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Prescriptions

Complete guide to electronic prescribing with SNOMED CT medication autocomplete.

Overview

The Prescription module handles:

  • Medication orders with SNOMED CT autocomplete
  • Dosage and administration instructions
  • Refill management
  • Drug interaction warnings (planned)
  • E-prescribing integration (planned)

Writing a Prescription

Step 1: Navigate to Medications

  1. Open patient record
  2. Click Medications tab
  3. Click New Prescription button

Check Allergies First

The allergy safety banner appears on this page. Review before prescribing.

Step 2: Use SNOMED Medication Autocomplete

Medication Name field with autocomplete:

  1. Start typing medication name (2+ characters)
  2. Dropdown appears instantly (<200ms)
  3. Select from local SNOMED library
  4. Code auto-fills

Example: Type "metf"

┌─────────────────────────────────────────────┐
│ 108774000                                   │
│ Metformin                                   │
│ SNOMED-CT                                   │
└─────────────────────────────────────────────┘

Common Medications

Search Medication SNOMED Code
metf Metformin 108774000
lisin Lisinopril 386873009
atorv Atorvastatin 318272004
levo Levothyroxine 318137008
amlod Amlodipine 386872004
aspi Aspirin 372756006
omep Omeprazole 372756006

Step 3: Drug Information

Strength: e.g., 500mg, 10mg, 5mg/5mL

Form: - Tablet - Capsule - Solution - Suspension - Injection - Cream/Ointment - Inhaler - Patch

Generic Name: Optional (e.g., Metformin HCl)

Step 4: Dosage Instructions

Dosage: Amount per dose (e.g., 500 mg, 10 mL)

Route: - Oral - Intravenous (IV) - Intramuscular (IM) - Subcutaneous - Topical - Rectal - Inhalation - Ophthalmic - Otic

Frequency: - Once daily - Twice daily (BID) - Three times daily (TID) - Four times daily (QID) - Every 4 hours - Every 6 hours - As needed (PRN)

Duration: e.g., 30 days, 2 weeks, Until finished

Step 5: Dispensing Instructions

Quantity: Total amount (e.g., 60 tablets, 100 mL)

Refills: Number of refills (0-12)

Instructions: Patient instructions (e.g., "Take with food", "Take in morning")

Step 6: Prescription Details

Status: - Active - On Hold - Cancelled - Completed - Stopped

Intent: - Order (actual prescription) - Plan (planned medication) - Proposal (suggested)

Priority: - Routine - Urgent - ASAP - STAT

Prescriber: Select from practitioner list

Step 7: Save

Click Save Prescription.

Prescription Examples

Example 1: Diabetes Medication

Medication: Metformin
Strength: 500 mg
Form: Tablet
Dosage: 500 mg
Route: Oral
Frequency: Twice daily
Duration: 90 days
Quantity: 180 tablets
Refills: 3
Instructions: Take with breakfast and dinner

Example 2: Blood Pressure

Medication: Lisinopril
Strength: 10 mg
Form: Tablet
Dosage: 10 mg
Route: Oral
Frequency: Once daily
Duration: 90 days
Quantity: 90 tablets
Refills: 3
Instructions: Take in the morning

Example 3: Antibiotic (Short Course)

Medication: Azithromycin
Strength: 250 mg
Form: Tablet
Dosage: 250 mg
Route: Oral
Frequency: Once daily
Duration: 5 days
Quantity: 5 tablets
Refills: 0
Instructions: Take on empty stomach, complete full course

Medication List Management

Active Medications

Shows: - Medication name - Dosage and frequency - Prescriber - Start date - Refills remaining

Medication Reconciliation

Review at every visit: - Confirm patient taking medications - Check for side effects - Verify adherence - Update stopped medications

FHIR MedicationRequest Resource

{
  "resourceType": "MedicationRequest",
  "status": "active",
  "intent": "order",
  "medicationCodeableConcept": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "108774000",
        "display": "Metformin"
      }
    ]
  },
  "subject": {
    "reference": "Patient/patient-123"
  },
  "authoredOn": "2024-02-18",
  "requester": {
    "reference": "Practitioner/dr-smith"
  },
  "dosageInstruction": [
    {
      "text": "500 mg twice daily with meals",
      "timing": {
        "repeat": {
          "frequency": 2,
          "period": 1,
          "periodUnit": "d"
        }
      },
      "route": {
        "coding": [
          {
            "system": "http://snomed.info/sct",
            "code": "26643006",
            "display": "Oral"
          }
        ]
      },
      "doseAndRate": [
        {
          "doseQuantity": {
            "value": 500,
            "unit": "mg"
          }
        }
      ]
    }
  ],
  "dispenseRequest": {
    "numberOfRepeatsAllowed": 3,
    "quantity": {
      "value": 180,
      "unit": "tablet"
    },
    "expectedSupplyDuration": {
      "value": 90,
      "unit": "days"
    }
  }
}

Best Practices

✅ Do: - Check allergies before prescribing - Use autocomplete for accuracy - Include patient instructions - Verify dose and frequency - Check for drug interactions - Document indication

❌ Don't: - Prescribe without allergy check - Use abbreviations in instructions - Forget to set refills - Miss contraindications

Next Steps