The pharmacist has the authority to make certain changes to the clinician’s order without having to seek a replacement order from the prescriber. This class contains information concerning any such changes. For example, if the prescriber cited a brand name drug, but also indicated that a generic drug could be substituted for it, this class will point to a new copy of the order with the generic drug instead of the brand-name drug. Another potential change might be where the prescriber indicated 20mg tablets, but the pharmacy only has 10 mg tablets. In this case, the sig may need to be changed from “take 1 tablet…� to “take 2 tablets…� to reflect that the tablets are now half the strength as originally prescribed. Again, this class is used to hold this new information.

Attributes
«CS» Code	kind	"A code signifying whether a different drug was dispensed from what was prescribed." - HL7 FHIR, MedicationDispense.substitution.type
«EntryPoint» PharmacyPromise	pharmacyPromise	Pointer to a new Pharmacy Promise record created as a result of a change made to the original order by the pharmacist.
String	reason	This property provides an optional textual description why the pharmacist changed the original prescriber's order. In most cases, the substitution code will be sufficient, but in some cases the pharmacist may wish to document a more detailed reason. "Indicates the reason for the substitution (or lack of substitution) from what was prescribed." - HL7 FHIR, MedicationDispense.substitution.reason
Attribution	responsibleParty	"The person or organization that has primary responsibility for the substitution." - HL7 FHIR, MedicationDispense.substitution.responsibleParty
String	revisedAdministrationInstructions	If the pharmacist has changed the instructions to the person administering the medication (usually a nurse in an inpatient situation) from the one originally ordered by the prescriber, this field contains the new instructions. For example, if the prescriber indicated 20mg tablets, but the pharmacy only has 10 mg tablets, the sig may need to be changed from “give 1 tablet…� to “give 2 tablets…� to reflect that the tablets are now half the strength as originally prescribed.
String	revisedPatientInstructions	If the pharmacist has changed any "additional instructions" to the patient from the one originally ordered by the prescriber, this field contains the new instructions. For example, if the prescriber indicated that the medication should be taken with milk, but the pharmacist made a therapeutic substitution to different medication the new instructions may now say "take on an empty stomach" to reflect the characteristics of the new medication.
String	revisedSig	If the pharmacist has changed the instructions to the patient (i.e., the "sig") from the one originally ordered by the prescriber, this field contains the new instructions. For example, if the prescriber indicated 20mg tablets, but the pharmacy only has 10 mg tablets, the sig may need to be changed from “take 1 tablet…� to “take 2 tablets…� to reflect that the tablets are now half the strength as originally prescribed.

 kind

Public Â«CS» Code kind

"A code signifying whether a different drug was dispensed from what was prescribed." - HL7 FHIR, MedicationDispense.substitution.type

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	PharmacyGeneratedOrderModification
Terminologies	[ HL7_FHIR_R4 V3 Value SetActSubstanceAdminSubstitutionCode http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode ]
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	kind
Name Expression
Namespace	PharmacyGeneratedOrderModification
Opposite
Owner	PharmacyGeneratedOrderModification
Owning Association
Owning Template Parameter
Qualified Name	FHIM::Pharmacy::PharmacyGeneratedOrderModification::kind
Stereotype	ValueSetConstraints
Template Parameter
Type	«CS» Code
Upper	1
Upper Value	(1)
Visibility	Public

 pharmacyPromise

Public Â«EntryPoint» PharmacyPromise pharmacyPromise

Pointer to a new Pharmacy Promise record created as a result of a change made to the original order by the pharmacist.

Constraints:

Properties:

Aggregation	None
Alias
Association	pharmacyGeneratedOrderModification_pharmacyPromise
Association End
Class	PharmacyGeneratedOrderModification
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	pharmacyPromise
Name Expression
Namespace	PharmacyGeneratedOrderModification
Opposite
Owner	PharmacyGeneratedOrderModification
Owning Association
Owning Template Parameter
Qualified Name	FHIM::Pharmacy::PharmacyGeneratedOrderModification::pharmacyPromise
Stereotype
Template Parameter
Type	«EntryPoint» PharmacyPromise
Upper	1
Upper Value	(1)
Visibility	Public

 reason

Public String reason

This property provides an optional textual description why the pharmacist changed the original prescriber's order. In most cases, the substitution code will be sufficient, but in some cases the pharmacist may wish to document a more detailed reason.
"Indicates the reason for the substitution (or lack of substitution) from what was prescribed." - HL7 FHIR, MedicationDispense.substitution.reason

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	PharmacyGeneratedOrderModification
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	reason
Name Expression
Namespace	PharmacyGeneratedOrderModification
Opposite
Owner	PharmacyGeneratedOrderModification
Owning Association
Owning Template Parameter
Qualified Name	FHIM::Pharmacy::PharmacyGeneratedOrderModification::reason
Stereotype
Template Parameter
Type	String
Upper	1
Upper Value	(1)
Visibility	Public

 responsibleParty

Public Attribution responsibleParty

"The person or organization that has primary responsibility for the substitution." - HL7 FHIR, MedicationDispense.substitution.responsibleParty

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	PharmacyGeneratedOrderModification
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	responsibleParty
Name Expression
Namespace	PharmacyGeneratedOrderModification
Opposite
Owner	PharmacyGeneratedOrderModification
Owning Association
Owning Template Parameter
Qualified Name	FHIM::Pharmacy::PharmacyGeneratedOrderModification::responsibleParty
Stereotype
Template Parameter
Type	Attribution
Upper	1
Upper Value	(1)
Visibility	Public

 revisedAdministrationInstructions

Public String revisedAdministrationInstructions

If the pharmacist has changed the instructions to the person administering the medication (usually a nurse in an inpatient situation) from the one originally ordered by the prescriber, this field contains the new instructions. For example, if the prescriber indicated 20mg tablets, but the pharmacy only has 10 mg tablets, the sig may need to be changed from “give 1 tablet…� to “give 2 tablets…� to reflect that the tablets are now half the strength as originally prescribed.

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	PharmacyGeneratedOrderModification
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	revisedAdministrationInstructions
Name Expression
Namespace	PharmacyGeneratedOrderModification
Opposite
Owner	PharmacyGeneratedOrderModification
Owning Association
Owning Template Parameter
Qualified Name	FHIM::Pharmacy::PharmacyGeneratedOrderModification::revisedAdministrationInstructions
Stereotype
Template Parameter
Type	String
Upper	1
Upper Value	(1)
Visibility	Public

 revisedPatientInstructions

Public String revisedPatientInstructions

If the pharmacist has changed any "additional instructions" to the patient from the one originally ordered by the prescriber, this field contains the new instructions. For example, if the prescriber indicated that the medication should be taken with milk, but the pharmacist made a therapeutic substitution to different medication the new instructions may now say "take on an empty stomach" to reflect the characteristics of the new medication.

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	PharmacyGeneratedOrderModification
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	revisedPatientInstructions
Name Expression
Namespace	PharmacyGeneratedOrderModification
Opposite
Owner	PharmacyGeneratedOrderModification
Owning Association
Owning Template Parameter
Qualified Name	FHIM::Pharmacy::PharmacyGeneratedOrderModification::revisedPatientInstructions
Stereotype
Template Parameter
Type	String
Upper	1
Upper Value	(1)
Visibility	Public

 revisedSig

Public String revisedSig

If the pharmacist has changed the instructions to the patient (i.e., the "sig") from the one originally ordered by the prescriber, this field contains the new instructions. For example, if the prescriber indicated 20mg tablets, but the pharmacy only has 10 mg tablets, the sig may need to be changed from “take 1 tablet…� to “take 2 tablets…� to reflect that the tablets are now half the strength as originally prescribed.

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	PharmacyGeneratedOrderModification
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	revisedSig
Name Expression
Namespace	PharmacyGeneratedOrderModification
Opposite
Owner	PharmacyGeneratedOrderModification
Owning Association
Owning Template Parameter
Qualified Name	FHIM::Pharmacy::PharmacyGeneratedOrderModification::revisedSig
Stereotype
Template Parameter
Type	String
Upper	1
Upper Value	(1)
Visibility	Public