the ECL. Assumed NCI FDA 

RouteOfAdministration terminology]

Structured Sig Implementation Guide: 

 Recommended: SNOMED CT

Site of 

Administration

(O)

(Optional)

Structured Sig: <SiteofAdministrationCode> / <SiteofAdministrationCodeQualifier>

ECL: 

 SNOMED CT [No constraints specified]

 FMT [Particular terminology not specified in the ECL]

Structured Sig Implementation Guide: 

 Recommended: SNOMED CT
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Excerpts from the SCRIPT 10.6 IG, Structured Sig 1.1 IG, and April 2011 ECL document

Frequency 

Time Period

(O)

(Optional)

Structured Sig: <FrequencyUnitsCode> / <FrequencyUnitsCodeQualifier>

ECL: 

 SNOMED CT [No constraints specified]

 FMT [Particular terminology not specified in the ECL]

Structured Sig Implementation Guide: 

 Recommended: SNOMED CT

Interval Time 

Period

(O)

(Optional)

Structured Sig: <IntervalUnitsCode> / <IntervalUnitsCodeQualifier>

ECL: 

 SNOMED CT [No constraints specified]

 FMT [Particular terminology not specified in the ECL]

Structured Sig Implementation Guide: 

 Recommended: SNOMED CT

Administration 

Timing 

(descriptive or 

based on 

activities of 

daily living)

(O)

(Optional)

Structured Sig: <AdministrationTimingCode> / <AdministrationTimingCodeQualifier>

ECL: 

 SNOMED CT [No constraints specified]

 FMT [Particular terminology not specified in the ECL]

Structured Sig Implementation Guide: 

 Recommended: SNOMED CT

Duration 

Period

(O)

(Optional)

Structured Sig: <DurationTextCode> / <DurationTextCodeQualifier>

ECL: 

 SNOMED CT [No constraints specified]

 FMT [Particular terminology not specified in the ECL]

Structured Sig Implementation Guide: 

 Recommended: SNOMED CT
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Excerpts from the SCRIPT 10.6 IG, Structured Sig 1.1 IG, and April 2011 ECL document

Rate of 

Administration

(O)

(Optional)

Structured Sig: <RateUnitofMeasureCode> / <RateUnitofMeasureCodeQualifier> 

ECL: 

 SNOMED CT [No constraints specified]

 FMT [Particular terminology not specified in the ECL]

Structured Sig Implementation Guide: 

 Recommended: SNOMED CT

Calculated 

Dose Time 

Period

(O)

(Optional)

Structured Sig: <TimePeriodBasisCode> / <TimePeriodBasisCodeQualifier>

ECL: 

 SNOMED CT [No constraints specified]

 FMT [Particular terminology not specified in the ECL]

Structured Sig Implementation Guide: 

 Recommended: SNOMED CT

Maximum 

Dose Time 

Period

(Optional)

Structured Sig: <MaximumDoseRestrictionVariableUnitsCode> / 

<MaximumDoseRestrictionVariableUnitsCodeQualifier>

ECL: 

 SNOMED CT [No constraints specified]

 FMT [Particular terminology not specified in the ECL]

Structured Sig Implementation Guide: 

 Recommended: SNOMED CT

Indication

(O)

(Optional)

Structured Sig: <IndicationPrecursorCode> / <IndicationPrecursorCodeQualifier>

ECL: 

 SNOMED CT [No constraints specified]

 FMT [Particular terminology not specified in the ECL]

Structured Sig Implementation Guide: 

 Recommended: SNOMED CT
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Excerpts from the SCRIPT 10.6 IG, Structured Sig 1.1 IG, and April 2011 ECL document

Indication 

Precursor Text 

(Optional)

Structured Sig: <IndicationTextCode> / <IndicationTextCodeQualifier>

ECL: 

 SNOMED CT [No constraints specified]

 FMT [Particular terminology not specified in the ECL]

Structured Sig Implementation Guide: 

 Recommended: SNOMED CT

Indicate 

Medication 

Stopped

Not supported

Adverse Reaction (Census message only)

Type of Allergy 

or Adverse 

Reaction

(O)

(Optional)

Allergy: <AdverseEvent> <ItemNumber>

ECL: SNOMEDAdverseEventCode 

420134006 Used to record an adverse reaction.

418038007 Used to record an adverse reaction to an environmental agent.

419511003 Used to record an adverse reaction to a drug.

418471000 Used to record an adverse reaction to a food.

419199007 Used to record an allergy to an environmental agent.

416098002 Used to record an allergy to a drug.

414285001 Used to record an allergy to a food.

59037007 Used to record intolerance to a drug.

235719002 Used to record intolerance to a food.

Note: Allowed values match the set of SNOMED CT values defined in HITSP C80 Table 2-86 

Allergy / Adverse Event Type Value Set Definition
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Excerpts from the SCRIPT 10.6 IG, Structured Sig 1.1 IG, and April 2011 ECL document

Medication 

product

(O)

(Optional)

Allergy: <DrugProductCoded><ItemNumber>

10.6 Implementation Guide direction: The product causing the adverse event shall be coded to 

UNII for Food and substance allergies, or RxNorm or NDC when to medications, or NDF-RT when 

to classes of medications.

External Code List document excerpts:

(Note: April 2011 ECL: AllergyDrugProductCodedQualifier concept contains the note: “Used in 

Specialized Standard Version 2Ø1Ø121 or later not in earlier versions.” Implementers should 

defer to the October 2008 ECL, excerpts below)

October 2008 ECL: 

Code List Responsibility Agency (ALG Ø5Ø-SØ37-Ø3-3Ø55) for Drug-Product Coded (ALG Ø5ØSØ38-Ø2-714Ø): 

CODE DESCRIPTION 

ND NDC 

RX RXNORM - Maintained and distributed by National Library of Medicine (NLM) 

[Note that separate qualifiers for the different RxNorm types (SCD, SBD, etc.) are not supported 

in the ECL allowed for SCRIPT 10.6]

RT NDF-RT – National Drug File Reference Terminology ... for classes of medication

UP UPC *

MF MFG *

[* Note that, in addition to the terminologies directed in the Implementation Guide (RxNorm, 

NDC, NDF-RT, UNII), the ECL also allows MFG/Manufacturer’s code and HRI/Health Related Item. 

This is contrary to the IG guidance and the original intent of the segment to stay consistent with 

HITSP C32.]

Values for Code List Responsibility Agency (ALG Ø5Ø-SØ37-Ø3-3Ø55) for Drug-Product Coded 

for Food and Substance Allergies (ALG Ø5Ø-SØ38-Ø2-714Ø): 

CODE DESCRIPTION 

UN UNII - Unique Ingredient Identifier - Maintained by FDA and EPA, distributed by 

FDA Substance Registration System (SRS)
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Excerpts from the SCRIPT 10.6 IG, Structured Sig 1.1 IG, and April 2011 ECL document

Reaction

(O)

(Optional)

Allergy: <ReactionCoded> <ItemNumber>

External Code List document excerpts:

(Note: April 2011 ECL: ReactionCoded concept contains the note: “Used in Specialized Standard 

Version 2Ø1Ø121 or later.” Implementers should defer to the October 2008 ECL, excerpts 

below)

October 2008 ECL: 

Values for Code List Responsibility Agency (ALG Ø6Ø-SØ37-Ø3-3Ø55) for Reaction Coded (ALG 

Ø6Ø-SØ38-Ø2-714Ø): 

The values shall be coded using the VA/KP Problem list subset of SNOMED CT, and shall be terms 

that descend from clinical finding (404684003) concept.

[Values are a subset of those defined in HITSP C80 (v2.01) 2.2.3.4.2 Allergy / Adverse Event Type. 

Specifically, only Clinical Findings (concepts descending from 404684003) are allowed, and not

concepts descending from Situation with Explicit Context (243796009). 

This variance o the HITSP guidance is due to SCRIPT's use of initial VA/KP problem list definition]

Reaction 

Severity 

(O)

(Optional)

Allergy: <SeverityCoded><ItemNumber>

External Code List document excerpts:

(Note: April 2011 ECL: SeverityCoded concept contains the note: “Used in Specialized Standard 

Version 2Ø1Ø121 or later.” Implementers should defer to the October 2008 ECL, excerpts 

below)

October 2008 ECL: 

Values for Code List Responsibility Agency (ALG Ø7Ø-SØ37-Ø3-3Ø55) for Severity Coded (ALG 

Ø7Ø-SØ38-Ø2-714Ø): 

The terminology used for severity of the adverse event shall be recorded using the subset of 

SNOMED CT terms that descend from the severities (272141005) concept. 

[Values conform to HITSP C80 2.2.3.1.6 Table 2-67 Problem Severity set]

Problem / Condition (Census message only)

Diagnosis 

Priority

Not supported
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Excerpts from the SCRIPT 10.6 IG, Structured Sig 1.1 IG, and April 2011 ECL document

Problem Type (Optional)

Diagnosis: <ProblemType><ItemNumber>

External Code List document excerpts:

(Note: April 2011 ECL: ProblemTypeCode concept contains the note: “Used in Specialized 

Standard Version 2Ø1Ø121 or later.” Implementers should defer to the October 2008 ECL, 

excerpts below)

October 2008 ECL: 

Values for Code List Responsibility Agency (DIA Ø3Ø-SØ37-Ø3-3Ø55) for Problem Types (DIA 

Ø3Ø-SØ37-Ø2-714Ø): 

CODE DESCRIPTION 

LD SNOMED - Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) 

[Values conform to HITSP C80 2.2.3.1.2 Table 2-60 Problem Type Value Set Definition]

Problem Code

(R)

(Element required if Diagnosis segment is used)

Diagnosis: <ProblemNameCoded><ItemNumber>

External Code List document excerpts:

(Note: April 2011 ECL: ProblemNameCodeQualifier concept contains the note: “Used in 

Specialized Standard Version 2Ø1Ø121 or later.” Implementers should defer to the October 

2008 ECL, excerpts below)

October 2008 ECL: 

Values for Code List Responsibility Agency (DIA Ø4Ø-SØ37-Ø3-3Ø55) for Problem Name Coded 

(DIA Ø4Ø-SØ38-Ø2-714Ø): 

 Values from the ProblemListSubset from SNOMED (preferred) **

 ICD-9 

 ICD-10

[** Values are a subset of those defined in HITSP C80 (v2.01) C80 (v2.01) 2.2.3.1.1 Problem 

Value Set. Specifically, only Clinical Findings (concepts descending from 404684003) are 

allowed, and not concepts descending from Situation with Explicit Context (243796009). 

This variance o the HITSP guidance is due to SCRIPT's use of initial VA/KP problem list 

definition]

NOTE: Meaningful Use rules allow... (from Table 2A, 45 CFR Part 170)

Stage 1: Applicable HIPAA code set required by law (i.e.,ICD-9-CM); or SNOMED CT®

Stage 2: Applicable HIPAA code set required by law (e.g.,ICD-10-CM) or SNOMED CT®

Problem 

Status

Not supported
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CCR Terminology References

Excerpts from the ASTM E2369 CCR Implementation guide

Note: Whereas terminology sources are specified for the C32 CCD and Medication History, typically at an 

element-by-element level, the CCR standard includes few constraints on the terminology to be used to state 

and/or codify values. Most elements are optional in either text or coded form, and the optionality of codified 

values are typically not called out separately from the textual value.

The implementation guide commonly recommends terminologies, and in some cases indicates a particular 

terminology should be used. However, there are very few cases where a particular value set is required, and 

in those cases the values are typically textual and proprietary to the CCR—not references to an external 

terminology.

Below is guidance contained in the CCR implementation guide regarding medication and related concepts.

CCR Guidance Excerpts (ASTM E2369 Implementation Guide)

Medication

Example from 

Imp Guide

Example 32 – <Medication>/<Product> (excerpt)

<Medication>

<CCRDataObjectID>___________</CCRDataObjectID>

<DateTime>

<Type>

<Text>Prescription Date</Text>

</Type>

<ExactDateTime>2004-09-01T13:25:34-

05:00</ExactDateTime>

</DateTime>

<Type>

<Text>Medication</Text>

</Type>

<Source>

<Actor>

<ActorID>75307</ActorID>

<ActorRole>

<Text>Primary Care Provider</Text>

</ActorRole>

</Actor>

</Source>

<Product>

<ProductName>

<Text>Amoxicillin</Text>

<Code>

<Value>_______</Value>

<CodingSystem>RxNorm</CodingSystem>

<Version>________</Version>

</Code>

</ProductName>

<BrandName>

<Text>Amoxil</Text>

<Code>

<Value>_______</Value>

<CodingSystem>RxNorm</CodingSystem>

<Version>________</Version>

</Code>

</BrandName>

 <Strength>

<Value>250</Value>

<Units>

<Unit>mg</Unit>

</Units>

</Strength>

</Product>

...

</Medication>

Generic 

Medication 

Name

(R)

<ProductName> / <ProductName> <Code>

Instance of CodedDescriptionType. Required and Bounded to one instance (0..1).

The generic, non-proprietary, name of the product. 

5. Specifications. 5.5.3: Products and agents should be coded with RxNorm to as granular a 

level as possible. In addition, they may be coded with another standard as applicable (NDC, for 

example) or proprietary code, with the type of code and the source and version clearly defined. 

If any coding system is used, however, an RxNorm code must be included, if legally required.
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CCR Guidance Excerpts (ASTM E2369 Implementation Guide)

Brand Name

(O)

<BrandName> / <BrandName><Code>

Instance of CodedDescriptionType. Optional and Bounded to one instance (0..1).

The Brand Name

Terminology: RxNorm (See 5. Specifications. 5.5.3, cited above)

Dosage Form

(O)

<Form> / <Form><Code>

Child of Product and instance of CodedDescriptionType. Optional and Unbounded (0..n).

The Form – Tablet, Capsule, Elixir, Suspension, Crème, Powder, Box, Syringe, and so forth

[No terminology cited specifically for this element. SNOMED cited generally as a preferred code 

source]

Strength, 

Strength Unit 

of Measure

(O)

<Strength> / <Strength><Code>

Child of Product and instance of MeasureType. Optional and Unbounded (0..n)

The predefined strength that the medication comes in –500mg tablets, for example.

<Concentration> / <Concentration><Code>

Child of Product and instance of MeasureType. Optional and Unbounded (0..n).

Used to define product concentration, when applicable – 250 mg/ml, for example.

[No terminology cited specifically for this element. SNOMED cited generally as a preferred code 

source]

Type of 

Medication

Not supported

Orders and Status

Example from 

Imp. Guide

Example 32 – <Medication>/<Product> (excerpt)

<Medication>

...

<Quantity>

<Value>30</Value>

<Units>

<Unit>Capsules</Unit>

</Units>

</Quantity>

...

</Medication>

Prescribed 

Date

(O)

<DateTime> 

This can be an exact DateTime, an age, an approximate DateTime, or a DateTime range.

Optional and Unbounded (0..n). 

Quantity 

Ordered / Unit 

of Measure

(O)

<Quantity><Units> / <Quantity><Units><Code>

Instance of MeasureType. Optional and Unbounded (0..n).

Defines the quantity – to be ordered, dispensed, or used, for example.

[No terminology cited specifically for this element. SNOMED cited generally as a preferred code 

source]
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CCR Guidance Excerpts (ASTM E2369 Implementation Guide)

Fills

(O)

<Refill> 

A Child of <Refills> and includes <Number>, <Quantity>, <DateTime>, to define ’Last

Refill’, for example, and <Comment> for any specific <Refill> alerts or comments. Optional and 

Unbounded (1..n).

Number of allowed refills per prescription.

Medication 

Status

(O)

<Status> 

Instance of CodedDescriptionType with restricted content that must be one of the defined 

structured text values. Active, On Hold, Prior History No Longer Active. Optional and Bounded 

to one instance (0..1)

Defines the <Status> of the <Product>.

Potential 

Interactions

It does not appear that potential interactions considered during prescribing are supported.

Directions

Note re.: all 

Directions 

elements (CCR 

imp. guide 

page 75)

A2.5.4.9 <Medications>, <MedicalEquipment>, and <Immunizations> 

...

(4) Careful consideration has gone to make StructuredProductType within the CCR map explicitly 

to and support:

(a) NCPDP Script and the ongoing cooperative work on SIG definitions for medication 

prescriptions and orders with NCPDP, HL7, and ASTM.

Note—The <Directions> under <Product> within this Implementation Guide maps explicitly to 

the latest available version of NCPCP Script SIG submitted (DERF) by the SIG Workgroup 

October 7, 2005.

...

Imp Guide 

Example

Example 32 – <Medication>/<Product> (excerpt)

<Medication>

...

<Directions>

<Direction>

<Dose>

<Value>1</Value>

</Dose>

<Route>

<Text>po</Text>

</Route>

<Frequency>

<Value>tid</Value>

</Frequency>

<Duration>

<Value>10</Value>

<Units>

<Unit>Days</Unit>

</Units>

</Duration>

</Direction>

</Directions>

...

</Medication>

Free Text Sig

(O)

<Directions><Direction><Description> 

Container for the <Directions>/SIG. This maps explicitly to NCPDP Script SIG as submitted (DERF) 

October 7, 2005. Optional and Unbounded (0..n).

Contains the directions for use. This is the ‘SIG’ component of the Prescription, for example, or is 

the use or administration instructions for a <Product>.

<Description> can contain a text string or complex, coded data object.
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CCR Guidance Excerpts (ASTM E2369 Implementation Guide)

Delivery 

Method

(O)

<Direction><DeliveryMethod><Code> 

The textual representation of the Dose Delivery Method. This is the method in which the dose is 

delivered (describes how the dose is administered/consumed). Optional and Bounded to

one instance (0..1). 

Defines the method: take, apply, swish, swallow, inject, insert, chew, use, give, sprinkle, mix, 

dissolve...

[Per SCRIPT Sig: Recommended: SNOMED; allowed: FMT]

Delivery 

Method 

Modifier

Not supported

Dose Unit of 

Administration

(O)

<Direction><Dose> <Units><Code>

A Child of <Direction>. It is of MeasureType with <Value>, <Units>, and <Code>. Dose also 

contains <Rate>. Optional and Unbounded (0..n).

Defines the dose parameter 125, 250, 500; units mg, mcg, g, U; rate per minute, per hour; and 

can repeat for multiple doses to support sliding scales, pulse

[Per SCRIPT Sig: Recommended: SNOMED; allowed: FMT]

Maximum 

Dose Unit of 

Administration

(O)

<Direction><DoseRestriction> <Dose><Code>

A Child of <Direction> and instance of DoseCalculationType. Optional and Unbounded (0..n).

Used to provide a dose restriction. Otherwise, the same as above.

[Per SCRIPT Sig: Recommended: SNOMED; allowed: FMT]

Route of 

Administration

(O)

<Direction><Route> <Code>

A Child of <Direction> and instance of CodedDescriptionType. Optional and Unbounded (0..n).

This defines the Route of administration – po, pr, sl, in either plain English or Latin abbreviation.

[Per SCRIPT Sig: Recommended: SNOMED; allowed: FMT]

Site of 

Administration

(O)

<Direction><Site> <Code>

A Child of <Direction> and instance of CodedDescriptionType. Optional and Unbounded (0..n).

Physical location on the patient of use, implantation, or administration, when specified 

(commonly used in IM, IV, and immunizations, and implantable devices).

[Per SCRIPT Sig: Recommended: SNOMED; allowed: FMT]

Frequency 

Time Period

(O)

<Direction><Frequency><Units><Code>

A Child of <Direction> and can be expressed as a <Description> (CodedDescriptionType) or a 

<Value> and <Units>. Optional and Unbounded (0..n).

Defines the frequency of administration – qd, bid, tid, qid, 5x/d...

[Per SCRIPT Sig: Recommended: SNOMED; allowed: FMT]

Interval Time 

Period

(O)

<Direction><Interval><Units><Code>

A Child of <Direction> and can be expressed as a <Description> (CodedDescriptionType) or a 

<Value> and <Units>. Optional and Unbounded (0..m).

Defines an interval q15m, q2h, q4h, q12h.

[Per SCRIPT Sig: Recommended: SNOMED; allowed: FMT]
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CCR Guidance Excerpts (ASTM E2369 Implementation Guide)

Administration 

Timing 

(descriptive or 

based on 

activities of 

daily living)

(O)

<Direction><AdministrationTiming><ApproximateDateTime><Code>

A Child of <Direction> and instance of DateTimeType Optional and Unbounded (0..n).

This is used to define a specific administration or use time. Can repeat for more than one 

administration time. Can be a text string (Morning, Evening, Before Meals, 1 Hour After Meals, 3 

Hours After Meals, Before Bed) or an exact time.

A2.3.8.3 <ApproximateDateTime> 

(1) <ApproximateDateTime> is expressed as a text string using CodedDescriptionType. Since 

there are no currently encoded values to express <ApproximateDateTime>, CodedDescriptionType is used as a text string container only as illustrated in the following 

examples:

Example 10 – <ApproximateDateTime>

<ApproximateDateTime><Text>One Week Ago</Text></ApproximateDateTime>

<ApproximateDateTime><Text>As A Child</Text></ApproximateDateTime>

<ApproximateDateTime><Text>Thirty Years Ago</Text></ApproximateDateTime>

<ApproximateDateTime><Text>In 30s</Text></ApproximateDateTime>

[Note re: terminology: While A2.3.8.3 above indicates that only text strings are supported, the 

composite does contain a <Code> element, which presumably could contain a SNOMED CT code 

or other code. SCRIPT Sig segment, which the CCR imp guide cites as a model, allows SNOMED or 

FMT codes in this element (SNOMED preferred)]

Duration 

Period

(O)

<Direction><Duration><Units><Code.

A Child of <Direction> and can be expressed as a <Description> (CodedDescriptionType) or a 

<Value> and <Units>. Optional and Unbounded (0..n).

Defines the duration of use/administration.

[Per SCRIPT Sig: Recommended: SNOMED; allowed: FMT]

Rate of 

Administration

(O)

<Direction><Dose><Rate><Units><Code>

[Per SCRIPT Sig: Recommended: SNOMED; allowed: FMT]

Calculated 

Dose Time 

Period

(O)

<Direction><DoseCalculation> <Rate><Units><Code>

A Child of <Direction> and instance of DoseCalculationType. Optional and Unbounded (0..n).

Used to provide a dose calculation. <Dose> defines the dose parameter 125, 250, 500; <Unit> 

and <Rate> define the unit parameters mg/kg/hr, for example <Variables> defines dosing 

variables, which can be more than one. <Calculation> defines the calculation.

[Per SCRIPT Sig: Recommended: SNOMED; allowed: FMT]

Maximum 

Dose Time 

Period

<Direction><DoseRestriction>Variable: Units: Code

A Child of <Direction> and instance of DoseCalculationType. Optional and Unbounded (0..n).

Used to provide a dose restriction. Otherwise, the same as above.

[Per SCRIPT Sig: Recommended: SNOMED; allowed: FMT]
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CCR Guidance Excerpts (ASTM E2369 Implementation Guide)

Indication

(O)

<Indication> 

A Child of <Direction> and can be a <Description> or a <Problem> or a link to a <Problem> 

within the CCR, or one or more <PhysiologicalParameter>. Also includes a PRN designator.

Optional and Unbounded (0..n). Indication for a product.

Terminology: SNOMED CT recommended. ICD-9, 10 allowed. Recommended that, when possible, 

all problems be coded (ICD-9CM, ICD-10, and/or SNOMED).

Section A2.3.4.1 Problems should be coded at the highest level using SNOMED CT and the most 

recent ICD-9 CM codes at the time the CCR is generated. ... It is recommended that problems be 

categorized with SNOMED CT codes to as granular a level as possible

Indication 

Precursor Text 

Not supported

Indicate 

Medication 

Stopped

(O)

See Status above

Adverse Reaction

Alerts 

(adverse 

reactions)

section

(O)

A2.5.4.8 <Alerts>: (1) <Alerts> is optional and bound to one instance (0..1). The child element 

<Alert> is required and unbounded (1..n) and contains data used to define a patient’s warnings 

such as allergies, adverse reactions, and other alerts (for example, enzyme or metabolic 

pathway deficiencies and critical lab or result values).
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CCR Guidance Excerpts (ASTM E2369 Implementation Guide)

Imp Guide 

Example

Example 31 – <Alert> Data Object

<Alert>

<CCRDataObjectID>___________</CCRDataObjectID>

<DateTime>

<Type>

<Text>Onset Date</Text>

</Type>

<ApproximateDateTime>

<Text>As A Child</Text>

</ApproximateDateTime>

</DateTime>

<Type>

<Text>Allergy</Text>

</Type>

<Status>

<Text>Current</Text>

</Status>

<Source>

<Actor>

<ActorID>___________</ActorID>

</Actor>

</Source>

<Agent>

<Products>

<Product>

<CCRDataObjectID>___________</CCRDataObjectID>

<Description>

<Text>Penicillin</Text>

<Code>

<Value>__________</Value>

<CodingSystem>RxNorm</CodingSystem>

<Version>________</Version>

</Code>

</Description>

<Source>

<Actor>

<ActorID>___________</ActorID>

</Actor>

</Source>

<Product>

<ProductName>

<Text>PenVK</Text>

</ProductName>

</Product>

</Product>

</Products>

</Agent>

<Reaction>

<Description>

<ObjectAttribute>

<Attribute>Reaction</Attribute>

<AttributeValue>

<Value>Anyphylaxis</Value>

<Code>

<Value>__________</Value>

<CodingSystem>SNOMED CT</CodingSystem>

<Version>20050131</Version>

</Code>

</AttributeValue>

</ObjectAttribute>

</Description>

<Severity>

<ObjectAttribute>

<Attribute>Severity</Attribute>

<AttributeValue>

<Value>Life Threatening</Value>

<Code>

<Value>__________</Value>

<CodingSystem>SNOMED CT</CodingSystem>

<Version>20050131</Version>

</Code>

</AttributeValue>

</ObjectAttribute>

</Severity>

<Interventions>

<Intervention>

<CCRDataObjectID>___________</CCRDataObjectID>

<Source><Actor><ActorID>___________</ActorID></Actor></Source>

<CCRDataObjectID>___________</CCRDataObjectID>

<Description>

<Text>Cardiopulmonary Resuscitation</Text>

<Code>

<Value>__________</Value>

<CodingSystem>RxNorm</CodingSystem>

<Version>________</Version>

</Code>

</Description>

<Source><Actor><ActorID>___________</ActorID></Actor></Source>

</Procedure>

</Procedures>

</Intervention>

</Interventions>

</Reaction>

</Alert>

Type of Allergy 

or Adverse 

Reaction

(O)

<Alert><Type> 

An instance of CodedDescriptionType with restricted content that must be one of the defined 

structured text values. Allergy, Adverse Reaction, Alert, Critical Result.

Optional and Bounded to one instance (0..1).

Defines what <Type> of <Alert> is being itemized.
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CCR Guidance Excerpts (ASTM E2369 Implementation Guide)

Medication 

product

(O)

<Alert><Agent> 

<Agent> has children <Products>,<EnvironmentalAgents>, <Problems>, <Procedures>, and 

<Results>. Optional and Unbounded (0..`). If an <Agent> is unknown, then “Unknown” is 

required content for <Agent>

Defines an <Agent> that caused an <Alert>, specifically a <Product> (Penicillin), an 

EnvironmentalAgent> (dust, bee stings), a <Problem> (G6PD Deficiency), a <Procedure> (IVP, 

Endoscopy), or a , <Result> (K+, Na+, Dig Level, Mammogram, PAP, Pathology, Cytology).

A2.3.4.3 Products and agents should be coded with RxNorm to as granular a level as possible. In

addition, they may be coded with another standard as applicable (NDC, for example) or 

proprietary code. .. If any coding system is used, however, an RxNorm code must be included, if 

legally required

Reaction

(O)

<Alert><Reaction><Description><Code>

Reaction> <Reaction> has children <Description>, <Severity>, and <Interventions>. Optional and 

Unbounded (0..n). 

<Description> is used to describe the <Reaction>, if any, that the <Alert> addresses – Rash, 

Angioedema, Anaphylaxis, Nausea, and so forth <Description> can be a string or can be used to 

encode the reaction (recommended/preferred).

Optional

[No terminology cited specifically for this element. SNOMED cited generally as a preferred code 

source]

Reaction 

Severity 

(O)

<Alert><Reaction><Severity><Text>

An instance of CodedDescriptionType with restricted content that must be one of the defined 

structured text values. Minimal, Mild, Moderate, Severe, Life Threatening, Critical. Optional 

and Bounded to one instance (0..1).

Defines the <Severity> of the <Reaction>.

Problem / 

Condition

Problems 

section

(O)

A2.5.4.5 <Problems>: At a minimum, a CCR should contain all pertinent current and historical 

problems relevant to that patient at the point in time a CCR is generated and relative to the 

<Purpose> of that instance of a CCR.
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CCR Guidance Excerpts (ASTM E2369 Implementation Guide)

Imp Guide 

Example

Example 28 – Data Object <Problem>

<Problem>

<CCRDataObjectID>___________</CCRDataObjectID>

<DateTime>

<Type>

<Text>Date of Onset</Text>

</Type>

<ExactDateTime>2004-09-01T13:25:34-

05:00</ExactDateTime>

</DateTime>

<Type>

<Text>Diagnosis</Text>

</Type>

<Description>

<ObjectAttribute>

<Attribute>Diagnosis</Attribute>

<AttributeValue>

<Value>Myocardial Infarction</Value>

<Code>

<Value>22298006</Value>

<CodingSystem>SNOMED CT</CodingSystem>

<Version>20050131</Version>

</Code>

</AttributeValue>

</ObjectAttribute>

<ObjectAttribute>

<Attribute>Acuity</Attribute>

<AttributeValue>

<Value>Acute</Value>

<Code>

<Value>53737009</Value>

<CodingSystem>SNOMED CT</CodingSystem>

<Version>20050131</Version>

</Code>

</AttributeValue>

</ObjectAttribute>

<ObjectAttribute>

<Attribute>Site</Attribute>

<AttributeValue>

<Value>Antereoseptal</Value>

<Code>

<Value>20706007</Value>

<CodingSystem>SNOMED CT</CodingSystem>

<Version>20050131</Version>

</Code>

</AttributeValue>

</ObjectAttribute>

<Code>

<Value>410.1</Value>

<CodingSystem>ICD-9 CM</CodingSystem>

<Version>2004</Version>

</Code>

</Description>

<Status>

<Text>Resolved</Text>

</Status>

<Source>

<Actor>

<ActorID>75307</ActorID>

<ActorRole>

<Text>Primary Care Provider</Text>

</ActorRole>

</Actor>

</Source>

<Episodes>

<Number>2</Number>

<Episode>

<CCRDataObjectID>___________</CCRDataObjectID>

<DateTime>

<Type>

<Text>Age At Onset</Text>

</Type>

<Age>

<Value>35</Value>

<Units>

<Unit>Years</Unit>

</Units>

</Age>

</DateTime>

<Status>

<Text>Resolved</Text>

</Status>

<Source>

<Actor>

<ActorID>75307</ActorID>

<ActorRole>

<Text>Primary Care Provider</Text>

</ActorRole>

</Actor>

</Source>

</Episode>

<Source>

<Actor>

<ActorID>75307</ActorID>

<ActorRole>

<Text>Primary Care Provider</Text>

</ActorRole>

</Actor>

</Source>

</Episodes>

</Problem>

Diagnosis 

Priority

Not supported

Problem Type <Problem><Type><Text> 

An instance of CodedDescriptionType with restricted content that must be one of the defined 

structured text values. Problem, Condition, Diagnosis, Symptom, Finding, Complaint, 

Functional Limitation. 

Optional and Bounded to one instance (0..1).
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CCR Guidance Excerpts (ASTM E2369 Implementation Guide)

Problem Code

(O)

<Problem><Description><Code>

An instance of CodedDescriptionType that supports a free text string, a structured text string or 

strings, or a structured and coded text string or strings. It is recommended that, when possible, 

all problems be coded (ICD-9CM, ICD-10, or SNOMED, or both).

Optional and Bounded to one instance (0..1).

E.g.: Myocardial Infarction, Nausea, Headache, Parkinson’s Disease, etc.

A2.3.4.1 Problems—Problems should be coded at the highest level using SNOMED CT and the 

most recent ICD-9 CM codes at the time the CCR is generated to accommodate the need for the 

various healthcare entities that will be interacting with the CCR data to have accurate coding for 

reimbursement purposes. These and other controlled vocabularies are integral to the 

enhancement of data contained within the CCR to support intelligent clinical decision 

support. It is recommended that problems be categorized with SNOMED CT codes to as

granular a level as possible.

NOTE: Meaningful Use rules allow... (from Table 2A, 45 CFR Part 170)

Stage 1: Applicable HIPAA code set required by law (i.e.,ICD-9-CM); or SNOMED CT®

Stage 2: Applicable HIPAA code set required by law (e.g.,ICD-10-CM) or SNOMED CT®

Problem 

Status

(O)

<Problem><Status><Text>

An instance of CodedDescriptionType with restricted content that must be one of the defined 

structured text values. Active, Inactive, Chronic, Intermittent, Recurrent, Rule Out, Ruled Out, 

Resolved.

Optional and Bounded to one instance (0..1).
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C32 CCD Medication-Related Terminology References

Excerpts from HITSP C32 CCD component document and referenced documents (C83, C80, C154)

CCD Guidance Excerpts (C32, C83, C80, C154, IHE Patient Care Coordination Technical Framework)

Medication

Medication

Section

(R)

C83-[CT-112-2] The Medications Section SHALL include entries from the Medication module to 

provide the relevant medications in coded form

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:consumable/cda:manufacturedProduct Medication Information R/Y 2.2.2.8.10

 cda:manufacturedMaterial/cda:code/@code 8.13 - Coded Product Name R2/Y 2.2.2.8.11

 cda:translation/@code 8.14 - Coded Brand Name R2/Y 2.2.2.8.12

 cda:originalText 8.15 - Free Text Product Name R/N 2.2.2.8.13

cda:manufacturedMaterial/cda:name 8.16 - Free Text Brand Name R2/N 2.2.2.8.14

C83-[DE-8-CDA-4] Medication Information data elements SHALL declare conformance to the 

IHE Product Entry template by including a <templateID> element with the 

root attribute set to the value 1.3.6.1.4.1.19376.1.5.3.1.4.7.2

C83-[DE-8-CDA-5] A CDA Document SHALL declare conformance for the Medication 

Information data element by including a <templateID> element with the 

root attribute set to the value 2.16.840.1.113883.3.88.11.83.8.2

Generic 

Medication 

Name

(Text: R

Coded: R if 

known)

2.2.2.8.11 Coded Product Name Constraints 

C83-[DE-8.13-CDA-1] The coded product name SHALL appear in the code attribute of the <code> 

element. 

C83-[DE-8.13-CDA-2] If the code for the generic product is unknown, the code and codeSystem 

attributes MAY be omitted 

C154-[DE-8.13-1] The coded product name SHALL be coded as specified in HITSP/C80 Section 

2.2.3.3.8 Medication Clinical Drug Names. 

C80 2.2.3.3.8: Shall contain RxNorm normal forms for concepts type of 

“Ingredient Name” [term type: SCD] or Generic Packs [term type: GPCK]

C154-[DE-8.13-2] When only the class of the drug is known (e.g., Beta Blocker or Sulfa Drug), 

it SHALL be coded as specified in HITSP/C80 Section 2.2.3.3.9 Medication 

Drug Class. 

C80 2.2.3.3.9: Shall contain a value descending from the NDF-RT concept 

types of “Mechanism of Action - N0000000223”, “Physiologic Effect -

N0000009802” or “Chemical Structure - N0000000002”`. NUI will be used 

as the concept code

C154-[DE-8.13-3] When only the medication ingredient name is know, the coded product 

name MAY be coded as specified in HITSP/C80 Section 2.2.3.3.11 

Ingredient Name

C80 2.2.3.3.11: Unique identifiers for active drug ingredient [UNII]

2.2.2.8.13 Free Text Product Name Constraints

C83-[DE-8.15-CDA-1] The product (generic) name SHALL appear in the <originalText> element 

beneath the <code> element 
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CCD Guidance Excerpts (C32, C83, C80, C154, IHE Patient Care Coordination Technical Framework)

Brand Name

(Text: R

Coded: R if 

known)

CDA Data Location HITSP Data Element ID/Name Opt Constraint

 cda:manufacturedMaterial/cda:code/@code 8.13 - Coded Product Name 

 cda:translation/@code 8.14 - Coded Brand Name R2/Y 2.2.2.8.12

2.2.2.8.12 Coded Brand Name Constraints 

C83-[DE-8.14-CDA-1] The code for the specific brand of product SHALL appear in a <translation> 

element 

C154-[DE-8.14-1] The brand name SHALL be coded as specified in HITSP/C80 Section 

2.2.3.3.7 Medication Brand Name or 2.2.3.3.10 Medication Packaged 

Product. 

C80 2.2.3.3.10: Shall contain RxNorm normal forms for concepts type of 

“Brand Name” or Brand Name Packs

C80 2.2.3.3.10: Shall contain a value from NDC. Each listed drug product 

listed is assigned a unique 10-digit, 3-segment number

2.2.2.8.14 Free Text Brand Name Constraints 

C83-[DE-8.14-CDA-1] The coded product name SHALL appear in the code attribute of the 

<translation> element 

C83-[DE-8.14-CDA-2] The brand name SHALL appear in the <name> element of the 

<manufacturedMaterial>

Dosage Form

(Text: n/a:

Coded: O)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:administrationUnitCode/@code 8.11 - Product Form O/N 2.2.2.8.8

2.2.2.8.8 Product Form Constraints

C154-[DE-8.11-1] SHALL be coded as specified in HITSP/C80 Section 2.2.3.3.3 Medication 

Product Form

C80 2.2.3.3.3: This is the physical form of the product as presented to the 

individual. For example: tablet, capsule, liquid or ointment. NCI concept 

code for pharmaceutical dosage form: C42636

Strength, 

Strength Unit 

of Measure

(n/a)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

n/a 8.18 - Product Concentration n/a 2.2.2.8.15

2.2.2.8.15 Product Concentration Constraints 

The product concentration is determined from the coded product or brand 

name using knowledge base information in the vocabularies specified for 

these fields, and therefore this information is not explicitly included.
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CCD Guidance Excerpts (C32, C83, C80, C154, IHE Patient Care Coordination Technical Framework)

Type of 

Medication

(R if known)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:entryRelationship[@typeCode='REFR']/ 8.19 - Type of Medication R2/N 2.2.2.8.16

 cda:observation[cda:templateId/@root= 

 '2.16.840.1.113883.10.20.1.47']/ 

 cda:value/@code

2.2.2.8.16 Type of Medication Constraints 

The template identifier for this data element is 2.16.840.1.113883.3.88.11.83.8.1.

C83-[DE-8.19-CDA-1] A CDA Document SHALL declare conformance for the Type of Medication 

by including a <templateID> element with the root attribute set to the 

value 2.16.840.1.113883.3.88.11.83.8.1 

C83-[DE-8.19-CDA-2] Each <supply> or <substanceAdministration> act MAY reference an 

<observation> element that describes the type of medication, by including 

an <entryRelationship typeCode=SUBJ/> element 

C83-[DE-8.19-CDA-3] The type of a medication SHALL be represented with an <observation> 

element in the <entryRelationship> 

C83-[DE-8.19-CDA-4] The <observation> element SHALL have a <templateId> with a root 

attribute set to 2.16.840.1.113883.3.88.11.83.8.1 

C83-[DE-8.19-CDA-5] The <observation> SHALL have a <code> element that represents the kind 

of medication actually or intended to be administered or supplied 

C154-[DE-8.19-1] The type of medication SHALL be coded as specified in HITSP/C80 Section 

2.2.3.3.5 Medication Type.

C80 2.2.3.3.5: The SNOMED CT® has been limited by HITSP to the value set 

reproduced below in Table 2-78 Medication Type Value Set Definition

Concept Name 

Concept Code (SNOMED Fully Specified Name) Usage Note

329505003 Over the counter products (product) Over the counter products 

73639000 Prescription drug (product) Prescription Drug 

Orders and Status

Prescribed 

Date

(O)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:author/cda:time 8.30 - Order Date/Time O/N

Quantity 

Ordered

(O)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:quantity 8.28 - Quantity Ordered R2/N 2.2.2.8.23
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CCD Guidance Excerpts (C32, C83, C80, C154, IHE Patient Care Coordination Technical Framework)

Quantity Unit 

of Measure

(Text: R:

Coded: R if 

other than 

admin. units)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:quantity 8.28 - Quantity Ordered R2/ 2.2.2.8.23

2.2.2.8.23 Quantity Ordered Constraints 

The units of presentation can be retrieved from www.fda.gov, and include 

only those terms which have not been mapped to UCUM. Terms with 

mappings to UCUM are units of administration, rather than units of 

presentation.

C83-[DE-8.26-CDA-1] The quantity ordered SHALL be recorded in the value attribute of 

<quantity> element inside a <supply> element used to record order 

information 

C83-[DE-8.26-CDA-2] The unit attribute SHALL be present 

C83-[DE-8.26-CDA-3] When the quantity ordered is in other than administration units (e.g., 

when the quantity ordered is a volume of liquid or mass of substance) 

units SHALL be coded as specified in HITSP/C80 Section 2.2.3.6.6 Units of 

Measure 

C80 2.2.3.6.6: Units of measure concepts that includes atomic UCUM units 

as well as UCUM expression. Commonly used UCUM units of measure 

concepts can be obtained from UCUM Web Site

http://aurora.regenstrief.org/~ucum/ucum.html#datyp2apdxatblxmp 

C83-[DE-8.26-CDA-4] When the quantity ordered is in administration units, the unit attribute 

SHOULD contain the preferred name of the presentation units within 

braces { } using the units of presentation^ as specified in HITSP/C80 

Section 2.2.3.3.3 Medication Product Form

C80 2.2.3.3.3: This is the physical form of the product as presented to the 

individual. For example: tablet, capsule, liquid or ointment. NCI concept 

code for pharmaceutical dosage form: C42636

[Inconsistency note: The C83 C83-[DE-8.26-CDA-4] and C80 2.2.3.3.3 constraints refer to “units of 

presentation”, but specify instead the NCI C42636 pharmaceutical dosage form terminology]

Fills

(O)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda cda:repeatNumber 8.27 - Fills O/N 2.2.2.8.22

Ordering 

Provider

(O)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:author/cda: assignedAuthor/ 8.31 - Ordering Provider O/N

 cda:assignedPerson/cda:name 
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CCD Guidance Excerpts (C32, C83, C80, C154, IHE Patient Care Coordination Technical Framework)

Medication 

Status

(R if known)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:entryRelationship[@typeCode='REFR']/ 8.20 - Status of Medication R2/N 2.2.2.8.17

 cda:observation[cda:templateId/@root= 

 '2.16.840.1.113883.10.20.1.47']/ 

 cda:value/@code

2.2.2.8.17 Status of Medication Constraints 

See Sections 3.9.2.3 and 5.1 of the HL7 Continuity of Care Document Implementation Guide for 

additional requirements for this data element. 

C154-[DE-8.20-1] The medication status MAY be recorded using the CCD Medication Status 

observation using the value set defined in the CCD

CCD R1 Implementation Guide: 3.9.2.3 Representation of “status” values 

The template identifier for a medication status observation is 2.16.840.1.113883.10.20.1.47.

CONF-350: A medication activity MAY contain exactly one medication status 

observation.

CONF-351: A supply activity MAY contain exactly one medication status observation

CONF-352: A medication status observation (templateId 

2.16.840.1.113883.10.20.1.47) SHALL be a conformant status observation 

(templateId 2.16.840.1.113883.10.20.1.57) (as defined in section 5.1 

“Type” and “Status” values).

5.1 “Type” and “Status” values: (excerpts)

ASTM CCR defines restricted Type and Status value sets to further define 

observations in many of the CCR sections. ... A complete mapping between 

all ASTM CCR Type and Status values and their corresponding RIM 

(potentially coupled with SNOMED CT, LOINC, etc) representations is 

beyond the scope of this specification. 

[Note: ASTM CCR Imp Guide: Status values: Active, On Hold, Prior History No Longer Active]

CONF-353: The value for “Observation / value” in a medication status observation 

SHALL be selected from Value Set 2.16.840.1.113883.1.11.20.7 

MedicationStatusCode STATIC 20061017.

Figure 2-35 Status of Medication Example 

<!-- These examples assume the default namespace is 'urn:hl7-org:v3' --> 

<substanceAdministration classCode='SBADM' moodCode='INT'> 

 ... 

 <entryRelationship typeCode='REFR'> 

 <observation classCode='OBS' moodCode='EVN'> 

 <code code='33999-4' displayName='Status' 

 codeSystem='2.16.840.1.113883.6.1' codeSystemName='LOINC'/> 

 <statusCode code='completed'/> 

 <value xsi:type='CE' code='55561003' displayName='Active' 

 codeSystem='2.16.840.1.113883.6.96' codeSystemName='SNOMED CT'/> 

 </observation> 

 </entryRelationship> 

 ... 

</substanceAdministration>
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CCD Guidance Excerpts (C32, C83, C80, C154, IHE Patient Care Coordination Technical Framework)

Potential 

Interactions

Potential interaction: It does not appear that the standard enables capturing of potential

interactions considered during the prescribing process (drug/drug, drug/adverse reaction, 

drug/dose, etc.)

--------

Related: CCD enables capturing of actual reactions, or absence of reaction, once the patient has 

started the medication:

3.9.2.2.5 Reaction observations and interventions

A reaction represents an adverse event due to an administered substance. Significant reactions are 

to be listed in the Alerts section. Reactions in the Medications section can be used to track 

reactions associated with individual substance administrations or to track routine follow up to an 

administration (e.g. “no adverse reaction 30 minutes post administration”).

The reaction observation (templateId 2.16.840.1.113883.10.20.1.54) and severity observation 

(templateID 2.16.840.1.113883.10.20.1.55) templates are defined above, in the Alerts section (see 

section 3.8.2.4 Reaction observations and interventions).

CONF-348: A medication activity MAY contain one or more reaction observations (templateId 

2.16.840.1.113883.10.20.1.54), each of which MAY contain exactly one severity

observation (templateId 2.16.840.1.113883.10.20.1.55) AND/OR one or more 

reaction interventions. 

CONF-349: The value for “entryRelationship / @typeCode” in a relationship between a

medication activity and reaction observation SHALL be “CAUS” “Is etiology for” 

2.16.840.1.113883.5.1002 ActRelationshipType STATIC.

Directions

Free Text Sig

(Text: O:

Coded: n/a)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:text 8.01 - Free Text Sig O 2.2.2.8.2

2.2.2.8.2 Free Text Sig Constraints 

Figure 2-27 Free Text Sig Example

<!-- These examples assume the default namespace is 'urn:hl7-org:v3' --> 

<section> 

 ... 

 <text> 

 ... 

 <content ID='sig-1'> Acetaminophen 325 mg tablet tid po prn</content> 

 ... 

 </text> 

 ... 

 <entry> 

 <substanceAdministration classCode='SBADM' moodCode='INT'> 

 <templateId root='2.16.840.1.113883.10.20.1.24'/> 

 <templateId root='2.16.840.1.113883.3.88.11.83.8'/> 

 <templateId root='1.3.6.1.4.1.19376.1.5.3.1.4.7’/> 

 ... 

 <text><reference value='#sig-1'/></text> 

 ... 

 </substanceAdministration> 

 </entry> 

</section>
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CCD Guidance Excerpts (C32, C83, C80, C154, IHE Patient Care Coordination Technical Framework)

Delivery 

Method

(Text: O:

Coded: O)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:code/@code 8.12 - Delivery Method O 2.2.2.8.9

2.2.2.8.9 Delivery Method Constraints 

Please note that HITSP has not specified a vocabulary for Delivery Method because ongoing 

harmonization work with the NCPDP Industry SIG Task Force and the e-Prescribing pilots has not 

yet published results. 

C83-[DE-8.12-CDA-1] The Delivery Method MAY be recorded in the <cda:code> element 

C83-[DE-8.12-CDA-2] The free text description of the delivery method MAY be included within a 

<cda:originalText> element beneath the <cda:code> element

Delivery 

Method 

Modifier (n/a)

Concept not directly supported in C32 CCD. Potentially could include with free text description of 

delivery method.

Dose Unit of 

Administration

(O)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:doseQuantity 8.08 – Dose O/N 2.2.2.8.6

2.2.2.8.6 Dose Constraints 

The units of presentation can be found at www.fda.gov, and include only those terms that have 

not been mapped to Unified Code for Units of Measure (UCUM). Terms with mappings to UCUM 

are units of administration. 

C154-[DE-8.08-1] Units MAY be present when needed. If present it SHALL be coded as 

specified in HITSP/C80 Section 2.2.3.6.6 Units of Measurement

C80 2.2.3.6.6: Units of measure concepts that includes atomic UCUM units 

as well as UCUM expression. Commonly used UCUM units of measure 

concepts can be obtained from UCUM Web Site

http://aurora.regenstrief.org/~ucum/ucum.html#datyp2apdxatblxmp

C154-[DE-8.08-2] When the coded product or brand name describes the strength or 

concentration of the medication, and the dosing is in administration units 

(e.g., 1 tablet, 2 capsules), units SHOULD contain the preferred name of 

the presentation units within braces { } using the units of presentation 

from the NCI Thesaurus

Figure 2-30 Dose Examples 

<!-- These examples assume the default namespace is 'urn:hl7-org:v3' --> 

<!-- example 1, dose is in units of tablets --> 

<code code='' displayName='Acetaminophen 325 mg tablet' 

 codeSystem='2.16.840.1.113883.6.88' codeSystemName='RxNorm'/> 

 ... 

<doseQuantity value='1' unit='{TABLET}'/> 

<!-- example 2, dose is in measurable units --> 

<code code='' displayName='Tylenol' 

 codeSystem='2.16.840.1.113883.6.88' codeSystemName='RxNorm'/> 

 ... 

<doseQuantity value='325' unit='mg'/> 
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CCD Guidance Excerpts (C32, C83, C80, C154, IHE Patient Care Coordination Technical Framework)

Maximum 

Dose Unit of 

Administration

(O)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:maxDoseQuantity 8.10 - Dose Restriction O/Y none

Code as described in DoseQuantity, above

Route of 

Administration

(O)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:routeCode/@code 8.07 – Route O/Y 2.2.2.8.5

2.2.2.8.5 Route of Administration Constraints 

C83-[DE-8.07-CDA-1] SHALL be coded as specified in HITSP/C80 Section 2.2.3.3.4.1 Medication 

Route FDA.

C80 2.2.3.3.4.1: This indicates the method for the medication received by 

the individual (e.g., by mouth, intravenously, topically, etc). NCI concept 

code for route of administration: C38114

[Note that the IHE PCC recommends use of the HL7 RouteOfAdministration code set, in conflict 

with the HITSP recommendation:]

IHE Patient Care Coordination Technical Framework Volume 2 Rev 5.0: 

6.3.4.16.13 <routeCode code=' ' displayName=' ' codeSystem='2.16.840.1.113883.5.112' 

codeSystemName='RouteOfAdministration'>

The <routeCode> element specifies the route of administration using the 

HL7 RouteOfAdministration vocabulary. A code must be specified if the 

route is known, and the displayName attribute should be specified. If the 

route is unknown, this element shall not be sent. 

Figure 2-29 Route of Administration Example 

 ... 

<routeCode code='C38288' displayName='ORAL' 

 codeSystem='2.16.840.1.113883.3.26.1.1' codeSystemName='NCI Thesaurus'/> 

 ... 

Site of 

Administration

(O)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:approachSiteCode/@code 8.09 - Site O/Y 2.2.2.8.7

2.2.2.8.7 Site Constraints 

C154-[DE-8.09-1] The Site SHALL be coded as specified in HITSP/C80 Section 2.2.3.2.1 Body 

Site

C80 2.2.3.2.1: Shall contain a value descending from the SNOMED CT® 

Anatomical Structure (91723000) hierarchy or Acquired body structure 

(body structure) (280115004) or Anatomical site notations for tumor 

staging (body structure) (258331007) or Body structure, altered from its 

original anatomical structure (morphologic abnormality) (118956008) or 

Physical anatomical entity (body structure) (91722005). This indicates the 

anatomical site
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CCD Guidance Excerpts (C32, C83, C80, C154, IHE Patient Care Coordination Technical Framework)

Frequency 

Time Period

(O)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:effectiveTime[2] 8.04 – Frequency O/Y 2.2.2.8.4

2.2.2.8.4 Administrative Timing Constraints 

The HL7 data type for PIVL_TS uses the institutionSpecified attribute to indicate whether it is the 

interval (time between dosing), or frequency (number of doses in a time period) that is important. 

If instititutionSpecified is not present or is set to false, then the time between dosing is important 

(every 8 hours). If true, then the frequency of administration is important (e.g., 3 times per day). 

C83-[DE-8-CDA-3] The first <effectiveTime> SHALL use the IVL_TS data type unless for a single 

administration, in which case, it SHALL use the TS data type 

C83-[DE-8.04-CDA-1] Medications that are administered at a specified frequency SHALL record 

the expected interval between doses in the <period> element beneath an 

<effectiveTime> of type PIVL_TS. The <effectiveTime> element SHALL have 

an institutionSpecified attribute value of "true" 

Figure 2-28 Administration Timing Examples 

<!-- These examples assume the default namespace is 'urn:hl7-org:v3' --> 

<!-- twice a day for 10 days from 2/1/07 to 2/10/07 --> 

<effectiveTime xsi:type='IVL_TS'> 

 <low value='20070201'/> 

 <high value='20070210'/> 

</effectiveTime> 

<effectiveTime xsi:type='PIVL_TS' institutionSpecified='true' operator='A'> 

 <period value='12' unit='h' /> 

</effectiveTime> 

<!-- Once, on 2005-09-01 at 1:18am. --> 

<effectiveTime value='200509010118'/> 

<!-- Three times a day, for 10 days from 2/1/07 to 2/10/07 --> 

<effectiveTime xsi:type='IVL_TS'> 

 <low value='20070201'/> 

 <high value='20070210'/> 

</effectiveTime> 

<effectiveTime xsi:type='PIVL_TS' institutionSpecified='true' operator='A'> 

 <period value='8' unit='h' /> 

</effectiveTime> 
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CCD Guidance Excerpts (C32, C83, C80, C154, IHE Patient Care Coordination Technical Framework)

Interval Time 

Period

(O)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:effectiveTime[2] 8.04 – Frequency O/Y 2.2.2.8.4

See below for 2.2.2.8.4 content related to administration based on activities of daily living

2.2.2.8.4 Administrative Timing Constraints 

The HL7 data type for PIVL_TS uses the institutionSpecified attribute to indicate whether it is the 

interval (time between dosing), or frequency (number of doses in a time period) that is important. 

If instititutionSpecified is not present or is set to false, then the time between dosing is important 

(every 8 hours). If true, then the frequency of administration is important (e.g., 3 times per day). 

C83-[DE-8.05-CDA-1] Medications that are administered at a specified interval SHALL record 

interval between doses in the <period> element beneath an 

<effectiveTime> element of type PIVL_TS. The <effectiveTime> element 

SHALL have an institutionSpecified attribute value of "false"

PIVL_TS definition includes: “Legal values for the unit attribute of <period> are s, min, h, d, wk 

and mo representing seconds, minutes, hours, days, weeks, and months 

respectively.”

Figure 2-28 Administration Timing Examples 

<!-- every 12 hours for 10 days from 2/1/07 to 2/10/07 --> 

<effectiveTime xsi:type='IVL_TS'> 

 <low value='20070201'/> 

 <high value='20070210'/> 

</effectiveTime> 

<effectiveTime xsi:type='PIVL_TS' institutionSpecified='false' operator='A'> 

 <period value='12' unit='h' /> 

</effectiveTime> 

<!-- every 8 hours for 10 days from 2/1/07 to 2/10/07 --> 

<effectiveTime xsi:type='IVL_TS'> 

 <low value='20070201'/> 

 <high value='20070210'/> 

</effectiveTime> 

<effectiveTime xsi:type='PIVL_TS' institutionSpecified='false' operator='A'> 

 <period value='8' unit='h' /> 

</effectiveTime> 
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CCD Guidance Excerpts (C32, C83, C80, C154, IHE Patient Care Coordination Technical Framework)

Administration 

Timing 

(descriptive or 

based on 

activities of 

daily living)

(O)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:effectiveTime[2] 8.03 - Administration Timing O/Y 2.2.2.8.4

See above for 2.2.2.8.4 content related to frequency, interval, or one-time administration

C83-[DE-8.03-CDA-1] Medications that are administered based on activities of daily living SHALL 

identify the events that trigger administration in the <event> element 

beneath the <effectiveTime> element. The <effectiveTime> element SHALL 

be of type EIVL_TS 

IHE Patient Care Coordination Technical Framework Volume 2 Rev 5.0: 

6.3.4.16.12.2 Data types used in Frequency Specifications. An xsi:type of 

EIVL_TS represents an event based time interval, where the event is not a 

precise time, but is often used for timing purposes (e.g. with meals, 

between meals, before breakfast, before sleep). Refer to the HL7 

TimingEvent vocabulary for the codes to use for the <event> element. This 

interval may specify an <offset> which provides information about the 

time offset from the specified event (e.g., <offset><low value='-1' 

unit='h'/><width value='10' unit='min'/></offset> means 1 hour before the 

event. In that same example, the <width> element indicates the duration 

for the dose to be given. 

TimingEvent 

Lvl Type, Domain name and/or 

Mnemonic code

Concept 

ID

Mnemonic Print 

Name

Definition/Description

1 L: (AC) 10708 AC AC before meal (from lat. ante cibus)

1 L: (ACD) 10712 ACD ACT before lunch (from lat. ante cibus 

diurnus)

1 L: (ACM) 10711 ACM ACM before breakfast (from lat. ante cibus 

matutinus)

1 L: (ACV) 10713 ACV ACV before dinner (from lat. ante cibus 

vespertinus)

1 L: (HS) 10707 HS HS the hour of sleep

1 L: (IC) 10710 IC IC between meals (from lat. inter cibus)

1 L: (ICD) 10718 ICD ICD between lunch and dinner

1 L: (ICM) 10717 ICM ICM between breakfast and lunch

1 L: (ICV) 10719 ICV ICV between dinner and the hour of sleep

1 L: (PC) 10709 PC PC after meal (from lat. post cibus)

1 L: (PCD) 10715 PCD PCD after lunch (from lat. post cibus diurnus)

1 L: (PCM) 10714 PCM PCM after breakfast (from lat. post cibus 

matutinus)

1 L: (PCV) 10716 PCV PCV after dinner (from lat. post cibus 

vespertinus)

Figure 2-28 Administration Timing Examples 

<!-- in the morning for 10 days from 2/1/07 to 2/10/07 --> 

<effectiveTime xsi:type='IVL_TS'> 

 <low value='20070201'/> 

 <high value='20070210'/> 

</effectiveTime> 
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CCD Guidance Excerpts (C32, C83, C80, C154, IHE Patient Care Coordination Technical Framework)

Duration 

Period

(O)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:effectiveTime[2] 8.06 – Duration O/Y 2.2.2.8.4

IHE Patient Care Coordination Technical Framework Volume 2 Rev 5.0: 6.3.4.16.12.2 Data types 

used in Frequency Specifications: 

PIVL_TS. An xsi:type of PIVL_TS is the most commonly used, representing a periodic interval of 

time. The <low> element of <phase> may be present. If so it specifies the starting point, and only 

the lower order components of this value are relevant with respect to the <period>. The <width> 

element represents the duration of the dose administration (e.g., for IV administration). The 

<period> indicates how often the dose is given. Legal values for the unit attribute of <period> are 

s, min, h, d, wk and mo representing seconds, minutes, hours, days, weeks, and months 

respectively. 

Figure 2-28 Administration Timing Examples 

<!-- Every day at 8 in the morning for 10 minutes for 10 days from 2/1/07 to 2/10/07 --> 

<effectiveTime xsi:type='IVL_TS'> 

 <low value='20070201'/> 

 <high value='20070210'/> 

</effectiveTime> 

<effectiveTime xsi:type='PIVL_TS' operator='A'> 

 <phase> 

 <low value="198701010800" inclusive="true"/> 

 <width value="10" unit="min"/> 

 </phase> 

 <period value='1' unit='d'/>

</effectiveTime>

Rate of 

Administration

(O)

No guidance in C80 or C83

IHE Patient Care Coordination Technical Framework Volume 2 Rev 5.0: 

6.3.4.16.17 <rateQuantity><low value=' ' unit=' '/><high value=' ' unit=' '/></rateQuantity> 

The rate is specified in the <rateQuantity> element. The rate is given in units that have measure 

over time. In this case, the units should be specified as a string made up of a unit of measure (see 

doseQuantity above), followed by a slash (/), followed by a time unit (s, min, h or d). Again, if a

range is given, then the <low> and <high> elements contain the lower and upper bound of the 

range, otherwise, they contain the same value. 

Calculated 

Dose Time 

Period

(unknown)

No guidance specific to calculated dose in C80, C83 IHE PCC Technical Framework Vol. 2 Rev 5.0

PIVL_TS definition includes: “Legal values for the unit attribute of <period> are s, min, h, d, wk 

and mo representing seconds, minutes, hours, days, weeks, and months respectively.”
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CCD Guidance Excerpts (C32, C83, C80, C154, IHE Patient Care Coordination Technical Framework)

Maximum 

Dose Time 

Period

No guidance specific to max dose time period in C80, C83 IHE PCC Technical Framework Vol. 2 Rev 

5.0

Per HL7 RIM Version: V 02-07 (12/9/2004):

3.1.17.6 SubstanceAdministration.maxDoseQuantity :: SET<RTO> (0..*) 

Definition:Identifies the maximum total quantity of a therapeutic substance that may be 

administered to a subject over the period of time. 

Discussion: This attribute is particularly useful where the allowed dosage is specified as a range or 

the timing is variable or PRN (as needed). It provides an overall limit on the quantity that may be 

administered in a period of time. Multiple occurrences of maxDoseQuantity may be used to 

indicate different limits over different time periods. 

Examples: 500 mg/day; 1200mg/week. 

Constraints: invariant(SubstanceAdministration med, RTO max) where 

med.maxDoseQuantity.contains(max) {max.numerator.compares(med.doseQuantity); 

max.denominator.compares(1 s);} Numerator must be in units comparable to doseQuantity and 

denominator must be a measurement of time. 

PIVL_TS definition includes: “Legal values for the unit attribute of <period> are s, min, h, d, wk 

and mo representing seconds, minutes, hours, days, weeks, and months respectively.”
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CCD Guidance Excerpts (C32, C83, C80, C154, IHE Patient Care Coordination Technical Framework)

Indication

(O)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:entryRelationship[@typeCode='RSON']/ 8.21 - Indication O/Y 2.2.2.8.18

 cda:observation[cda:templateId/@root= 

 '2.16.840.1.113883.10.20.1.28']

2.2.2.8.18 Indication Constraints 

C83-[DE-8.20-CDA-1] The indication SHALL be recorded using the Indication <observation> 

described in Section 3.9.2.2.1 of the HL7 Continuity of Care Document 

Implementation Guide, and which conforms 

C83-[DE-8.20-CDA-2] The indication <observation> SHALL contain a <text> element that includes 

a <reference> element whose value attribute points to the narrative text 

that is the indication for the medication 

C154-[DE-8.20-1] The indication SHALL be coded as specified in HITSP/C80 Section 2.2.3.1.1 

Problem

C80 2.2.3.1.1: Describes the problem. The SNOMED CT® has been limited 

by HITSP to terms descending from the Clinical Findings (404684003) or 

Situation with Explicit Context (243796009) hierarchies.

Figure 2-36 Indication Example 

<!-- These examples assume the default namespace is 'urn:hl7-org:v3' --> 

<substanceAdministration classCode='SBADM' moodCode='INT'> 

 ... 

 <entryRelationship typeCode="RSON"> 

 <observation classCode="OBS" moodCode="EVN"> 

 <templateId root="2.16.840.1.113883.10.20.1.28"/> 

 <code code='' displayName='' 

 codeSystem='2.16.840.1.113883.6.96' codeSystemName='SNOMED CT'/> 

 <text><reference value="#indication-1"/></text> 

 <statusCode code="completed"/> 

 <effectiveTime value="..."/> 

 </observation> 

 </entryRelationship> 

 ... 

</substanceAdministration> 

Indication 

Precursor Text 

(unknown)

No guidance in C80, C83 IHE PCC Technical Framework Vol. 2 Rev 5.0

Unknown whether supported

Indicate 

Medication 

Stopped

(O)

C83: 2.2.2.8 MEDICATION. Table 2-12 Medication... Data Mapping Table Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:effectiveTime[1]/cda:high 8.02 - Indicate Medication Stopped O/N 2.2.2.8.3

2.2.2.8.3 Indicate Medication Stopped Constraints 

The time at which the medication was stopped is determined based on the 

content of the <high> element of the first <effectiveTime> element.
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CCD Guidance Excerpts (C32, C83, C80, C154, IHE Patient Care Coordination Technical Framework)

Adverse Reaction

Section 2.2.1.2 ALLERGIES AND OTHER ADVERSE REACTIONS SECTION (C32 p22)

The Allergies and Other Adverse Reactions Section contains data on the substance intolerances 

and the associated adverse reactions suffered by the patient. At a minimum, currently active and 

any relevant historical allergies and adverse reactions shall be listed. The template identifier for 

this section is 2.16.840.1.113883.3.88.11.83.102 

C83-[CT-102-1] The allergies and other adverse reactions section SHALL include entries 

from the Allergy/Drug Sensitivity module 

C83-[CT-102-2] This section SHALL conform to the IHE Allergies and Other Adverse 

Reactions Section template, and SHALL contain a templateId element 

whose root attribute is 1.3.6.1.4.1.19376.1.5.3.1.3.13

2.2.2.6.1 Allergy/Drug Sensitivity Module Constraints (C83 p47)

C83-[DE-6-CDA-1] A CDA Document SHALL declare conformance for the Allergy/Drug 

Sensitivity Module by including a <templateID> element with the root 

attribute set to the value 2.16.840.1.113883.3.88.11.83.6 

C83-[DE-6-CDA-2] All allergy entries SHALL conform to the IHE PCC Allergy and Intolerance 

Concern template by including a <templateID> element with the root 

attribute set to the value 1.3.6.1.4.1.19376.1.5.3.1.4.5.3

Type of Allergy 

or Adverse 

Reaction

(R)

C83: Table 2-10 Allergy/Drug Sensitivity Data Mapping Table – Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:code/@code 6.02 - Adverse Event Type R/N 2.2.2.6.2

2.2.2.6.2 Adverse Event Vocabulary Constraints 

C154-[DE-6.02-1] Adverse event types SHALL be coded as specified in HITSP/C80 Section 

2.2.3.4.2 Allergy/Adverse Event Type

C80 2.2.3.4.2: The SNOMED CT has been limited by HITSP to the value set 

reproduced below in Table 2-86 Allergy/Adverse Event Type Value Set 

Definition
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CCD Guidance Excerpts (C32, C83, C80, C154, IHE Patient Care Coordination Technical Framework)

Medication 

product

(R if known)

C83: Table 2-10 Allergy/Drug Sensitivity Data Mapping Table – Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:participant[@typeCode='CSM']/ 6.04 - Product Coded R2/N 2.2.2.6.3

cda:code/@code

2.2.2.6.3 Product Coded Vocabulary Constraints 

C154-[DE-6.04-1] Food and substance allergies SHALL be coded as specified in HITSP/C80 

Section 2.2.3.3.11 Ingredient Name 

C80 2.2.3.3.11: Unique identifiers for active drug ingredient [UNII]

C154-[DE-6.04-2] Allergies to a class of medication SHALL be coded as specified in HITSP/C80 

Section 2.2.3.3.9 Medication Drug Class 

C80 2.2.3.3.9: Shall contain a value descending from the NDF-RT concept 

types of “Mechanism of Action - N0000000223”, “Physiologic Effect -

N0000009802” or “Chemical Structure - N0000000002”`. NUI will be used 

as the concept code

C154-[DE-6.04-3] Allergies to a specific medication SHALL be coded as specified in HITSP/C80 

Section 2.2.3.3.7 Medication Brand Name or HITSP/C80 Section 2.2.3.3.8 

Medication Clinical Drug Names.

C80 2.2.3.3.8: Shall contain RxNorm normal forms for concepts type of 

“Ingredient Name” [term type: SCD] or Generic Packs [term type: GPCK]

Reaction

(R if known)

C83: Table 2-10 Allergy/Drug Sensitivity Data Mapping Table – Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:entryRelationship[@typeCode='MFST']/ 6.06 - Reaction Coded R2/N 2.2.2.6.4

 cda:observation[templateId/@root= 

 '2.16.840.1.113883.10.20.1.54'] 

 cda:value/@code

2.2.2.6.4 Reaction Coded Constraints 

C154-[DE-6.06-1] The reaction SHALL be coded as specified in HITSP/C80 Section 2.2.3.4.1 

Allergy/Adverse Event (Reaction)

C80 2.2.3.4.1: Allergy/Adverse Event (Reaction). This indicates the 

reaction that may be caused by the product or agent. See 2.2.3.1.1 

Problem

C80 2.2.3.1.1: Describes the problem. The SNOMED CT has been limited by 

HITSP to terms descending from the Clinical Findings (404684003) or 

Situation with Explicit Context (243796009) hierarchies.
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CCD Guidance Excerpts (C32, C83, C80, C154, IHE Patient Care Coordination Technical Framework)

Reaction 

Severity 

(R if known)

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:entryRelationship[@typeCode='SUBJ']/ 6.08 - Severity Coded R2/N 2.2.2.6.5

 cda:observation[templateId/@root= 

 '2.16.840.1.113883.10.20.1.55']

 cda:value/@code

2.2.2.6.5 Severity Coded Constraints 

C154-[DE-6.08-1] The severity of the adverse event SHALL be coded as specified in 

HITSP/C80 Section 2.2.3.4.3 Allergy/Adverse Event Severity

C80 2.2.3.4.3: Allergy/Adverse Event Severity. This is a description of the 

level of the severity of the allergy or intolerance. See 2.2.3.1.6 Problem 

Severity

C80 2.2.3.1.6: The SNOMED CT has been limited by HITSP to the value set 

reproduced below in Table 2-67 Problem Severity Value Set Definition. 

These terms descend from the severities (272141005) concept

Problem / 

Condition

Section 2.2.1.3 PROBLEM LIST SECTION 

The Problem List Section contains data on the problems currently being monitored for the 

patient. The template identifier for this section is 2.16.840.1.113883.3.88.11.83.103 

C83-[CT-103-1] The problem list section SHALL include entries from the Condition module 

C83-[CT-103-2] This section SHALL conform to the IHE Active Problems Section template, 

and SHALL contain a templateId element whose root attribute is 

1.3.6.1.4.1.19376.1.5.3.1.3.6

Condition Module: The template identifier for this module is 2.16.840.1.113883.3.88.11.83.7

cda:act[cda:templateId/@root= 

 '2.16.840.1.113883.10.20.1.27']/ 

 cda:entryRelationship[@typeCode='SUBJ']/

Diagnosis 

Priority

(R if known)

C83: Table 2-11 Conditions Data Mapping Table – Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:sequenceNumber 7.10 Diagnosis Priority R2/N
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CCD Guidance Excerpts (C32, C83, C80, C154, IHE Patient Care Coordination Technical Framework)

Problem Type

(R if known)

C83: Table 2-11 Conditions Data Mapping Table – Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:code/@code 7.02 - Problem Type R2/N 2.2.2.7.3

2.2.2.7.3 Problem Type Constraints 

C154-[DE-7.02-1] The problem type SHALL be coded as specified in HITSP/C80 Section 

2.2.3.1.2 Problem Type

C80 2.2.3.1.2: The SNOMED CT has been limited by HITSP to the value set 

reproduced below in Table 2-60 Problem Type Value Set Definition. This 

indicates the level of medical judgment used to determine the existence of 

a problem

Figure 2-23 Problem Type Example 

<!-- These examples assume the default namespace is 'urn:hl7-org:v3' --> 

<observation classCode='OBS' moodCode='EVN'> 

 <templateId root='2.16.840.1.113883.10.20.1.28'/> 

 ... 

 <code code='404684003' displayName='Finding' 

 codeSystem='2.16.840.1.113883.96' codeSystemName='SNOMED CT'/> 

 ... 
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CCD Guidance Excerpts (C32, C83, C80, C154, IHE Patient Care Coordination Technical Framework)

Problem 

Name

(Name: R

Code: O)

C83: Table 2-11 Conditions Data Mapping Table – Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:value/@code 7.04 - Problem Code O/N 2.2.2.7.5

2.2.2.7.5 Problem Code Constraints 

C154-[DE-7.04-1] If the code attribute is present, the problem SHALL be coded as specified in 

HITSP/C80 Section 2.2.3.1.1 Problem

C80 2.2.3.1.1: Describes the problem. The SNOMED CT® has been limited 

by HITSP to terms descending from the Clinical Findings (404684003) or 

Situation with Explicit Context (243796009) hierarchies.

Figure 2-25 Problem Code Example 

<!-- These examples assume the default namespace is 'urn:hl7-org:v3' --> 

<observation classCode='OBS' moodCode='EVN'> 

 <templateId root='2.16.840.1.113883.10.20.1.28'/> 

 ... 

 <value xsi:type='CD' code='37796009' displayName='Migraine' 

 codeSystem='2.16.840.1.113883.96' codeSystemName='SNOMED CT'/> 

</observation> 

NOTE: Meaningful Use rules allow... (from Table 2A, 45 CFR Part 170)

Stage 1: Applicable HIPAA code set required by law (i.e.,ICD-9-CM); or SNOMED CT®

Stage 2: Applicable HIPAA code set required by law (e.g.,ICD-10-CM) or SNOMED CT®
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CCD Guidance Excerpts (C32, C83, C80, C154, IHE Patient Care Coordination Technical Framework)

Problem 

Status

(O)

C83: Table 2-11 Conditions Data Mapping Table – Requirements

CDA Data Location HITSP Data Element ID/Name Opt Constraint

cda:entryRelationship/cda:observation 7.12 - Problem Status O/N 2.2.2.18.17

 [cda:templateId/@root = 

 '2.16.840.1.113883.10.20.1.50']/ 

 value/@code

2.2.2.18.17 Family Member Problem Status 

The problem status records whether the indicated problem is active, inactive, or resolved.

C83-[DE-18.25-CDA-1] A problem status observation SHALL conform to the CCD Templates 

2.16.840.1.113883.10.20.1.50 and 2.16.840.1.113883.10.20.1.57. 

C83-[DE-18.25-CDA-2] A problem status observation SHALL conform to the IHE Template 

1.3.6.1.4.1.19376.1.5.3.1.4.1.1 for problem status. 

C154-[DE-18.23-1] The problem SHALL be coded as specified in HITSP/C80 Section 2.2.3.1.1 

Problem Status [typo: Should be 2.2.3.1.8]

C80 2.2.3.1.8: Shall contain a SNOMED Code from Table 2-70 Problem 

Status Value Set Definition.

Figure 2-54 Problem Status Example 

<entryRelationship typeCode='REFR'> 

 <observation classCode='OBS' moodCode='EVN'> 

 <templateId root='2.16.840.1.113883.10.20.1.50'/> 

 <templateId root='2.16.840.1.113883.10.20.1.57'/> 

 <templateId root='1.3.6.1.4.1.19376.1.5.3.1.4.1.1'/> 

 <code code='33999-4' displayName='Status' 

 codeSystem='2.16.840.1.113883.6.1' codeSystemName='LOINC'/> 

 <text><reference value='#cstatus-2'/></text> 

 <statusCode code='completed'/> 

 <value xsi:type='CD' code='55561003' displayName='Active' 

 codeSystem='2.16.840.1.113883.6.96' codeSystemName='SNOMED CT'/> 

 </observation> 

</entryRelationship>