diff --git a/versioned_docs/version-3.1/concepts/medications/medication-request.mdx b/versioned_docs/version-3.1/concepts/medications/medication-request.mdx index 406627cb..7f88ff7f 100644 --- a/versioned_docs/version-3.1/concepts/medications/medication-request.mdx +++ b/versioned_docs/version-3.1/concepts/medications/medication-request.mdx @@ -4,81 +4,118 @@ sidebar_position: 1 # Medication Request -A **medication request** is a prescriber's instruction to supply and/or administer a medication to a patient. It is the starting point of the medication journey in Care — the order that everything downstream (dispensing, administration, the patient's medication history) refers back to. - -## What it represents - -In Care's FHIR-aligned model, a medication request maps to the **MedicationRequest** resource. It captures: - -- **What to give** — a coded drug from a managed list, or a specific product from your facility's catalogue -- **How to give it** — structured dosage instructions: dose, route, body site, timing and frequency, and whether the medication is taken only as needed (PRN) -- **Why and how urgently** — the intent (a proposal, a plan, or a firm order), the care setting (inpatient, outpatient, community, or discharge), and the priority (routine through stat) -- **Who and where** — the patient, the encounter it was written during, the prescriber, and when it was authored - -A medication request records the *intent* to medicate — it is not proof that the drug was handed over or taken. Handing the drug out is a [medication dispense](../medications/medication-dispense.mdx), giving it to the patient is a [medication administration](../medications/medication-administration.mdx), and what the patient reports actually taking is a [medication statement](../medications/medication-statement.mdx). The request is the order; the others are the follow-through. - -## How it connects - -A medication request never stands alone. It is always tied to a clinical context: - -- **Patient** — every request belongs to one patient. The patient is taken from the encounter, never supplied directly, so a request can never point at someone who wasn't actually seen. -- **Encounter** — the visit or admission the order was written during. This anchors the order in time and place and decides who is allowed to touch it. -- **Prescription** — requests authored together in one sitting are grouped under a single **prescription** for the encounter. Think of the prescription as the sheet of paper and each medication request as one line on it. -- **Requester** — the clinician who authored the order. - -Grouping by prescription is what lets a pharmacist review or act on a whole prescribing event at once, rather than one drug at a time. - -## Lifecycle - -A medication request moves through a status that reflects where the order stands: - -```text -draft → active → (on_hold) → completed / stopped / ended / cancelled -``` - -- **draft** — written but not yet finalised or acted on -- **active** — the live order; this is the default for a real prescription -- **on_hold** — temporarily suspended (for example, paused before surgery), expected to resume -- **completed** — the course has run as intended -- **stopped** — deliberately discontinued before completion (for example, an adverse reaction) -- **ended** — the order's validity period has lapsed -- **cancelled** — withdrawn before it took effect -- **entered_in_error** — recorded by mistake and retracted; kept for audit, not treatment -- **unknown** — status cannot be determined - -When a request is stopped or changed, a **status reason** can record *why* — for example an allergy, a suspected drug interaction, a duplicate therapy, or the patient being scheduled for surgery. Once a request is created, only a narrow set of things can change: its status, its note, and its dispensing progress. The clinical substance of the order — the drug and the dosage — is fixed at authoring. - -## Classification - -Two coded fields shape how a request is read and routed: - -- **Intent** — how firm the order is, from a loose `proposal`, to a `plan`, to a true `order`. This separates "we're thinking about this drug" from "give this drug." -- **Category** — the care setting the order applies to: `inpatient`, `outpatient`, `community`, or `discharge`. Discharge medications, for instance, are what the patient goes home with. - -A request can also be marked **do not perform** — an explicit instruction that a medication must *not* be given, which is a clinical statement in its own right, not merely the absence of an order. +## Definition + +A **[medication request](https://build.fhir.org/medicationrequest.html)** in Care is an order +or prescription for a specific medicine for a patient. You create a medication request during +an encounter. Care groups one or more medication requests together under a named prescription. +A medication request records what you order, not what the patient receives. + +Care keeps the medication request separate from three related records. Medicine Administration +records a dose that staff give to the patient. Dispense History records the pharmacy dispense. +Medication Statements record the medicines that the patient reports or took in the past. Care +shows each of these records in its own sub-tab of the **Medicines** tab. + +## Key Attributes + +| Components | What it captures | +| --- | --- | +| Medicine | The drug that you prescribe. You select it from a clinical drug list or from the facility's inventory. | +| Dosage | The amount of the medicine that the patient takes. This field is mandatory. | +| Frequency | How often the patient takes the medicine. This field is mandatory. | +| Duration | How long the patient takes the medicine. This field is optional. | +| Instructions | More instructions for the patient. This includes the reason to take the medicine when needed. This field is optional. | +| Route | How the patient receives the medicine, for example by mouth or by injection. This field is optional. | +| Site | The body site that the medicine applies to. This field is optional. | +| Method | The method of administration. This field is optional. | +| Authored On | The date that you write the request. Care sets the current date and time by default. You cannot enter a future date. | +| Requester | The user that Care records as the person who requests the medicine. This field is optional. | +| Note | Free text notes about the medicine. This field is optional. | +| Status | The current state of the request. | +| Category | The care setting that the request applies to. | +| Priority | The urgency of the request. | +| Dispense Status | How much of the request the pharmacy dispensed. The separate dispense process updates this field. | + +### Prescription + +A prescription is a named batch that groups one or more medication requests for the same +encounter. When you prescribe a medicine, you add it to a new prescription or to an existing +one. A new prescription needs a name. You can also add an optional note to it. An encounter can +have more than one prescription. Care lets you switch between the prescriptions of an encounter. + +### Changes after you save + +After you save a medicine on a prescription, you cannot change its dosage, frequency, route, or +other clinical details. You can edit its note. You can add new medicines to the same +prescription. You can also remove the medicine. When you remove a medicine, Care marks it as +Entered in Error and keeps the record. + +### Category + +| Category | Description | +| --- | --- | +| Inpatient | The request applies to a patient who stays in the facility. | +| Outpatient | The request applies to a patient who visits the facility. | +| Community | The request applies to care in the community. | +| Discharge | The request applies to the medicines that the patient takes after discharge. | + +### Priority + +| Priority | Description | +| --- | --- | +| Routine | The patient takes the medicine in the normal order of work. | +| Urgent | Staff act on the request before routine requests. | +| ASAP | Staff act on the request as soon as possible. | +| Stat | Staff act on the request immediately. | + +### Dispense Status + +| Dispense Status | Description | +| --- | --- | +| Complete | The pharmacy dispensed the full amount of the request. | +| Partial | The pharmacy dispensed part of the request. | +| Incomplete | The pharmacy did not finish the dispense of the request. | +| Declined | The pharmacy declined to dispense the request. | + +## Status + +| Status | Description | +| --- | --- | +| Active | The patient takes the medicine now. | +| On Hold | The patient stops the medicine for a limited time. | +| Ended | The request reached its end. | +| Stopped | Staff stopped the medicine before its planned end. | +| Completed | The patient took the full course of the medicine. | +| Cancelled | Staff cancelled the request before the patient took the medicine. | +| Entered in Error | Staff created the request by mistake. | +| Draft | The request is not complete and staff did not issue it. | +| Unknown | The state of the request is not known. | ## Permissions -Access to a medication request follows the encounter it belongs to, with one addition: pharmacists get a facility-wide grant so they can fill orders across the floor. Authoring an order requires write access on the encounter; reading one requires clinical-data access for the patient, or read access on the specific encounter. +| Permission | What it allows | +| --- | --- | +| Update Encounter related clinical data | Prescribe a medication, add medicines to an existing prescription, edit a note, and remove a medicine. | +| Can view clinical data about patients | View the medication requests and the prescriptions of a patient. | +| Can Read encounter related clinical data | View the medication requests and the prescriptions of an encounter. | -| Permission | Description | System Roles | -| --- | --- | --- | -| `can_write_encounter_clinical_data` | Author, update, or discontinue a medication request on an encounter | Admin, Doctor, Nurse, Facility Admin | -| `is_pharmacist` | Pharmacist-wide access to read every medication request in a facility (and create dispenses) | Facility Admin, Admin, Pharmacist | -| `can_view_clinical_data` | Read the medication requests recorded for a patient | Staff, Doctor, Nurse, Admin, Facility Admin | -| `can_read_encounter_clinical_data` | Read the medication requests on a specific encounter (when scoped by encounter) | Admin, Doctor, Nurse, Facility Admin | +To change medicines, you also need an open encounter. Care blocks changes when the encounter +status is Completed, Cancelled, Discontinued, or Entered in Error. -Roles are granted to a user through their membership in an organization, facility, or patient's care team; permissions cascade down the organization tree, so access granted higher up flows to the facilities and encounters beneath it. +Care has a separate Pharmacist role. This role has its own permissions for pharmacy work on +dispense records and prescription status. -## Related +## Configuration -- Reference: [Medication Request (technical)](../../references/medications/medication-request.mdx) -- Concept: [Medication Dispense](../medications/medication-dispense.mdx) -- Concept: [Medication Administration](../medications/medication-administration.mdx) -- Concept: [Medication Statement](../medications/medication-statement.mdx) -- Concept: [Encounter](../clinical/encounter.mdx) -- Concept: [Patient](../clinical/patient) +No deployment configuration changes which fields are mandatory. One configuration option sets +the default tab of the medicine picker. This option selects either the clinical drug list or the +facility's inventory. -## FHIR reference +## Related -This concept aligns with the HL7 FHIR [MedicationRequest](https://hl7.org/fhir/medicationrequest.html) resource, which represents an order or instruction for a medication for a patient. Care uses underscored status and intent values (for example `on_hold`, `original_order`) rather than the hyphenated FHIR spellings. +- Flow: [Prescribe a medication](../../flows/medications/medication-request/prescribe-medication.mdx) +- Flow: [Manage a prescription](../../flows/medications/medication-request/manage-prescription.mdx) +- Flow: [Add medications from past records](../../flows/medications/medication-request/add-medications-from-past-records.mdx) +- Flow: [View prescriptions and medications for an encounter](../../flows/medications/medication-request/view-encounter-medications.mdx) +- Flow: [Update a prescription](../../flows/medications/medication-request/update-prescription.mdx) +- Flow: [Print a prescription](../../flows/medications/medication-request/print-prescription.mdx) diff --git a/versioned_docs/version-3.1/flows/medications/_category_.json b/versioned_docs/version-3.1/flows/medications/_category_.json new file mode 100644 index 00000000..70b39a81 --- /dev/null +++ b/versioned_docs/version-3.1/flows/medications/_category_.json @@ -0,0 +1,5 @@ +{ + "label": "Medications", + "position": 3, + "key": "medications-flows" +} diff --git a/versioned_docs/version-3.1/flows/medications/medication-request/_category_.json b/versioned_docs/version-3.1/flows/medications/medication-request/_category_.json new file mode 100644 index 00000000..7071a222 --- /dev/null +++ b/versioned_docs/version-3.1/flows/medications/medication-request/_category_.json @@ -0,0 +1,5 @@ +{ + "label": "Medication Request", + "position": 1, + "key": "medications-medication-request-flows" +} diff --git a/versioned_docs/version-3.1/flows/medications/medication-request/add-medications-from-past-records.mdx b/versioned_docs/version-3.1/flows/medications/medication-request/add-medications-from-past-records.mdx new file mode 100644 index 00000000..1fa53259 --- /dev/null +++ b/versioned_docs/version-3.1/flows/medications/medication-request/add-medications-from-past-records.mdx @@ -0,0 +1,56 @@ +--- +sidebar_position: 3 +--- + +# Add medications from past records + +## Overview + +This flow describes how to add medicines from a patient's past records into a new prescription in Care. You start from the same screen that you use to prescribe a [medication request](../../../concepts/medications/medication-request.mdx). + +## Pre-requisites + +- The patient is registered in Care, and you record the encounter for that patient. +- The encounter is open. You cannot add medicines when the encounter status is Completed, Cancelled, Discontinued, or Entered in Error. +- You prescribe a medicine for the encounter. See [Prescribe a medication](./prescribe-medication.mdx). +- You have the permissions listed below. + +## Permissions + +| Permission | Access | +| --- | --- | +| Update Encounter related clinical data | Lets you add and change medicines for the encounter. | + +## Steps + +### 1. Open the medication history + +Select the **Medication History** action on the prescription screen. Care opens a picker. + +### 2. Review the past records + +The picker shows the patient's earlier medication requests. The picker also shows the patient's medication statements, which record the medicines that the patient reports or used before. + +### 3. Select the medicines to add + +Select each past record that you want to add. Care adds each selected record to the current prescription as a new medicine row. + +### 4. Review and save + +Review each new medicine row. Change the details when you need to. Save the prescription. + +## Expected Outcome + +- Care adds the selected past medicines to the current prescription as new medicine rows. +- You see the added medicines with the other medicines for the encounter. See [View prescriptions and medications for an encounter](./view-encounter-medications.mdx). + +## Related + +Concepts: + +- [Medication Request](../../../concepts/medications/medication-request.mdx) + +Flows: + +- [Prescribe a medication](./prescribe-medication.mdx) +- [View prescriptions and medications for an encounter](./view-encounter-medications.mdx) diff --git a/versioned_docs/version-3.1/flows/medications/medication-request/manage-prescription.mdx b/versioned_docs/version-3.1/flows/medications/medication-request/manage-prescription.mdx new file mode 100644 index 00000000..2900d71f --- /dev/null +++ b/versioned_docs/version-3.1/flows/medications/medication-request/manage-prescription.mdx @@ -0,0 +1,69 @@ +--- +sidebar_position: 2 +--- + +# Manage a prescription + +## Overview + +A prescription is a named batch that groups one or more [medication requests](../../../concepts/medications/medication-request.mdx) for the same encounter. This flow describes how to create a prescription and how to see the prescriptions of an encounter. + +## Pre-requisites + +- The patient is registered in Care, and you record the encounter for that patient. +- You are a member of the facility that manages the encounter. +- If you create a prescription, you prescribe a medicine in the same encounter. See [Prescribe a medication](./prescribe-medication.mdx). +- You have the permissions listed below. + +## Permissions + +| Permission | Access | +| --- | --- | +| Update Encounter related clinical data | Lets you create a prescription when you prescribe a medicine. | +| Can view clinical data about patients | Lets you see the prescriptions of the encounter. | +| Can Read encounter related clinical data | Lets you see the prescriptions of the encounter. | + +## Steps + +### 1. Create a prescription + +Create a prescription when you prescribe a medicine. + +1. Prescribe a medicine for the encounter. +2. Choose to add the medicine to a new prescription. +3. Enter a name for the prescription. +4. Enter a note for the prescription. The note is optional. +5. Save the medicine. + +Note: An encounter can have more than one prescription. To add a medicine to a prescription that exists, choose that prescription instead of a new one. + +### 2. Open the prescriptions of the encounter + +1. Open the encounter. +2. Select the **Medicines** tab. +3. Select the **Prescriptions** sub-tab. + +Care shows a list of the prescriptions of the encounter. The list shows each prescription by name. + +### 3. Select a prescription + +- Select a prescription in the list. Care shows only the medicines that belong to that prescription. +- Select **All Prescriptions**. Care shows every medicine of every prescription of the encounter. + +## Expected Outcome + +- Care groups the medicine in the prescription that you choose. +- The list shows each prescription of the encounter by name. +- You see the medicines of one prescription, or the medicines of all prescriptions. + +## Related + +Concepts: + +- [Medication Request](../../../concepts/medications/medication-request.mdx) + +Flows: + +- [Prescribe a medication](./prescribe-medication.mdx) +- [View prescriptions and medications for an encounter](./view-encounter-medications.mdx) +- [Update a prescription](./update-prescription.mdx) diff --git a/versioned_docs/version-3.1/flows/medications/medication-request/prescribe-medication.mdx b/versioned_docs/version-3.1/flows/medications/medication-request/prescribe-medication.mdx new file mode 100644 index 00000000..fa2d336d --- /dev/null +++ b/versioned_docs/version-3.1/flows/medications/medication-request/prescribe-medication.mdx @@ -0,0 +1,105 @@ +--- +sidebar_position: 1 +--- + +# Prescribe a medication + +## Overview + +This flow describes how to prescribe a [medication](../../../concepts/medications/medication-request.mdx) for a patient during an open encounter in Care. + +## Pre-requisites + +- The patient is registered in Care, and you record the medication for that patient. +- The encounter is open. You cannot prescribe a medication when the encounter status is Completed, Cancelled, Discontinued, or Entered in Error. +- You have write access to the encounter. +- You have the permissions listed below. + +## Permissions + +| Permission | Access | +| --- | --- | +| Update Encounter related clinical data | Lets you add and change medications for the encounter. | + +## Steps + +### 1. Open the Prescriptions sub-tab + +1. Open the encounter. +2. Select the **Medicines** tab. +3. Select the **Prescriptions** sub-tab. + +Note: Press `g` then `m` to go to the **Medicines** tab. + +### 2. Start a new medication entry + +Select the action to add a medicine. Care shows this action only if you have write access to the encounter. + +Note: Press `k` anywhere in the encounter to go straight to adding a medication. + +### 3. Select the medicine + +Select the medicine in the picker. The picker lets you search a clinical drug list. The picker also lets you search the facility's inventory. + +Note: Which list the picker opens on by default depends on your deployment's configuration. + +### 4. Complete the required fields + +Care shows the medicine as a row. Complete the fields in the row. + +| Components | What it captures | +| --- | --- | +| Dosage | The amount of the medicine to give. Required. | +| Frequency | How often to give the medicine. Required. | +| Duration | How long the patient takes the medicine. Optional. | + +### 5. Complete the advanced fields + +Expand **Advanced fields** to record more detail. + +| Components | What it captures | +| --- | --- | +| Instructions | Directions for the patient or the staff. If the patient takes the medicine as needed, record the reason here. | +| Route | The route to give the medicine. | +| Site | The body site for the medicine. | +| Method | The method to give the medicine. | +| Intent | The intent of the medication request. | +| Authored On | The date of the request. You cannot enter a future date. | +| Requester | The user recorded as the person who requested the medicine. | + +Note: If you add more than one medicine, you can copy the same requester to all of the medicines at one time. + +### 6. Add a note + +To record more detail for one medicine, enter a free-text note for that medicine. + +### 7. Select the prescription + +Add the medicine to a new prescription, or add the medicine to an existing prescription for this encounter. + +For a new prescription, enter a name. You can also enter a note for the prescription. + +For more about prescription batches, see [Manage a prescription](./manage-prescription.mdx). + +### 8. Save the medication + +Submit the form to save the medication. + +Note: Press `Shift+Enter` to submit the form. + +## Expected Outcome + +- Care saves the medication for the encounter. +- Care shows the medication under the prescription that you selected in the **Prescriptions** sub-tab. + +## Related + +Concepts: + +- [Medication Request](../../../concepts/medications/medication-request.mdx) + +Flows: + +- [Manage a prescription](./manage-prescription.mdx) +- [Add medications from past records](./add-medications-from-past-records.mdx) +- [View prescriptions and medications for an encounter](./view-encounter-medications.mdx) diff --git a/versioned_docs/version-3.1/flows/medications/medication-request/print-prescription.mdx b/versioned_docs/version-3.1/flows/medications/medication-request/print-prescription.mdx new file mode 100644 index 00000000..2302c99d --- /dev/null +++ b/versioned_docs/version-3.1/flows/medications/medication-request/print-prescription.mdx @@ -0,0 +1,58 @@ +--- +sidebar_position: 6 +--- + +# Print a prescription + +## Overview + +This flow describes how to print a [prescription](../../../concepts/medications/medication-request.mdx) from an encounter in Care. You can print one prescription, or every prescription in the encounter. + +## Pre-requisites + +- The patient is registered in Care, and you open the encounter for that patient. +- The encounter has at least one prescription with medicines on it. +- You have the permissions listed below. + +## Permissions + +| Permission | Access | +| --- | --- | +| Can view clinical data about patients | Lets you open and print the prescription. | +| Can Read encounter related clinical data | Lets you open and print the prescriptions in the encounter. | + +Note: You need at least one of these permissions to print a prescription. + +## Steps + +### 1. Open the prescription view + +Open the encounter for the patient. Go to the prescription view for that encounter. See [View prescriptions and medications for an encounter](./view-encounter-medications.mdx). + +### 2. Print one prescription + +Open the prescription that you want to print. Select **Print**. Care opens a print-ready view of the medicines on that prescription. + +Note: Care does not offer the print action when the prescription has no medicines on it. + +Note: Press `p` to print from any screen that shows a print action. + +### 3. Print every prescription in the encounter + +Select **Print All Prescriptions**. Care opens a print-ready view that covers every prescription in the encounter. + +## Expected Outcome + +- Care shows a print-ready view of the prescription that you selected. +- Care shows a print-ready view of every prescription in the encounter when you select **Print All Prescriptions**. + +## Related + +Concepts: + +- [Medication Request](../../../concepts/medications/medication-request.mdx) + +Flows: + +- [Prescribe a medication](./prescribe-medication.mdx) +- [View prescriptions and medications for an encounter](./view-encounter-medications.mdx) diff --git a/versioned_docs/version-3.1/flows/medications/medication-request/update-prescription.mdx b/versioned_docs/version-3.1/flows/medications/medication-request/update-prescription.mdx new file mode 100644 index 00000000..0149d079 --- /dev/null +++ b/versioned_docs/version-3.1/flows/medications/medication-request/update-prescription.mdx @@ -0,0 +1,82 @@ +--- +sidebar_position: 5 +--- + +# Update a prescription + +## Overview + +This flow describes how to update a saved [prescription](../../../concepts/medications/medication-request.mdx) in Care. You can add new medicines, edit notes, and remove a medicine you no longer need. + +## Pre-requisites + +- The encounter is open. You cannot update a prescription when the encounter status is Completed, Cancelled, Discontinued, or Entered in Error. +- The prescription has at least one saved medicine. +- You have the permissions listed below. + +## Permissions + +| Permission | Access | +| --- | --- | +| Update Encounter related clinical data | Lets you change the medicines and notes on a prescription for the encounter. | + +## Steps + +### 1. Open the prescription for editing + +1. Open the prescription view for the encounter. See [View prescriptions and medications for an encounter](./view-encounter-medications.mdx). +2. Select **Edit** on the prescription that you want to update. + +Care opens the same screen that you use to prescribe a medication. The screen shows the medicines that are already on the prescription. + +### 2. Edit the note on a saved medicine + +For each saved medicine, you can change only the free-text **Note**. + +1. Find the medicine on the prescription. +2. Enter or change the text in the **Note** field. + +Note: After you save a medicine, Care locks its clinical fields. These fields are the dosage, frequency, duration, instructions, route, site, method, intent, authored date, and requester. + +### 3. Add a new medicine to the prescription + +1. Add the medicine with the same steps as in [Prescribe a medication](./prescribe-medication.mdx). +2. Complete the fields for the new medicine. + +A new medicine stays fully editable until you save it. + +### 4. Remove a medicine from the prescription + +1. Select the remove icon on the row of the medicine. +2. Confirm the removal. + +Care handles the removal in one of two ways: + +- If you already saved the medicine, Care does not delete it. Care sets its status to **Entered in Error** and keeps it on the prescription. To take it out of your view, hide the inactive medicines. See [View prescriptions and medications for an encounter](./view-encounter-medications.mdx). +- If you did not save the medicine yet, Care removes the row from the list. Care keeps no record of it. + +Note: The status **Entered in Error** records that the entry was a mistake. It is different from a clinical decision to stop a medicine that the patient takes correctly. Care has no separate action for that decision on this screen. + +### 5. Save the prescription + +1. Save the prescription. +2. Check the prescription view for your changes. + +## Expected Outcome + +- The prescription shows the new medicines that you added. +- The notes that you changed show on the saved medicines. +- Each medicine that you removed after a save shows the status **Entered in Error**. +- Each unsaved medicine that you removed is no longer on the prescription. + +## Related + +Concepts: + +- [Medication Request](../../../concepts/medications/medication-request.mdx) + +Flows: + +- [Prescribe a medication](./prescribe-medication.mdx) +- [Manage a prescription](./manage-prescription.mdx) +- [View prescriptions and medications for an encounter](./view-encounter-medications.mdx) diff --git a/versioned_docs/version-3.1/flows/medications/medication-request/view-encounter-medications.mdx b/versioned_docs/version-3.1/flows/medications/medication-request/view-encounter-medications.mdx new file mode 100644 index 00000000..14e2db27 --- /dev/null +++ b/versioned_docs/version-3.1/flows/medications/medication-request/view-encounter-medications.mdx @@ -0,0 +1,88 @@ +--- +sidebar_position: 4 +--- + +# View prescriptions and medications for an encounter + +## Overview + +This flow describes how to view the prescriptions and the prescribed medicines for an encounter in Care. + +## Pre-requisites + +- The patient is registered in Care, and you open the encounter for that patient. +- You have the permissions listed below. + +## Permissions + +| Permission | Access | +| --- | --- | +| Can view clinical data about patients | Lets you open the **Medicines** tab of the encounter. | +| Can Read encounter related clinical data | Lets you read the clinical records of the encounter. | + +## Steps + +### 1. Open the Medicines tab + +Open the encounter. + +Select the **Medicines** tab. + +Note: To open the **Medicines** tab from anywhere in the encounter, press `g` and then press `m`. + +The **Medicines** tab has four sub-tabs: + +| Sub-tab | What it shows | +| --- | --- | +| Prescriptions | The prescriptions for this encounter. | +| Medication Statements | The ongoing or self-reported medicine use of the patient. | +| Medicine Administration | The record of the doses that staff gave. | +| Dispense History | The dispensing record of the pharmacy. | + +Note: This flow covers the **Prescriptions** sub-tab. The other three sub-tabs hold separate records. + +### 2. Select a prescription + +Select the **Prescriptions** sub-tab. + +A list on one side shows the prescriptions for this encounter by name. + +Select a prescription to see its medicines. + +To see every medicine across every prescription at one time, select **All Prescriptions**. + +### 3. Read the medicine details + +Care shows the medicines of the selected prescription in a table with these columns: + +| Column | What it shows | +| --- | --- | +| Medicine | The name of the medicine. | +| Dosage | The quantity of the medicine for each dose. | +| Frequency | How often the patient takes the medicine. | +| Duration | How long the patient takes the medicine. | +| Instructions | The instructions for the patient. | + +### 4. Show or hide inactive medicines + +Care dims or strikes through the medicines that are no longer active. A medicine that staff marked as **Entered in Error** is one example. + +Select the eye icon to show or hide these inactive medicines. + +## Expected Outcome + +- You see the prescriptions for the encounter and the medicines in each prescription. +- You see the dosage, frequency, duration, and instructions for each medicine. + +## Related + +Concepts: + +- [Medication Request](../../../concepts/medications/medication-request.mdx) + +Flows: + +- [Prescribe a medication](./prescribe-medication.mdx) +- [Manage a prescription](./manage-prescription.mdx) +- [Update a prescription](./update-prescription.mdx) +- [Print a prescription](./print-prescription.mdx) diff --git a/versioned_sidebars/version-3.1-sidebars.json b/versioned_sidebars/version-3.1-sidebars.json index 8ee32bd7..d8af03f0 100644 --- a/versioned_sidebars/version-3.1-sidebars.json +++ b/versioned_sidebars/version-3.1-sidebars.json @@ -51,6 +51,26 @@ "flows/facility/update-facility-details", "flows/facility/delete-facility" ] + }, + { + "type": "category", + "label": "Medications", + "key": "medications-flows", + "items": [ + { + "type": "category", + "label": "Medication Request", + "key": "medications-medication-request-flows", + "items": [ + "flows/medications/medication-request/prescribe-medication", + "flows/medications/medication-request/manage-prescription", + "flows/medications/medication-request/add-medications-from-past-records", + "flows/medications/medication-request/view-encounter-medications", + "flows/medications/medication-request/update-prescription", + "flows/medications/medication-request/print-prescription" + ] + } + ] } ] },