Medication Prescription and Dispense (MPD), published by Integrating the Healthcare Enterprise (IHE). This guide is not an authorized publication; it is the continuous build for version 1.0.0-comment-2 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IHE/pharm-mpd/tree/jct-draft and changes regularly. See the Directory of published versions
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PHARM-6: Submit Prescription Bundle

This section corresponds to transaction [PHARM-6] of the IHE Technical Framework. Transaction [PHARM-6] is used by the Medication Order Placer and the Medication Order Receiver actors. The Submit Prescription Bundle [PHARM-6] transaction is used to transmit a complete prescription as a Bundle — including one or more MedicationRequest resources, coordination Tasks, grouping resources, and supporting context such as Patient and Medication.

This transaction complements PHARM-5 (which submits a single MedicationRequest) by supporting the common real-world case where a prescription is a composite document: multiple medication lines, coordination constraints, and supporting resources that must be submitted atomically.

Delivery Patterns

PHARM-6 defines the content of a prescription Bundle. This same Bundle can be delivered through different patterns:

For pull/query scenarios — where a consumer fetches prescription data on demand — see PHARM-7: Retrieve Medication Orders. PHARM-7 returns the equivalent content as a search Bundle using _include and _revInclude parameters.

The three patterns together provide full coverage:

Subscription-based delivery

Systems that support FHIR Subscriptions can use them to receive prescription Bundles automatically when criteria are met (e.g., new prescription for a patient, prescription assigned to a pharmacy). The Subscription is set up using standard FHIR Subscription mechanics — no IHE-specific transaction is needed for managing the Subscription itself.

When a Subscription is triggered, the server delivers the same subscription-notification Bundle defined in this transaction. The receiving system processes it identically to a direct push.

X:Y.Z.1 Scope

The Submit Prescription Bundle [PHARM-6] transaction passes a prescription Bundle from a Medication Order Placer to a Medication Order Receiver.

The Bundle may contain:

• One or more MedicationRequest resources (prescription lines)
• A coordination Task — grouping MedicationRequests that must be fulfilled together (e.g., due to regulatory or clinical requirements)
• A RequestOrchestration — expressing dependencies, sequencing, or alternative logic between orders
• Patient — the subject of the prescription
• Medication — referenced medication products
• Other supporting resources (e.g., Condition, Observation, Coverage) as needed

This transaction is aligned with the Clinical Order Workflows (COW) IG subscription-notification Bundle pattern, where the Bundle carries a complete, self-contained set of resources for processing.

X:Y.Z.2 Actors Roles

Table X:Y.Z.2-1: Actor Roles

X:Y.Z.3 Referenced Standards

FHIR-R5 HL7 FHIR Release 5.0

X:Y.Z.4 Messages

Figure X:Y.Z.4-1: Submit Prescription Bundle Interactions

X:Y.Z.4.1 Submit Prescription Bundle Request Message

The Medication Order Placer submits a Bundle resource using the HTTP POST method to the server's base endpoint.

X:Y.Z.4.1.1 Trigger Events

This method is invoked when a prescriber creates or updates a prescription that involves:

• Multiple medication lines that belong together
• Coordination requirements (e.g., all lines must be dispensed at the same place)
• Supporting resources that must be available to the filler at receipt time

X:Y.Z.4.1.2 Message Semantics

The content type of the HTTP body shall be either application/fhir+json or application/fhir+xml.

The Medication Order Placer shall assure the Bundle is consistent and complete before sending.

X:Y.Z.4.1.2.1 Bundle type

The Bundle type SHALL be subscription-notification, following the COW IG pattern for order notification bundles. This Bundle type signals that the content is a push notification containing a coherent set of resources for processing, not a transaction to be executed atomically by the server.

X:Y.Z.4.1.2.2 Resource content

The Bundle SHALL contain at minimum:

• One or more MedicationRequest resources conforming to the MedicationOrder profile

The Bundle MAY additionally contain:

• A coordination Task — whose focus references the MedicationRequests that must be fulfilled together. See Coordinating Execution Across Lines.
• A RequestOrchestration — expressing dependencies or sequencing between the orders. See Dependencies Between Orders.
• Patient — the subject of the prescription
• Medication — medication product details referenced by the MedicationRequests
• Other supporting resources as referenced by the MedicationRequests (e.g., Condition, Observation, AllergyIntolerance, Coverage)

Example Bundle structure:

Bundle:
  type: "subscription-notification"
  entry:
    # The MedicationRequests (prescription lines)
    - resource:
        resourceType: "MedicationRequest"
        id: "rx-line-001"
        status: "active"
        intent: "order"
        groupIdentifier:
          value: "RX-2025-100"
        medication:
          reference:
            reference: "Medication/med-amoxicillin"
        subject:
          reference: "Patient/patient-1"

    - resource:
        resourceType: "MedicationRequest"
        id: "rx-line-002"
        status: "active"
        intent: "order"
        groupIdentifier:
          value: "RX-2025-100"
        medication:
          reference:
            reference: "Medication/med-omeprazole"
        subject:
          reference: "Patient/patient-1"

    # Coordination Task: these lines must be dispensed together
    - resource:
        resourceType: "Task"
        id: "coordination-task-001"
        status: "requested"
        intent: "order"
        code:
          coding:
            - system: "http://hl7.org/fhir/CodeSystem/task-code"
              code: "fulfill"
        focus:
          reference: "MedicationRequest/rx-line-001"
        extension:
          - url: "http://hl7.org/fhir/4.0/StructureDefinition/extension-Task.focus"
            valueReference:
              reference: "MedicationRequest/rx-line-002"

    # Patient context
    - resource:
        resourceType: "Patient"
        id: "patient-1"
        name:
          - family: "Smith"
            given: ["John"]

    # Medication details
    - resource:
        resourceType: "Medication"
        id: "med-amoxicillin"
        code:
          coding:
            - display: "Amoxicillin 500mg capsule"

    - resource:
        resourceType: "Medication"
        id: "med-omeprazole"
        code:
          coding:
            - display: "Omeprazole 20mg capsule"

X:Y.Z.4.1.3 Expected Actions

Upon receiving the Bundle, the Medication Order Receiver is expected to:

• Validate the Bundle contents
• Store the MedicationRequests and associated resources
• Process any coordination Task and RequestOrchestration to understand fulfillment constraints
• Forward or make available the resources for downstream processing (e.g., dispense)

X:Y.Z.4.2 Submit Prescription Bundle Response

The Medication Order Receiver SHALL return an HTTP Status code appropriate to the processing outcome.

X:Y.Z.4.2.1 Trigger Events

This response is always expected and provides the Medication Order Placer with acknowledgement of the Bundle including any technical issues.

X:Y.Z.4.2.2 Message Semantics

• On success: 200 (OK) or 201 (Created)
• On error: Appropriate error code

X:Y.Z.4.2.2.1 Resource content

On success, the response MAY contain a Bundle with the created resources, including server-assigned id, version, etc.

In case of error, the response SHALL contain an OperationOutcome.

X:Y.Z.4.2.3 Expected Actions

Upon receiving the response, the Medication Order Placer can persist the assigned identifiers, status, or trigger any issue resolution if needed.