{

"resourceType": "PlanDefinition",
"id": "low-suicide-risk-order-set",
"contained": [
  {
    "resourceType": "ActivityDefinition",
    "id": "referralToMentalHealthCare",
    "status": "draft",
    "description": "refer to primary care mental-health integrated care program for evaluation and treatment of mental health conditions now",
    "kind": "ServiceRequest",
    "code": {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "306206005"
        }
      ],
      "text": "Referral to service (procedure)"
    },
    "timingTiming": {
      "_event": [
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/cqf-expression",
              "valueExpression": {
                "language": "text/cql",
                "expression": "Now()"
              }
            }
          ]
        }
      ]
    },
    "participant": [
      {
        "type": "practitioner"
      }
    ]
  },
  {
    "resourceType": "ActivityDefinition",
    "id": "citalopramPrescription",
    "status": "draft",
    "kind": "MedicationRequest",
    "productReference": {
      "reference": "#citalopramMedication"
    },
    "dosage": [
      {
        "text": "1 tablet oral 1 time daily",
        "timing": {
          "repeat": {
            "frequency": 1,
            "period": 1,
            "periodUnit": "d"
          }
        },
        "route": {
          "coding": [
            {
              "code": "26643006",
              "display": "Oral route (qualifier value)"
            }
          ],
          "text": "Oral route (qualifier value)"
        },
        "doseAndRate": [
          {
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type",
                  "code": "ordered",
                  "display": "Ordered"
                }
              ]
            },
            "doseQuantity": {
              "value": 1,
              "unit": "{tbl}"
            }
          }
        ]
      }
    ],
    "dynamicValue": [
      {
        "path": "dispenseRequest.numberOfRepeatsAllowed",
        "expression": {
          "language": "text/cql",
          "expression": "3"
        }
      },
      {
        "path": "dispenseRequest.quantity",
        "expression": {
          "language": "text/cql",
          "expression": "30 '{tbl}'"
        }
      }
    ]
  },
  {
    "resourceType": "Medication",
    "id": "citalopramMedication",
    "code": {
      "coding": [
        {
          "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
          "code": "200371"
        }
      ],
      "text": "citalopram"
    },
    "form": {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "385055001",
          "display": "Tablet dose form"
        }
      ],
      "text": "Tablet dose form"
    },
    "ingredient": [
      {
        "itemReference": {
          "reference": "#citalopramSubstance"
        },
        "strength": {
          "numerator": {
            "value": 20,
            "unit": "mg"
          },
          "denominator": {
            "value": 1,
            "unit": "{tbl}"
          }
        }
      }
    ]
  },
  {
    "resourceType": "Substance",
    "id": "citalopramSubstance",
    "code": {
      "coding": [
        {
          "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
          "code": "2556"
        }
      ],
      "text": "citalopram"
    }
  }
],
"url": "http://motivemi.com/artifacts/PlanDefinition/low-suicide-risk-order-set",
"identifier": [
  {
    "use": "official",
    "system": "http://motivemi.com/artifacts",
    "value": "mmi:low-suicide-risk-order-set"
  }
],
"version": "1.0.0",
"name": "LowSuicideRiskOrderSet",
"title": "Low Suicide Risk Order Set",
"status": "active",
"experimental": true,
"date": "2015-08-15",
"publisher": "Motive Medical Intelligence",
"contact": [
  {
    "telecom": [
      {
        "system": "phone",
        "value": "415-362-4007",
        "use": "work"
      },
      {
        "system": "email",
        "value": "info@motivemi.com",
        "use": "work"
      }
    ]
  }
],
"description": "Orders to be applied to a patient characterized as low suicide risk.",
"useContext": [
  {
    "code": {
      "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
      "code": "age"
    },
    "valueCodeableConcept": {
      "coding": [
        {
          "system": "https://meshb.nlm.nih.gov",
          "code": "D000328",
          "display": "Adult"
        }
      ]
    }
  },
  {
    "code": {
      "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
      "code": "focus"
    },
    "valueCodeableConcept": {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "87512008",
          "display": "Mild major depression"
        }
      ]
    }
  },
  {
    "code": {
      "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
      "code": "focus"
    },
    "valueCodeableConcept": {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "40379007",
          "display": "Major depression, recurrent, mild"
        }
      ]
    }
  },
  {
    "code": {
      "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
      "code": "focus"
    },
    "valueCodeableConcept": {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "394687007",
          "display": "Low suicide risk"
        }
      ]
    }
  },
  {
    "code": {
      "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
      "code": "focus"
    },
    "valueCodeableConcept": {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "225337009",
          "display": "Suicide risk assessment"
        }
      ]
    }
  },
  {
    "code": {
      "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
      "code": "user"
    },
    "valueCodeableConcept": {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "309343006",
          "display": "Physician"
        }
      ]
    }
  },
  {
    "code": {
      "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
      "code": "venue"
    },
    "valueCodeableConcept": {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "440655000",
          "display": "Outpatient environment"
        }
      ]
    }
  }
],
"jurisdiction": [
  {
    "coding": [
      {
        "system": "urn:iso:std:iso:3166",
        "code": "US"
      }
    ]
  }
],
"purpose": "This order set helps ensure consistent application of appropriate orders for the care of low suicide risk patients.",
"usage": "This order set should be applied after assessing a patient for suicide risk, when the findings of that assessment indicate the patient has low suicide risk.",
"copyright": "© Copyright 2016 Motive Medical Intelligence. All rights reserved.",
"approvalDate": "2016-03-12",
"lastReviewDate": "2016-08-15",
"effectivePeriod": {
  "start": "2016-01-01",
  "end": "2017-12-31"
},
"topic": [
  {
    "text": "Suicide risk assessment"
  }
],
"author": [
  {
    "name": "Motive Medical Intelligence",
    "telecom": [
      {
        "system": "phone",
        "value": "415-362-4007",
        "use": "work"
      },
      {
        "system": "email",
        "value": "info@motivemi.com",
        "use": "work"
      }
    ]
  }
],
"relatedArtifact": [
  {
    "type": "derived-from",
    "display": "Practice Guideline for the Treatment of Patients with Major Depressive Disorder",
    "url": "http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf"
  },
  {
    "type": "composed-of",
    "resource": "ActivityDefinition/referralPrimaryCareMentalHealth"
  },
  {
    "type": "composed-of",
    "resource": "ActivityDefinition/citalopramPrescription"
  }
],
"library": [
  "Library/suiciderisk-orderset-logic"
],
"action": [
  {
    "title": "Suicide Risk Assessment and Outpatient Management",
    "action": [
      {
        "title": "Consults and Referrals",
        "groupingBehavior": "logical-group",
        "selectionBehavior": "any",
        "action": [
          {
            "textEquivalent": "Refer to outpatient mental health program for evaluation and treatment of mental health conditions now",
            "definitionCanonical": "#referralToMentalHealthCare",
            "dynamicValue": [
              {
                "path": "timing.event",
                "expression": {
                  "language": "text/cql",
                  "expression": "Now()"
                }
              },
              {
                "path": "specialty",
                "expression": {
                  "language": "text/cql",
                  "expression": "Code '261QM0850X' from SuicideRiskLogic.\"NUCC Provider Taxonomy\" display 'Adult Mental Health'"
                }
              },
              {
                "path": "occurrenceDateTime",
                "expression": {
                  "language": "text/cql",
                  "expression": "SuicideRiskLogic.ServiceRequestFulfillmentTime"
                }
              },
              {
                "path": "subject",
                "expression": {
                  "language": "text/cql",
                  "expression": "SuicideRiskLogic.Patient"
                }
              },
              {
                "path": "requester.agent",
                "expression": {
                  "language": "text/cql",
                  "expression": "SuicideRiskLogic.Practitioner"
                }
              },
              {
                "path": "reasonCode",
                "expression": {
                  "language": "text/cql",
                  "expression": "SuicideRiskLogic.RiskAssessmentScore"
                }
              },
              {
                "path": "reasonReference",
                "expression": {
                  "language": "text/cql",
                  "expression": "SuicideRiskLogic.RiskAssessment"
                }
              }
            ]
          }
        ]
      },
      {
        "title": "Medications",
        "groupingBehavior": "logical-group",
        "selectionBehavior": "at-most-one",
        "action": [
          {
            "title": "First-Line Antidepressants",
            "documentation": [
              {
                "type": "citation",
                "document": {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/evidence-quality",
                            "code": "high"
                          }
                        ],
                        "text": "High Quality"
                      }
                    }
                  ],
                  "contentType": "text/html",
                  "url": "http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf",
                  "title": "Practice Guideline for the Treatment of Patients with Major Depressive Disorder"
                }
              }
            ],
            "groupingBehavior": "logical-group",
            "selectionBehavior": "at-most-one",
            "action": [
              {
                "title": "Selective Serotonin Reuptake Inhibitors (Choose a mazimum of one or document reasons for exception)",
                "documentation": [
                  {
                    "type": "citation",
                    "document": {
                      "contentType": "text/html",
                      "url": "http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6daeb45c-451d-b135-bf8f-2d6dff4b6b01",
                      "title": "National Library of Medicine. DailyMed website. CITALOPRAM- citalopram hydrobromide tablet, film coated."
                    }
                  }
                ],
                "groupingBehavior": "logical-group",
                "selectionBehavior": "at-most-one",
                "action": [
                  {
                    "textEquivalent": "citalopram 20 mg tablet 1 tablet oral 1 time daily now (30 table; 3 refills)",
                    "definitionCanonical": "#citalopramPrescription",
                    "dynamicValue": [
                      {
                        "path": "status",
                        "expression": {
                          "language": "text/cql",
                          "expression": "'draft'"
                        }
                      },
                      {
                        "path": "patient",
                        "expression": {
                          "language": "text/cql",
                          "expression": "SuicideRiskLogic.Patient"
                        }
                      },
                      {
                        "path": "prescriber",
                        "expression": {
                          "language": "text/cql",
                          "expression": "SuicideRiskLogic.Practitioner"
                        }
                      },
                      {
                        "path": "reasonCode",
                        "expression": {
                          "language": "text/cql",
                          "expression": "SuicideRiskLogic.RiskAssessmentScore"
                        }
                      },
                      {
                        "path": "reasonReference",
                        "expression": {
                          "language": "text/cql",
                          "expression": "SuicideRiskLogic.RiskAssessment"
                        }
                      }
                    ]
                  },
                  {
                    "textEquivalent": "escitalopram 10 mg tablet 1 tablet oral 1 time daily now (30 tablet; 3 refills)"
                  },
                  {
                    "textEquivalent": "fluoxetine 20 mg capsule 1 capsule oral 1 time daily now (30 tablet; 3 refills)"
                  },
                  {
                    "textEquivalent": "paroxetine 20 mg tablet 1 tablet oral 1 time daily now (30 tablet; 3 refills)"
                  },
                  {
                    "textEquivalent": "sertraline 50 mg tablet 1 tablet oral 1 time daily now (30 tablet; 3 refills)"
                  }
                ]
              },
              {
                "textEquivalent": "Dopamine Norepinephrine Reuptake Inhibitors (Choose a maximum of one or document reasons for exception)"
              },
              {
                "textEquivalent": "Serotonin Norepinephrine Reuptake Inhibitors (Choose a maximum of one or doument reasons for exception)"
              },
              {
                "textEquivalent": "Norepinephrine-Serotonin Modulators (Choose a maximum of one or document reasons for exception)"
              }
            ]
          }
        ]
      }
    ]
  }
]

}