Identifies why a specific query, request, or other trigger event occurred.

**Description:**The medication is no longer being manufactured or is otherwise no longer available.

**Description:**The therapy has been found to not have the desired therapeutic benefit on the patient.

**Description:**Monitoring the patient while taking the medication, the decision has been made that the therapy is no longer appropriate.

**Description:**The underlying condition has been resolved or has evolved such that a different treatment is no longer needed.

**Description:**The product does not have (or no longer has) coverage under the patientaTMs insurance policy.

**Description:**The patient refused to take the product.

**Description:**The manufacturer or other agency has requested that stocks of a medication be removed from circulation.

**Description:**Item in current order is no longer in use as requested and a new one has/will be created to replace it.

**Description:**The medication is being re-prescribed at a different dosage.

**Description:**Current order was issued with incorrect data and a new order has/will be created to replace it.

Description:<The patient is not (or is no longer) able to use the medication in a manner prescribed.

**Example:**CanaTMt swallow.

**Definition:**The original reason for suspending the medication has ended.

Definition:

Types of reason why a prescription is being changed.

Order was created with incorrect data and is changed to reflect the intended accuracy of the order.

Order is changed based on a clinical reason.

**Definition:**Identifies why the dispense event was not completed.

**Definition:**Contraindication identified

**Definition:**Order to be fulfilled was aborted

**Definition:**Order to be fulfilled was suspended

**Definition:**Patient did not come to get medication

**Definition:**Patient changed their mind regarding obtaining medication

**Definition:**Patient requested a revised quantity of medication

**Definition:**A collection of concepts that indicates the reason for a "bulk supply" of medication.

**Definition:**The bulk supply is issued to replenish a ward for local dispensing. (Includes both mobile and fixed-location ward stocks.)

**Definition:**The bulk supply will be administered within a long term care facility.

**Definition:**The bulk supply is intended for general clinician office use.

**Definition:**The bulk supply is being transferred to another dispensing facility to.

**Example:**Alleviate a temporary shortage.

**Definition:**The bulk supply is intended for dispensing according to a specific program.

**Example:**Mass immunization.

**Definition:**Patient has already been given a new (renewal) prescription.

**Definition:**Request for further authorization must be done through patient's family physician.

**Definition:**Therapy has been changed and new prescription issued

**Definition:**Patient must see prescriber prior to further fills.

**Definition:**Original prescriber is no longer available to prescribe and no other prescriber has taken responsibility for the patient.

**Definition:**Patient no longer or has never been under this prescribers care.

**Definition:**This medication is on hold.

**Description:**This product is not available or manufactured.

Renewing or original prescriber informed patient to stop using the medication.

**Definition:**The patient should have medication remaining.

**Definition:**The patient's medical condition has nearly abated.

**Description:**The patient has an intolerance to the medication.

**Definition:**The current medication will be replaced by a new strength of the same medication.

**Definition:**A new therapy will be commenced when current supply exhausted.

Indicates why the ConditionaTMs status was changed to Nullified. Examples administrative error, diagnostic error.

**Description:**Information has changed since the record was created.

**Description:**Previously recorded information was erroneous and is being corrected.

Information is combined into the record.

**Description:**New information has become available to supplement the record.

Information is separated from the record.

**Description:**This therapy has been ordered as a backup to a preferred therapy. This order will be released when and if the preferred therapy is unsuccessful.

**Description:**Clarification is required before the order can be acted upon.

**Description:**The current level of the medication in the patient's system is too high. The medication is suspended to allow the level to subside to a safer level.

**Description:**The patient has been admitted to a care facility and their community medications are suspended until hospital discharge.

**Description:**The therapy would interfere with a planned lab test and the therapy is being withdrawn until the test is completed.

**Description:**Patient not available for a period of time due to a scheduled therapy, leave of absence or other reason.

**Description:**The patient is pregnant or breast feeding. The therapy will be resumed when the pregnancy is complete and the patient is no longer breastfeeding.

**Description:**The patient is believed to be allergic to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.

**Description:**The drug interacts with a short-term treatment that is more urgently required. This order will be resumed when the short-term treatment is complete.

**Description:**Another short-term co-occurring therapy fulfills the same purpose as this therapy. This therapy will be resumed when the co-occuring therapy is complete.

**Description:**The patient is believed to have an intolerance to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.

**Description:**The drug is contraindicated for patients receiving surgery and the patient is scheduled to be admitted for surgery in the near future. The drug will be resumed when the patient has sufficiently recovered from the surgery.

**Description:**The patient was previously receiving a medication contraindicated with the current medication. The current medication will remain on hold until the prior medication has been cleansed from their system.

There is a clinical issue for the therapy that makes continuation of the therapy inappropriate.

Open Issue: The definition of this code does not correctly represent the concept space of its specializations (children)

Identifies types of detectyed issues for Act class "ALRT" for the administrative and patient administrative acts domains.

The requesting party has insufficient authorization to invoke the interaction.

Description: One or more records in the query response have been suppressed due to consent or privacy restrictions.

**Description:**The specified element did not pass business-rule validation.

The ID of the patient, order, etc., was not found. Used for transactions other than additions, e.g. transfer of a non-existent patient.

The ID of the patient, order, etc., already exists. Used in response to addition transactions (Admit, New Order, etc.).

There may be an issue with the patient complying with the intentions of the proposed therapy

The proposed therapy appears to duplicate an existing therapy

**Description:**The proposed therapy appears to have the same intended therapeutic benefit as an existing therapy, though the specific mechanisms of action vary.

**Description:**The proposed therapy appears to have the same intended therapeutic benefit as an existing therapy and uses the same mechanisms of action as the existing therapy.

**Description:**The proposed therapy is frequently misused or abused and therefore should be used with caution and/or monitoring.

**Description:**The request is suspected to have a fraudulent basis.

A similar or identical therapy was recently ordered by a different practitioner.

This patient was recently supplied a similar or identical therapy from a different pharmacy or supplier.

Proposed dosage instructions for therapy differ from standard practice.

**Description:**Proposed dosage is inappropriate due to patient's medical condition.

Proposed length of therapy differs from standard practice.

Proposed length of therapy is longer than standard practice

Proposed length of therapy is longer than standard practice for the identified indication or diagnosis

Proposed length of therapy is shorter than that necessary for therapeutic effect

Proposed length of therapy is shorter than standard practice for the identified indication or diagnosis

Proposed dosage exceeds standard practice

Proposed dosage exceeds standard practice for the patient's age

Proposed dosage exceeds standard practice for the patient's height or body surface area

Proposed dosage exceeds standard practice for the patient's weight

Proposed dosage interval/timing differs from standard practice

Proposed dosage interval/timing differs from standard practice for the identified indication or diagnosis

Proposed dosage is below suggested therapeutic levels

Proposed dosage is below suggested therapeutic levels for the patient's age

Proposed dosage is below suggested therapeutic levels for the patient's height or body surface area

Proposed dosage is below suggested therapeutic levels for the patient's weight

**Description:**The maximum quantity of this drug allowed to be administered within a particular time-range (month, year, lifetime) has been reached or exceeded.

Proposed therapy may be inappropriate or contraindicated due to conditions or characteristics of the patient

Proposed therapy may be inappropriate or contraindicated due to patient age

Proposed therapy is outside of the standard practice for an adult patient.

Proposed therapy is outside of standard practice for a geriatric patient.

Proposed therapy is outside of the standard practice for a pediatric patient.

Proposed therapy may be inappropriate or contraindicated due to an existing/recent patient condition or diagnosis

Proposed therapy may be inappropriate or contraindicated when breast-feeding

Proposed therapy may be inappropriate or contraindicated during pregnancy

**Description:**Proposed therapy may be inappropriate or contraindicated because of a common but non-patient specific reaction to the product.

**Example:**There is no record of a specific sensitivity for the patient, but the presence of the sensitivity is common and therefore caution is warranted.

Proposed therapy may be inappropriate or contraindicated due to patient genetic indicators.

Proposed therapy may be inappropriate or contraindicated due to patient gender.

Proposed therapy may be inappropriate or contraindicated due to recent lab test results

Proposed therapy may be inappropriate or contraindicated based on the potential for a patient reaction to the proposed product

Proposed therapy may be inappropriate or contraindicated because of a recorded patient allergy to the proposed product. (Allergies are immune based reactions.)

Proposed therapy may be inappropriate or contraindicated because of a recorded patient intolerance to the proposed product. (Intolerances are non-immune based sensitivities.)

Proposed therapy may be inappropriate or contraindicated because of a potential patient reaction to a cross-sensitivity related product.

Proposed therapy may be inappropriate or contraindicated because of a recorded patient allergy to a cross-sensitivity related product. (Allergies are immune based reactions.)

Proposed therapy may be inappropriate or contraindicated because of a recorded prior adverse reaction to a cross-sensitivity related product.

Proposed therapy may be inappropriate or contraindicated because of a recorded patient intolerance to a cross-sensitivity related product. (Intolerances are non-immune based sensitivities.)

**Description:**A local business rule relating multiple elements has been violated.

**Description:**The specified code is not valid against the list of codes allowed for the element.

**Description:**The specified code has been deprecated and should no longer be used. Select another code from the code system.

**Description:**The element does not follow the formatting or type rules defined for the field.

**Description:**The request is missing elements or contains elements which cause it to not meet the legal standards for actioning.

**Description:**The length of the data specified falls out of the range defined for the element.

**Description:**The length of the data specified is greater than the maximum length defined for the element.

**Description:**The length of the data specified is less than the minimum length defined for the element.

**Description:**The specified element must be specified with a non-null value under certain conditions. In this case, the conditions are true but the element is still missing or null.

**Description:**The specified element is mandatory and was not included in the instance.

**Description:**More than one element with the same value exists in the set. Duplicates not permission in this set in a set.

Description: Element in submitted message will not persist in data storage based on detected issue.

**Description:**The number of repeating elements falls outside the range of the allowed number of repetitions.

**Description:**The number of repeating elements is above the maximum number of repetitions allowed.

**Description:**The number of repeating elements is below the minimum number of repetitions allowed.

Description: Metadata associated with the identification (e.g. name or gender) does not match the identification being verified.

Description: One or more records in the query response have a status of 'obsolete'.

Identifies types of detected issues regarding the administration or supply of an item to a patient.

Administration of the proposed therapy may be inappropriate or contraindicated as proposed

Proposed therapy may interact with certain foods

Proposed therapy may interact with an existing or recent therapeutic product

Proposed therapy may interact with an existing or recent drug therapy

Proposed therapy may interact with existing or recent natural health product therapy

Proposed therapy may interact with a non-prescription drug (e.g. alcohol, tobacco, Aspirin)

**Definition:**The same or similar treatment has previously been attempted with the patient without achieving a positive effect.

**Description:**Proposed therapy may be contraindicated or ineffective based on an existing or recent drug therapy.

**Description:**Proposed therapy may be inappropriate or ineffective based on the proposed start or end time.

**Definition:**Proposed therapy may be inappropriate or ineffective because the end of administration is too close to another planned therapy.

**Definition:**Proposed therapy may be inappropriate or ineffective because the start of administration is too late after the onset of the condition.

Proposed therapy may be contraindicated or ineffective based on an existing or recent drug therapy

Proposed therapy may be inappropriate or ineffective based on the proposed start or end time.

Proposed therapy may be inappropriate or ineffective because the end of administration is too close to another planned therapy

Proposed therapy may be inappropriate or ineffective because the start of administration is too late after the onset of the condition

Supplying the product at this time may be inappropriate or indicate compliance issues with the associated therapy

**Definition:**The requested action has already been performed and so this request has no effect

**Definition:**The therapy being performed is in some way out of alignment with the requested therapy.

**Definition:**The status of the request being fulfilled has changed such that it is no longer actionable. This may be because the request has expired, has already been completely fulfilled or has been otherwise stopped or disabled. (Not used for 'suspended' orders.)

**Definition:**The therapy being performed is not sufficiently equivalent to the therapy which was requested.

**Definition:**The therapy being performed is not generically equivalent (having the identical biological action) to the therapy which was requested.

**Definition:**The therapy being performed is not therapeutically equivalent (having the same overall patient effect) to the therapy which was requested.

**Definition:**The therapy is being performed at a time which diverges from the time the therapy was requested

**Definition:**The therapy action is being performed outside the bounds of the time period requested

**Definition:**The therapy action is being performed too soon after the previous occurrence based on the requested frequency

**Definition:**There should be no actions taken in fulfillment of a request that has been held or suspended.

The patient is receiving a subsequent fill significantly later than would be expected based on the amount previously supplied and the therapy dosage instructions

The patient is receiving a subsequent fill significantly earlier than would be expected based on the amount previously supplied and the therapy dosage instructions

Description: While the record was accepted in the repository, there is a more recent version of a record of this type.

**Definition:**The proposed therapy goes against preferences or consent constraints recorded in the patient's record.

**Definition:**The proposed therapy goes against preferences or consent constraints recorded in the patient's record. An alternate therapy meeting those constraints is available.

Identifies types of detected issues for Act class "ALRT" for the financial acts domain.

Identifies types of issues detected regarding the performance of a clinical action on a patient.

Identifies the type of detected issues is care gap

Definition: To evaluate for service authorization, payment, reporting, or performance/outcome measures.

**Definition:**To provide information as a result of a subpoena.

**Definition:**To obtain records as part of patient care.

**Definition:**Patient requests information from their profile.

**Definition:**To evaluate the provider's current practice for professional-improvement reasons.

**Description:**Review for the purpose of regulatory compliance.

**Definition:**To provide research data, as authorized by the patient.

**Description:**To validate the patient's record.

**Example:**Merging or unmerging records.

**Description:**The decision on which the recorded information was based was changed before the decision had an effect.

**Example:**Aborted prescription before patient left office, released prescription before suspend took effect.

**Description:**The information was recorded incorrectly or was recorded in the wrong record.

Indicates why the act revision (status update) is being refused.

Description: There is no match for the record in the database.

The record is already in the requested state.

**Definition:**The user does not have permission

Ordered quantity has already been completely fulfilled.