Release 4B 5

This page is part of the FHIR Specification (v4.3.0: R4B (v5.0.0: R5 - STU ). The This is the current published version which supercedes in it's permanent home (it will always be available at this version is 5.0.0 . URL). For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R5 R4B R4

Plandefinition-opioidcds-10.ttl

Example PlanDefinition/opioidcds-10 (Turtle)

Clinical Decision Support Work Group Maturity Level : N/A Standards Status : Informative Compartments : Not linked to any No defined compartments

Raw Turtle (+ also see Turtle/RDF Format Specification )

Opioid CDS Recommendation 10 ECA Rule 

@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .

@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix sct: <http://snomed.info/sct/> .

@prefix sct: <http://snomed.info/id/> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .


# - resource -------------------------------------------------------------------

[] a fhir:PlanDefinition;
  fhir:Resource.id [ fhir:value "opioidcds-10"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ]
  ];
  fhir:PlanDefinition.url [ fhir:value "http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-10"];
  fhir:PlanDefinition.identifier [
     fhir:index 0;
     fhir:Identifier.use [ fhir:value "official" ];
     fhir:Identifier.value [ fhir:value "cdc-opioid-guidance" ]
  ];
  fhir:PlanDefinition.version [ fhir:value "0.1.0"];
  fhir:PlanDefinition.name [ fhir:value "cdc-opioid-10"];
  fhir:PlanDefinition.title [ fhir:value "CDC Opioid Prescribing Guideline Recommendation #10"];
  fhir:PlanDefinition.type [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/plan-definition-type" ];
       fhir:Coding.code [ fhir:value "eca-rule" ];
       fhir:Coding.display [ fhir:value "ECA Rule" ]
     ]
  ];
  fhir:PlanDefinition.status [ fhir:value "draft"];
  fhir:PlanDefinition.experimental [ fhir:value "true"];
  fhir:PlanDefinition.date [ fhir:value "2017-04-23"];
  fhir:PlanDefinition.publisher [ fhir:value "Centers for Disease Control and Prevention (CDC)"];
  fhir:PlanDefinition.description [ fhir:value "When prescribing opioids for chronic pain, providers should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs."];
  fhir:PlanDefinition.useContext [
     fhir:index 0;
     fhir:UsageContext.code [
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/usage-context-type" ];
       fhir:Coding.code [ fhir:value "focus" ];
       fhir:Coding.display [ fhir:value "Clinical Focus" ]
     ];
     fhir:UsageContext.value [
       a sct:182888003;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         a sct:182888003;
         fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
         fhir:Coding.code [ fhir:value "182888003" ];
         fhir:Coding.display [ fhir:value "Medication requested (situation)" ]
       ]
     ]
  ], [
     fhir:index 1;
     fhir:UsageContext.code [
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/usage-context-type" ];
       fhir:Coding.code [ fhir:value "focus" ];
       fhir:Coding.display [ fhir:value "Clinical Focus" ]
     ];
     fhir:UsageContext.value [
       a sct:82423001;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         a sct:82423001;
         fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
         fhir:Coding.code [ fhir:value "82423001" ];
         fhir:Coding.display [ fhir:value "Chronic pain (finding)" ]
       ]

[a fhir:PlanDefinition ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "opioidcds-10"] ; # 
  fhir:text [
     fhir:status [ fhir:v "generated" ] ;
     fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: PlanDefinition</b><a name=\"opioidcds-10\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource PlanDefinition &quot;opioidcds-10&quot; </p></div><p><b>url</b>: <code>http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-10</code></p><p><b>identifier</b>: id: urn:oid:2.16.840.1.113883.4.642.11.3, id: cdc-opioid-guidance (use: OFFICIAL)</p><p><b>version</b>: 0.1.0</p><p><b>name</b>: Cdcopioid10</p><p><b>title</b>: CDC Opioid Prescribing Guideline Recommendation #10</p><p><b>type</b>: ECA Rule <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.1.0/CodeSystem-plan-definition-type.html\">PlanDefinitionType</a>#eca-rule)</span></p><p><b>status</b>: draft</p><p><b>date</b>: 2017-04-23</p><p><b>publisher</b>: Centers for Disease Control and Prevention (CDC)</p><p><b>description</b>: When prescribing opioids for chronic pain, providers should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs.</p><h3>UseContexts</h3><table class=\"grid\"><tr><td>-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')</td><td>Medication requested (situation) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#182888003)</span></td></tr><tr><td>*</td><td>Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')</td><td>Chronic pain (finding) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#82423001)</span></td></tr></table><p><b>jurisdiction</b>: United States of America <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.1.0/CodeSystem-ISO3166Part1.html\">ISO 3166-1 Codes for the representation of names of countries and their subdivisions — Part 1: Country code</a>#US)</span></p><p><b>purpose</b>: CDC’s Guideline for Prescribing Opioids for Chronic Pain is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder and overdose. The Guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care.</p><p><b>usage</b>: Providers should be aware if patients are taking other prescription drugs or illicit drugs that might increase their risk of an overdose.</p><p><b>copyright</b>: © CDC 2016+.</p><p><b>topic</b>: Opioid Prescribing <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ()</span></p><p><b>author</b>: Kensaku Kawamoto, MD, PhD, MHS: , Bryn Rhodes: , Floyd Eisenberg, MD, MPH: , Robert McClure, MD, MPH: </p><blockquote><p><b>relatedArtifact</b></p><p><b>type</b>: documentation</p><p><b>display</b>: CDC guideline for prescribing opioids for chronic pain</p><blockquote><p><b>document</b></p></blockquote></blockquote><p><b>library</b>: <a href=\"http://example.org/fhir/Library/opioidcds-recommendation-10\">http://example.org/fhir/Library/opioidcds-recommendation-10</a></p><blockquote><p><b>action</b></p><p><b>title</b>: Annual Urine Screening Check</p><p><b>description</b>: Patient has not had a urine screening in the past 12 months</p><blockquote><p><b>documentation</b></p><p><b>type</b>: documentation</p><blockquote><p><b>document</b></p></blockquote></blockquote><h3>Triggers</h3><table class=\"grid\"><tr><td>-</td><td><b>Type</b></td><td><b>Name</b></td></tr><tr><td>*</td><td>named-event</td><td>medication-prescribe</td></tr></table><blockquote><p><b>condition</b></p><p><b>kind</b>: applicability</p><h3>Expressions</h3><table class=\"grid\"><tr><td>-</td><td><b>Description</b></td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td>*</td><td>Patient has not had a urine screening in the past 12 months</td><td>text/cql</td><td>No Screenings in Past Year</td></tr></table></blockquote><blockquote><p><b>dynamicValue</b></p><p><b>path</b>: activity.extension</p><h3>Expressions</h3><table class=\"grid\"><tr><td>-</td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td>*</td><td>text/cql</td><td>Get Indicator</td></tr></table></blockquote><h3>Actions</h3><table class=\"grid\"><tr><td>-</td><td><b>Description</b></td></tr><tr><td>*</td><td>Will perform urine screening</td></tr><tr><td>*</td><td>Not for chronic pain management. Snooze 3 months</td></tr></table></blockquote><blockquote><p><b>action</b></p><p><b>title</b>: Positive Urine Screening Check</p><p><b>description</b>: Patient has a urine screening testing positive for either unprescribed opioids or illicit drugs in the past 12 months</p><blockquote><p><b>documentation</b></p><p><b>type</b>: documentation</p><blockquote><p><b>document</b></p></blockquote></blockquote><blockquote><p><b>condition</b></p><p><b>kind</b>: applicability</p><h3>Expressions</h3><table class=\"grid\"><tr><td>-</td><td><b>Description</b></td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td>*</td><td>Patient has a positive urine screening in the past 12 months</td><td>text/cql</td><td>Has Positive Screening?</td></tr></table></blockquote><blockquote><p><b>action</b></p><p><b>title</b>: Unprescribed Opioids Found In Urine Screening</p><p><b>description</b>: Patient has a positive urine screening in the past 12 months for opioid(s), which is not prescribed</p><blockquote><p><b>documentation</b></p></blockquote><blockquote><p><b>condition</b></p></blockquote><blockquote><p><b>dynamicValue</b></p></blockquote><blockquote><p><b>dynamicValue</b></p></blockquote><blockquote><p><b>action</b></p></blockquote></blockquote><blockquote><p><b>action</b></p><p><b>title</b>: Prescribed Opioids Not Found In Urine Screening</p><p><b>description</b>: Patient has a positive urine screening in the past 12 months, which does not include prescribed opioids</p><blockquote><p><b>documentation</b></p></blockquote><blockquote><p><b>condition</b></p></blockquote><blockquote><p><b>dynamicValue</b></p></blockquote><blockquote><p><b>dynamicValue</b></p></blockquote></blockquote><blockquote><p><b>action</b></p><p><b>title</b>: Illicit Drugs Found In Urine Screening</p><p><b>description</b>: Patient has a positive urine screening in the past 12 months for illicit drugs</p><blockquote><p><b>documentation</b></p></blockquote><blockquote><p><b>condition</b></p></blockquote><blockquote><p><b>dynamicValue</b></p></blockquote><blockquote><p><b>dynamicValue</b></p></blockquote><blockquote><p><b>action</b></p></blockquote></blockquote></blockquote></div>"
  ] ; # 
  fhir:url [ fhir:v "http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-10"^^xsd:anyURI] ; # 
  fhir:identifier ( [
     fhir:system [ fhir:v "urn:ietf:rfc:3986"^^xsd:anyURI ] ;
     fhir:value [ fhir:v "urn:oid:2.16.840.1.113883.4.642.11.3" ]
  ] [
     fhir:use [ fhir:v "official" ] ;
     fhir:value [ fhir:v "cdc-opioid-guidance" ]
  ] ) ; # 
  fhir:version [ fhir:v "0.1.0"] ; # 
  fhir:name [ fhir:v "Cdcopioid10"] ; # 
  fhir:title [ fhir:v "CDC Opioid Prescribing Guideline Recommendation #10"] ; # 
  fhir:type [
     fhir:coding ( [
       fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/plan-definition-type"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "eca-rule" ] ;
       fhir:display [ fhir:v "ECA Rule" ]
     ] )
  ] ; # 
  fhir:status [ fhir:v "draft"] ; # 
  fhir:date [ fhir:v "2017-04-23"^^xsd:date] ; # 
  fhir:publisher [ fhir:v "Centers for Disease Control and Prevention (CDC)"] ; # 
  fhir:description [ fhir:v "When prescribing opioids for chronic pain, providers should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs."] ; # 
  fhir:useContext ( [
     fhir:code [
       fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/usage-context-type"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "focus" ] ;
       fhir:display [ fhir:v "Clinical Focus" ]
     ] ;
     fhir:value [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         a sct:182888003 ;
         fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "182888003" ] ;
         fhir:display [ fhir:v "Medication requested (situation)" ]
       ] )

     ]
  ];
  fhir:PlanDefinition.jurisdiction [
     fhir:index 0;
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "urn:iso:std:iso:3166" ];
       fhir:Coding.code [ fhir:value "US" ];
       fhir:Coding.display [ fhir:value "United States of America" ]

  ] [
     fhir:code [
       fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/usage-context-type"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "focus" ] ;
       fhir:display [ fhir:v "Clinical Focus" ]
     ] ;
     fhir:value [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         a sct:82423001 ;
         fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "82423001" ] ;
         fhir:display [ fhir:v "Chronic pain (finding)" ]
       ] )

     ]
  ];
  fhir:PlanDefinition.purpose [ fhir:value "CDC’s Guideline for Prescribing Opioids for Chronic Pain is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder and overdose. The Guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care."];
  fhir:PlanDefinition.usage [ fhir:value "Providers should be aware if patients are taking other prescription drugs or illicit drugs that might increase their risk of an overdose."];
  fhir:PlanDefinition.copyright [ fhir:value "© CDC 2016+."];
  fhir:PlanDefinition.topic [
     fhir:index 0;
     fhir:CodeableConcept.text [ fhir:value "Opioid Prescribing" ]
  ];
  fhir:PlanDefinition.author [
     fhir:index 0;
     fhir:ContactDetail.name [ fhir:value "Kensaku Kawamoto, MD, PhD, MHS" ]
  ], [
     fhir:index 1;
     fhir:ContactDetail.name [ fhir:value "Bryn Rhodes" ]
  ], [
     fhir:index 2;
     fhir:ContactDetail.name [ fhir:value "Floyd Eisenberg, MD, MPH" ]
  ], [
     fhir:index 3;
     fhir:ContactDetail.name [ fhir:value "Robert McClure, MD, MPH" ]
  ];
  fhir:PlanDefinition.relatedArtifact [
     fhir:index 0;
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.display [ fhir:value "CDC guideline for prescribing opioids for chronic pain" ];
     fhir:RelatedArtifact.url [ fhir:value "https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pain---united-states-2016#420" ];
     fhir:RelatedArtifact.document [
       fhir:Attachment.url [ fhir:value "https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pain---united-states-2016#420" ]

  ] ) ; # 
  fhir:jurisdiction ( [
     fhir:coding ( [
       fhir:system [ fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "US" ] ;
       fhir:display [ fhir:v "United States of America" ]
     ] )
  ] ) ; # 
  fhir:purpose [ fhir:v "CDC’s Guideline for Prescribing Opioids for Chronic Pain is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder and overdose. The Guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care."] ; # 
  fhir:usage [ fhir:v "Providers should be aware if patients are taking other prescription drugs or illicit drugs that might increase their risk of an overdose."] ; # 
  fhir:copyright [ fhir:v "© CDC 2016+."] ; # 
  fhir:topic ( [
     fhir:text [ fhir:v "Opioid Prescribing" ]
  ] ) ; # 
  fhir:author ( [
     fhir:name [ fhir:v "Kensaku Kawamoto, MD, PhD, MHS" ]
  ] [
     fhir:name [ fhir:v "Bryn Rhodes" ]
  ] [
     fhir:name [ fhir:v "Floyd Eisenberg, MD, MPH" ]
  ] [
     fhir:name [ fhir:v "Robert McClure, MD, MPH" ]
  ] ) ; # 
  fhir:relatedArtifact ( [
     fhir:type [ fhir:v "documentation" ] ;
     fhir:display [ fhir:v "CDC guideline for prescribing opioids for chronic pain" ] ;
     fhir:document [
       fhir:url [ fhir:v "https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pain---united-states-2016#420"^^xsd:anyURI ]

     ]
  ];
  fhir:PlanDefinition.library [
     fhir:value "http://example.org/fhir/Library/opioidcds-recommendation-10";
     fhir:index 0
  ];
  fhir:PlanDefinition.action [
     fhir:index 0;
     fhir:PlanDefinition.title [ fhir:value "Annual Urine Screening Check" ];
     fhir:PlanDefinition.description [ fhir:value "Patient has not had a urine screening in the past 12 months" ];
     fhir:PlanDefinition.documentation [
       fhir:index 0;
       fhir:RelatedArtifact.type [ fhir:value "documentation" ];
       fhir:RelatedArtifact.document [
         fhir:Element.extension [
           fhir:index 0;
           fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation" ];
           fhir:Extension.value [
             fhir:CodeableConcept.coding [
               fhir:index 0;
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/recommendation-strength" ];
               fhir:Coding.code [ fhir:value "strong" ];
               fhir:Coding.display [ fhir:value "Strong" ]
             ]

  ] ) ; # 
  fhir:library ( [
     fhir:v "http://example.org/fhir/Library/opioidcds-recommendation-10"^^xsd:anyURI ;
     fhir:link <http://example.org/fhir/Library/opioidcds-recommendation-10>
  ] ) ; # 
  fhir:action ( [
     fhir:title [ fhir:v "Annual Urine Screening Check" ] ;
     fhir:description [ fhir:v "Patient has not had a urine screening in the past 12 months" ] ;
     fhir:documentation ( [
       fhir:type [ fhir:v "documentation" ] ;
       fhir:document [
         fhir:extension ( [
           fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation"^^xsd:anyURI ] ;
           fhir:value [
             a fhir:CodeableConcept ;
             fhir:coding ( [
               fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/recommendation-strength"^^xsd:anyURI ] ;
               fhir:code [ fhir:v "strong" ] ;
               fhir:display [ fhir:v "Strong" ]
             ] )

           ]
         ], [
           fhir:index 1;
           fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence" ];
           fhir:Extension.value [
             fhir:CodeableConcept.coding [
               fhir:index 0;
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/evidence-quality" ];
               fhir:Coding.code [ fhir:value "low" ];
               fhir:Coding.display [ fhir:value "Low quality" ]
             ]

         ] [
           fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence"^^xsd:anyURI ] ;
           fhir:value [
             a fhir:CodeableConcept ;
             fhir:coding ( [
               fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/evidence-quality"^^xsd:anyURI ] ;
               fhir:code [ fhir:v "low" ] ;
               fhir:display [ fhir:v "Low quality" ]
             ] )

           ]
         ]

         ] )

       ]
     ];
     fhir:PlanDefinition.trigger [
       fhir:index 0;
       fhir:TriggerDefinition.type [ fhir:value "named-event" ];
       fhir:TriggerDefinition.name [ fhir:value "medication-prescribe" ]
     ];
     fhir:PlanDefinition.condition [
       fhir:index 0;
       fhir:PlanDefinition.kind [ fhir:value "applicability" ];
       fhir:PlanDefinition.expression [
         fhir:Expression.description [ fhir:value "Patient has not had a urine screening in the past 12 months" ];
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "No Screenings in Past Year" ]

     ] ) ;
     fhir:trigger ( [
       fhir:type [ fhir:v "named-event" ] ;
       fhir:name [ fhir:v "medication-prescribe" ]
     ] ) ;
     fhir:condition ( [
       fhir:kind [ fhir:v "applicability" ] ;
       fhir:expression [
         fhir:description [ fhir:v "Patient has not had a urine screening in the past 12 months" ] ;
         fhir:language [ fhir:v "text/cql" ] ;
         fhir:expression [ fhir:v "No Screenings in Past Year" ]

       ]
     ];
     fhir:PlanDefinition.dynamicValue [
       fhir:index 0;
       fhir:PlanDefinition.path [ fhir:value "activity.extension" ];
       fhir:PlanDefinition.expression [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "Get Indicator" ]

     ] ) ;
     fhir:dynamicValue ( [
       fhir:path [ fhir:v "activity.extension" ] ;
       fhir:expression [
         fhir:language [ fhir:v "text/cql" ] ;
         fhir:expression [ fhir:v "Get Indicator" ]

       ]
     ];
     fhir:PlanDefinition.action [
       fhir:index 0;
       fhir:PlanDefinition.description [ fhir:value "Will perform urine screening" ]
     ], [
       fhir:index 1;
       fhir:PlanDefinition.description [ fhir:value "Not for chronic pain management. Snooze 3 months" ]
     ]
  ], [
     fhir:index 1;
     fhir:PlanDefinition.title [ fhir:value "Positive Urine Screening Check" ];
     fhir:PlanDefinition.description [ fhir:value "Patient has a urine screening testing positive for either unprescribed opioids or illicit drugs in the past 12 months" ];
     fhir:PlanDefinition.documentation [
       fhir:index 0;
       fhir:RelatedArtifact.type [ fhir:value "documentation" ];
       fhir:RelatedArtifact.document [
         fhir:Element.extension [
           fhir:index 0;
           fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation" ];
           fhir:Extension.value [
             fhir:CodeableConcept.coding [
               fhir:index 0;
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/recommendation-strength" ];
               fhir:Coding.code [ fhir:value "strong" ];
               fhir:Coding.display [ fhir:value "Strong" ]
             ]

     ] ) ;
     fhir:action ( [
       fhir:description [ fhir:v "Will perform urine screening" ]
     ] [
       fhir:description [ fhir:v "Not for chronic pain management. Snooze 3 months" ]
     ] )
  ] [
     fhir:title [ fhir:v "Positive Urine Screening Check" ] ;
     fhir:description [ fhir:v "Patient has a urine screening testing positive for either unprescribed opioids or illicit drugs in the past 12 months" ] ;
     fhir:documentation ( [
       fhir:type [ fhir:v "documentation" ] ;
       fhir:document [
         fhir:extension ( [
           fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation"^^xsd:anyURI ] ;
           fhir:value [
             a fhir:CodeableConcept ;
             fhir:coding ( [
               fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/recommendation-strength"^^xsd:anyURI ] ;
               fhir:code [ fhir:v "strong" ] ;
               fhir:display [ fhir:v "Strong" ]
             ] )

           ]
         ], [
           fhir:index 1;
           fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence" ];
           fhir:Extension.value [
             fhir:CodeableConcept.coding [
               fhir:index 0;
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/evidence-quality" ];
               fhir:Coding.code [ fhir:value "low" ];
               fhir:Coding.display [ fhir:value "Low quality" ]
             ]

         ] [
           fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence"^^xsd:anyURI ] ;
           fhir:value [
             a fhir:CodeableConcept ;
             fhir:coding ( [
               fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/evidence-quality"^^xsd:anyURI ] ;
               fhir:code [ fhir:v "low" ] ;
               fhir:display [ fhir:v "Low quality" ]
             ] )

           ]
         ]

         ] )

       ]
     ];
     fhir:PlanDefinition.condition [
       fhir:index 0;
       fhir:PlanDefinition.kind [ fhir:value "applicability" ];
       fhir:PlanDefinition.expression [
         fhir:Expression.description [ fhir:value "Patient has a positive urine screening in the past 12 months" ];
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "Has Positive Screening?" ]

     ] ) ;
     fhir:condition ( [
       fhir:kind [ fhir:v "applicability" ] ;
       fhir:expression [
         fhir:description [ fhir:v "Patient has a positive urine screening in the past 12 months" ] ;
         fhir:language [ fhir:v "text/cql" ] ;
         fhir:expression [ fhir:v "Has Positive Screening?" ]

       ]
     ];
     fhir:PlanDefinition.action [
       fhir:index 0;
       fhir:PlanDefinition.title [ fhir:value "Unprescribed Opioids Found In Urine Screening" ];
       fhir:PlanDefinition.description [ fhir:value "Patient has a positive urine screening in the past 12 months for opioid(s), which is not prescribed" ];
       fhir:PlanDefinition.documentation [
         fhir:index 0;
         fhir:RelatedArtifact.type [ fhir:value "documentation" ];
         fhir:RelatedArtifact.document [
           fhir:Element.extension [
             fhir:index 0;
             fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation" ];
             fhir:Extension.value [
               fhir:CodeableConcept.coding [
                 fhir:index 0;
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/recommendation-strength" ];
                 fhir:Coding.code [ fhir:value "strong" ];
                 fhir:Coding.display [ fhir:value "Strong" ]
               ]

     ] ) ;
     fhir:action ( [
       fhir:title [ fhir:v "Unprescribed Opioids Found In Urine Screening" ] ;
       fhir:description [ fhir:v "Patient has a positive urine screening in the past 12 months for opioid(s), which is not prescribed" ] ;
       fhir:documentation ( [
         fhir:type [ fhir:v "documentation" ] ;
         fhir:document [
           fhir:extension ( [
             fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation"^^xsd:anyURI ] ;
             fhir:value [
               a fhir:CodeableConcept ;
               fhir:coding ( [
                 fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/recommendation-strength"^^xsd:anyURI ] ;
                 fhir:code [ fhir:v "strong" ] ;
                 fhir:display [ fhir:v "Strong" ]
               ] )

             ]
           ], [
             fhir:index 1;
             fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence" ];
             fhir:Extension.value [
               fhir:CodeableConcept.coding [
                 fhir:index 0;
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/evidence-quality" ];
                 fhir:Coding.code [ fhir:value "low" ];
                 fhir:Coding.display [ fhir:value "Low quality" ]
               ]

           ] [
             fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence"^^xsd:anyURI ] ;
             fhir:value [
               a fhir:CodeableConcept ;
               fhir:coding ( [
                 fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/evidence-quality"^^xsd:anyURI ] ;
                 fhir:code [ fhir:v "low" ] ;
                 fhir:display [ fhir:v "Low quality" ]
               ] )

             ]
           ]

           ] )

         ]
       ];
       fhir:PlanDefinition.condition [
         fhir:index 0;
         fhir:PlanDefinition.kind [ fhir:value "applicability" ];
         fhir:PlanDefinition.expression [
           fhir:Expression.description [ fhir:value "Patient has a positive urine screening in the past 12 months for opioid(s), which is not prescribed" ];
           fhir:Expression.language [ fhir:value "text/cql" ];
           fhir:Expression.expression [ fhir:value "Has Unprescribed Opioids?" ]

       ] ) ;
       fhir:condition ( [
         fhir:kind [ fhir:v "applicability" ] ;
         fhir:expression [
           fhir:description [ fhir:v "Patient has a positive urine screening in the past 12 months for opioid(s), which is not prescribed" ] ;
           fhir:language [ fhir:v "text/cql" ] ;
           fhir:expression [ fhir:v "Has Unprescribed Opioids?" ]

         ]
       ];
       fhir:PlanDefinition.dynamicValue [
         fhir:index 0;
         fhir:PlanDefinition.path [ fhir:value "activity.extension" ];
         fhir:PlanDefinition.expression [
           fhir:Expression.language [ fhir:value "text/cql" ];
           fhir:Expression.expression [ fhir:value "Get Indicator" ]

       ] ) ;
       fhir:dynamicValue ( [
         fhir:path [ fhir:v "activity.extension" ] ;
         fhir:expression [
           fhir:language [ fhir:v "text/cql" ] ;
           fhir:expression [ fhir:v "Get Indicator" ]

         ]
       ], [
         fhir:index 1;
         fhir:PlanDefinition.path [ fhir:value "action.description" ];
         fhir:PlanDefinition.expression [
           fhir:Expression.language [ fhir:value "text/cql" ];
           fhir:Expression.expression [ fhir:value "Inconsistent Unprescribed Opioids" ]

       ] [
         fhir:path [ fhir:v "action.description" ] ;
         fhir:expression [
           fhir:language [ fhir:v "text/cql" ] ;
           fhir:expression [ fhir:v "Inconsistent Unprescribed Opioids" ]

         ]
       ];
       fhir:PlanDefinition.action [
         fhir:index 0;
         fhir:PlanDefinition.description [ fhir:value "Not for chronic pain management. Snooze 3 months" ]
       ]
     ], [
       fhir:index 1;
       fhir:PlanDefinition.title [ fhir:value "Prescribed Opioids Not Found In Urine Screening" ];
       fhir:PlanDefinition.description [ fhir:value "Patient has a positive urine screening in the past 12 months, which does not include prescribed opioids" ];
       fhir:PlanDefinition.documentation [
         fhir:index 0;
         fhir:RelatedArtifact.type [ fhir:value "documentation" ];
         fhir:RelatedArtifact.document [
           fhir:Element.extension [
             fhir:index 0;
             fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation" ];
             fhir:Extension.value [
               fhir:CodeableConcept.coding [
                 fhir:index 0;
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/recommendation-strength" ];
                 fhir:Coding.code [ fhir:value "strong" ];
                 fhir:Coding.display [ fhir:value "Strong" ]
               ]

       ] ) ;
       fhir:action ( [
         fhir:description [ fhir:v "Not for chronic pain management. Snooze 3 months" ]
       ] )
     ] [
       fhir:title [ fhir:v "Prescribed Opioids Not Found In Urine Screening" ] ;
       fhir:description [ fhir:v "Patient has a positive urine screening in the past 12 months, which does not include prescribed opioids" ] ;
       fhir:documentation ( [
         fhir:type [ fhir:v "documentation" ] ;
         fhir:document [
           fhir:extension ( [
             fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation"^^xsd:anyURI ] ;
             fhir:value [
               a fhir:CodeableConcept ;
               fhir:coding ( [
                 fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/recommendation-strength"^^xsd:anyURI ] ;
                 fhir:code [ fhir:v "strong" ] ;
                 fhir:display [ fhir:v "Strong" ]
               ] )

             ]
           ], [
             fhir:index 1;
             fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence" ];
             fhir:Extension.value [
               fhir:CodeableConcept.coding [
                 fhir:index 0;
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/evidence-quality" ];
                 fhir:Coding.code [ fhir:value "low" ];
                 fhir:Coding.display [ fhir:value "Low quality" ]
               ]

           ] [
             fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence"^^xsd:anyURI ] ;
             fhir:value [
               a fhir:CodeableConcept ;
               fhir:coding ( [
                 fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/evidence-quality"^^xsd:anyURI ] ;
                 fhir:code [ fhir:v "low" ] ;
                 fhir:display [ fhir:v "Low quality" ]
               ] )

             ]
           ]

           ] )

         ]
       ];
       fhir:PlanDefinition.condition [
         fhir:index 0;
         fhir:PlanDefinition.kind [ fhir:value "applicability" ];
         fhir:PlanDefinition.expression [
           fhir:Expression.description [ fhir:value "Patient has a positive urine screening in the past 12 months, which does not include prescribed opioids" ];
           fhir:Expression.language [ fhir:value "text/cql" ];
           fhir:Expression.expression [ fhir:value "Has Missing Opioids?" ]

       ] ) ;
       fhir:condition ( [
         fhir:kind [ fhir:v "applicability" ] ;
         fhir:expression [
           fhir:description [ fhir:v "Patient has a positive urine screening in the past 12 months, which does not include prescribed opioids" ] ;
           fhir:language [ fhir:v "text/cql" ] ;
           fhir:expression [ fhir:v "Has Missing Opioids?" ]

         ]
       ];
       fhir:PlanDefinition.dynamicValue [
         fhir:index 0;
         fhir:PlanDefinition.path [ fhir:value "activity.extension" ];
         fhir:PlanDefinition.expression [
           fhir:Expression.language [ fhir:value "text/cql" ];
           fhir:Expression.expression [ fhir:value "Get Indicator" ]

       ] ) ;
       fhir:dynamicValue ( [
         fhir:path [ fhir:v "activity.extension" ] ;
         fhir:expression [
           fhir:language [ fhir:v "text/cql" ] ;
           fhir:expression [ fhir:v "Get Indicator" ]

         ]
       ], [
         fhir:index 1;
         fhir:PlanDefinition.path [ fhir:value "action.description" ];
         fhir:PlanDefinition.expression [
           fhir:Expression.language [ fhir:value "text/cql" ];
           fhir:Expression.expression [ fhir:value "Inconsistent Missing Opioids" ]

       ] [
         fhir:path [ fhir:v "action.description" ] ;
         fhir:expression [
           fhir:language [ fhir:v "text/cql" ] ;
           fhir:expression [ fhir:v "Inconsistent Missing Opioids" ]

         ]
       ]
     ], [
       fhir:index 2;
       fhir:PlanDefinition.title [ fhir:value "Illicit Drugs Found In Urine Screening" ];
       fhir:PlanDefinition.description [ fhir:value "Patient has a positive urine screening in the past 12 months for illicit drugs" ];
       fhir:PlanDefinition.documentation [
         fhir:index 0;
         fhir:RelatedArtifact.type [ fhir:value "documentation" ];
         fhir:RelatedArtifact.document [
           fhir:Element.extension [
             fhir:index 0;
             fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation" ];
             fhir:Extension.value [
               fhir:CodeableConcept.coding [
                 fhir:index 0;
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/recommendation-strength" ];
                 fhir:Coding.code [ fhir:value "strong" ];
                 fhir:Coding.display [ fhir:value "Strong" ]
               ]

       ] )
     ] [
       fhir:title [ fhir:v "Illicit Drugs Found In Urine Screening" ] ;
       fhir:description [ fhir:v "Patient has a positive urine screening in the past 12 months for illicit drugs" ] ;
       fhir:documentation ( [
         fhir:type [ fhir:v "documentation" ] ;
         fhir:document [
           fhir:extension ( [
             fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation"^^xsd:anyURI ] ;
             fhir:value [
               a fhir:CodeableConcept ;
               fhir:coding ( [
                 fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/recommendation-strength"^^xsd:anyURI ] ;
                 fhir:code [ fhir:v "strong" ] ;
                 fhir:display [ fhir:v "Strong" ]
               ] )

             ]
           ], [
             fhir:index 1;
             fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence" ];
             fhir:Extension.value [
               fhir:CodeableConcept.coding [
                 fhir:index 0;
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/evidence-quality" ];
                 fhir:Coding.code [ fhir:value "low" ];
                 fhir:Coding.display [ fhir:value "Low quality" ]
               ]

           ] [
             fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence"^^xsd:anyURI ] ;
             fhir:value [
               a fhir:CodeableConcept ;
               fhir:coding ( [
                 fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/evidence-quality"^^xsd:anyURI ] ;
                 fhir:code [ fhir:v "low" ] ;
                 fhir:display [ fhir:v "Low quality" ]
               ] )

             ]
           ]

           ] )

         ]
       ];
       fhir:PlanDefinition.condition [
         fhir:index 0;
         fhir:PlanDefinition.kind [ fhir:value "applicability" ];
         fhir:PlanDefinition.expression [
           fhir:Expression.description [ fhir:value "Patient has a positive urine screening in the past 12 months for illicit drugs" ];
           fhir:Expression.language [ fhir:value "text/cql" ];
           fhir:Expression.expression [ fhir:value "Has Illicit Drugs in Screening?" ]

       ] ) ;
       fhir:condition ( [
         fhir:kind [ fhir:v "applicability" ] ;
         fhir:expression [
           fhir:description [ fhir:v "Patient has a positive urine screening in the past 12 months for illicit drugs" ] ;
           fhir:language [ fhir:v "text/cql" ] ;
           fhir:expression [ fhir:v "Has Illicit Drugs in Screening?" ]

         ]
       ];
       fhir:PlanDefinition.dynamicValue [
         fhir:index 0;
         fhir:PlanDefinition.path [ fhir:value "activity.extension" ];
         fhir:PlanDefinition.expression [
           fhir:Expression.language [ fhir:value "text/cql" ];
           fhir:Expression.expression [ fhir:value "Get Indicator" ]

       ] ) ;
       fhir:dynamicValue ( [
         fhir:path [ fhir:v "activity.extension" ] ;
         fhir:expression [
           fhir:language [ fhir:v "text/cql" ] ;
           fhir:expression [ fhir:v "Get Indicator" ]

         ]
       ], [
         fhir:index 1;
         fhir:PlanDefinition.path [ fhir:value "action.description" ];
         fhir:PlanDefinition.expression [
           fhir:Expression.language [ fhir:value "text/cql" ];
           fhir:Expression.expression [ fhir:value "Inconsistent Illicit Drugs" ]

       ] [
         fhir:path [ fhir:v "action.description" ] ;
         fhir:expression [
           fhir:language [ fhir:v "text/cql" ] ;
           fhir:expression [ fhir:v "Inconsistent Illicit Drugs" ]

         ]
       ];
       fhir:PlanDefinition.action [
         fhir:index 0;
         fhir:PlanDefinition.description [ fhir:value "Not for chronic pain management. Snooze 3 months" ]
       ]
     ]
  ] .

       ] ) ;
       fhir:action ( [
         fhir:description [ fhir:v "Not for chronic pain management. Snooze 3 months" ]
       ] )
     ] )
  ] )] . # 


# -------------------------------------------------------------------------------------

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.