Gives information about the Presenting complaint or issue section
Important: This specification is based on the Professional Records Standards Body's Community Pharmacy Standard V2.2 standard which provides further information on document headings and content for messages:
Presenting complaint or issue Section Content
The Presenting complaint or issue section carries information about the details used. PRSB Elements should be formatted as subheadings in any HTML sent.
| PRESENTING COMPLAINT OR ISSUES | |||||
|---|---|---|---|---|---|
| Data Item | Description | Cardinality | Values | Mandatory/required/ optional | FHIR Target |
| Presenting complaint or issue | The health problem or issue experienced by the patient resulting in their attendance. This may include disease state, medical condition, response and reactions to therapies. Eg, blackout, dizziness, chest pain, follow up from admission, falls, a specific procedure, investigation or treatment. | 0 TO MANY | A coded value from SNOMED-CT (^1127581000000103 - Health issues simple reference set). If no code exists, Free Text may be used |
Required | Condition.code |
Example Section
Note: These examples have not been clinically assured against Digital Medicines use cases.
Examples are illustrative only.
Examples are illustrative only.
<!--<xml>-->
<!--Presenting complaint or issue-->
<section>
<title value="Presenting complaint or issue"/>
<code>
<coding>
<system value="http://snomed.info/sct"/>
<code value="886891000000102"/>
<display value="Presenting complaints or issues"/>
</coding>
</code>
<text>
<status value="additional"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<table width="100%">
<tbody>
<tr>
<th>Presenting complaint or issue</th>
<td>Burn of ear</td>
</tr>
</tbody>
</table>
</div>
</text>
<entry>
<reference value="urn:uuid:be79bf3e-baec-4d99-91e8-1d851e6fec7f"/>
</entry>
</section>
<!-- further sections -->
<!-- coded data -->
<entry>
<fullUrl value="urn:uuid:be79bf3e-baec-4d99-91e8-1d851e6fec7f"/>
<resource>
<Condition xmlns="http://hl7.org/fhir">
<clinicalStatus value="active"/>
<code>
<coding>
<system value="http://snomed.info/sct"/>
<code value="39065001"/>
<display value="Burn of ear"/>
</coding>
</code>
<subject>
<reference value="urn:uuid:9af701f7-5eb2-4402-bb3c-8ef8c8190082"/>
</subject>
</Condition>
</resource>
</entry>
<!--</xml>-->