<?xml version=“1.0” encoding=“UTF-8”?><PlanDefinition xmlns=“hl7.org/fhir”>

<id value="KDN5"/>
<text>
  <status value="additional"/>
  <div xmlns="http://www.w3.org/1999/xhtml">
    <table style="width: 100%;">
      <tr>
        <td>
          <!-- link to NCCN image -->
          <div style="width: 200px; height: 100px; vertical-align: top;">National Comprehensive Cancer Network</div>
        </td>
        <td>
          <h3>Chemotherapy Order Template</h3>
          <h1>Kidney Cancer</h1>
          <h2>Gemcitabine/CARBOplatin</h2>
        </td>
        <td style="text-align: right; vertical-align: top;">KDN5</td>
      </tr>
    </table>
    <table style="width: 100%; border-top: 1px solid; border-bottom: 1px solid;">
      <tr>
        <td style="width: 33%; border-right: 1px solid; vertical-align: top">
          <h4>INDICATION:</h4>
          <p>Metastatic or Relapsed &#x2013; Collecting Duct/Medullary Subtypes</p>
        </td>
        <td style="width: 34%; border-right: 1px solid; vertical-align: top">
          <h4>REFERENCES:</h4>
          <ol>
            <li><a href="http://www.example.org/professionals/physician_gls/PDF/kidney.pdf">NCCN Guidelines&#xAE; for Kidney Cancer. V.3.2015.</a></li>
            <li><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22The+Journal+of+urology%22%5BJour%5D+AND+1698%5Bpage%5D+AND+2007%5Bpdat%5D+AND+Oudard+S%5Bauthor%5D">Oudard S, et al. <em>J Urol</em>. 2007;177(5):1698-702.</a><sup>
                <a href="http://www.example.org/OrderTemplates/PDF/appendix_E.pdf">a</a></sup>
            </li>
          </ol>
        </td>
        <td style="width: 33%; vertical-align: top">
          <h4>NCCN SUPPORTIVE CARE:</h4>
          <ol>
            <li>
              <i>Emetic Risk:</i>
              <table>
                <tr>
                  <td>Day 1</td>
                  <td>Moderate</td>
                </tr>
                <tr>
                  <td>Day 8</td>
                  <td>Low</td>
                </tr>
              </table>
            </li>
            <li>
              <i>Fever Neutropenia Risk:</i><br/>
              Refer to <a href="http://www.example.org/professionals/physician_gls/PDF/myeloid_growth.pdf">NCCN Guidelines for Myeloid Growth Factors. V.2.2014</a>
            </li>
          </ol>
        </td>
      </tr>
    </table>
    <!--  same as the regimen section of the Composition resource only this version is without the style guide notes  -->
    <h4>CHEMOTHERAPY REGIMEN</h4>
    <p>
      <i>21-day cycle for 6 cycles</i>
    </p>
    <ul>
      <li>Gemcitabine 1250 mg/m<sup>2</sup> IV over 30 minutes on Days 1 and 8</li>
      <li>CARBOplatin AUC 5 IV over 30 minutes on Day 1</li>
    </ul>
  </div>
</text>
<!--  regimen entries represented using contained ActivityDefinition resources (with extensions)  -->
<contained>
  <ActivityDefinition>
    <id value="1111"/>
    <status value="draft"/>
    <productCodeableConcept>
      <coding>
        <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
        <code value="12574"/>
        <display value="gemcitabine"/>
      </coding>
      <text value="gemcitabine"/>
    </productCodeableConcept>
    <dosage>
      <text value="1250 mg/m&#xB2; IV over 30 minutes"/>
      <timing>
        <repeat>
          <duration value="30"/>
          <durationUnit value="min"/>
        </repeat>
      </timing>
      <route>
        <text value="IV"/>
      </route>
      <doseQuantity>
        <value value="1250"/>
        <unit value="mg/m&#xB2;"/>
      </doseQuantity>
    </dosage>
  </ActivityDefinition>
</contained>
<contained>
  <ActivityDefinition>
    <id value="2222"/>
    <status value="draft"/>
    <productCodeableConcept>
      <coding>
        <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
        <code value="40048"/>
        <display value="Carboplatin"/>
      </coding>
      <text value="CARBOplatin"/>
    </productCodeableConcept>
    <dosage>
      <text value="AUC 5 IV over 30 minutes"/>
      <timing>
        <repeat>
          <duration value="30"/>
          <durationUnit value="min"/>
        </repeat>
      </timing>
      <route>
        <text value="IV"/>
      </route>
      <doseQuantity>
        <!--  AUC as dose unit or as an extension?  -->
        <extension url="http://example.org/fhir/AUC-dose">
          <valueInteger value="5"/>
        </extension>
        <!--  <value value="5" />
        <unit value="AUC" />
        <system value="http://snomed.info/sct" />
        <code value="413573002" />  -->
      </doseQuantity>
    </dosage>
  </ActivityDefinition>
</contained>

<identifier>
  <system value="http://example.org/ordertemplates"/>
  <value value="KDN5"/>
</identifier>
<version value="1"/>
<title value="Gemcitabine/CARBOplatin"/>
<type>
  <text value="Chemotherapy Order Template"/>
</type>
<status value="draft"/>
<experimental value="true"/>
<publisher value="National Comprehensive Cancer Network, Inc."/>
<approvalDate value="2016-07-27"/>
<lastReviewDate value="2016-07-27"/>
<!--  Indications  -->
      <useContext>
              <extension url="http://hl7.org/fhir/StructureDefinition/usagecontext-group">
                      <valueString value="A"/>
              </extension>
              <code>
                      <system value="http://example.org/fhir/CodeSystem/indications"/>
                      <code value="treamentSetting-or-diseaseStatus"/>
              </code>
              <valueCodeableConcept>
                      <text value="Metastatic"/>
              </valueCodeableConcept>
      </useContext>
      <useContext>
              <extension url="http://hl7.org/fhir/StructureDefinition/usagecontext-group">
                      <valueString value="A"/>
              </extension>
              <code>
                      <system value="http://example.org/fhir/CodeSystem/indications"/>
                      <code value="disease-or-histology"/>
              </code>
              <valueCodeableConcept>
                      <text value="Collecting Duct/Medullary Subtypes"/>
              </valueCodeableConcept>
      </useContext>
      <useContext>
              <extension url="http://hl7.org/fhir/StructureDefinition/usagecontext-group">
                      <valueString value="A"/>
              </extension>
              <code>
                      <system value="http://hl7.org/fhir/usage-context-type"/>
                      <code value="focus"/>
              </code>
              <valueCodeableConcept>
                      <text value="Kidney Cancer"/>
              </valueCodeableConcept>
      </useContext>
      <useContext>
              <extension url="http://hl7.org/fhir/StructureDefinition/usagecontext-group">
                      <valueString value="B"/>
              </extension>
              <code>
                      <system value="http://example.org/fhir/CodeSystem/indications"/>
                      <code value="treatmentSetting-or-diseaseStatus"/>
              </code>
              <valueCodeableConcept>
                      <text value="Relapsed"/>
              </valueCodeableConcept>
      </useContext>
      <useContext>
              <extension url="http://hl7.org/fhir/StructureDefinition/usagecontext-group">
                      <valueString value="B"/>
              </extension>
              <code>
                      <system value="http://example.org/fhir/CodeSystem/indications"/>
                      <code value="disease-or-histology"/>
              </code>
              <valueCodeableConcept>
                      <text value="Collecting Duct/Medullary Subtypes"/>
              </valueCodeableConcept>
      </useContext>
      <useContext>
              <extension url="http://hl7.org/fhir/StructureDefinition/usagecontext-group">
                      <valueString value="B"/>
              </extension>
              <code>
                      <system value="http://hl7.org/fhir/usage-context-type"/>
                      <code value="focus"/>
              </code>
              <valueCodeableConcept>
                      <text value="Kidney Cancer &#x2013; Collecting Duct/Medullary Subtypes - Metastatic"/>
              </valueCodeableConcept>
      </useContext>
<contributor>
  <type value="author"/>
  <name value="Lee Surprenant"/>
</contributor>
<copyright value="All rights reserved."/>
<!--  list of references for the order template  -->
<relatedArtifact>
  <type value="derived-from"/>
  <display value="NCCN Guidelines for Kidney Cancer. V.2.2016"/>
  <url value="http://www.example.org/professionals/physician_gls/PDF/kidney.pdf"/>
</relatedArtifact>
<relatedArtifact>
  <type value="citation">
    <extension url="http://example.org/fhir/regimenReferenceType">
      <valueCode value="a"/>
    </extension>
  </type>
  <citation value="Oudard S, et al. J Urol. 2007;177(5):1698-702"/>
  <url value="http://www.ncbi.nlm.nih.gov/pubmed/17437788"/>
</relatedArtifact>

<action>
  <!--  list of regimen options. in this case only one  -->
  <selectionBehavior value="exactly-one"/>
  <action>
    <!--  list of regimen parts. in this case only one  -->
    <selectionBehavior value="all"/>
    <action>
      <!--  list of cycle definitions. in this case only one  -->
      <groupingBehavior value="sentence-group"/>
      <selectionBehavior value="exactly-one"/>
      <action id="cycle-definition-1">
        <textEquivalent value="21-day cycle for 6 cycles"/>

        <timingTiming>
          <repeat>
            <count value="6"/>
            <duration value="21"/>
            <durationUnit value="d"/>
          </repeat>
        </timingTiming>

        <!--  list of regimen entry references for this regimen part  -->
        <!--  references would duplicated in each cycle definition option
        (see http://build.fhir.org/codesystem-action-grouping-behavior.html#sentence-group) -->
        <action id="action-1">
          <extension url="http://hl7.org/fhir/StructureDefinition/timing-daysOfCycle">
            <extension url="day">
              <valueInteger value="1"/>
            </extension>
            <extension url="day">
              <valueInteger value="8"/>
            </extension>
          </extension>
          <textEquivalent value="Gemcitabine 1250 mg/m&#xB2; IV over 30 minutes on days 1 and 8"/>
          <definition>
            <reference value="#1111"/>
          </definition>
        </action>
        <action id="action-2">
          <extension url="http://hl7.org/fhir/StructureDefinition/timing-daysOfCycle">
            <extension url="day">
              <valueInteger value="1"/>
            </extension>
          </extension>
          <textEquivalent value="CARBOplatin AUC 5 IV over 30 minutes on Day 1"/>
          <relatedAction>
            <actionId value="action-1"/>
            <relationship value="concurrent-with-start"/>
          </relatedAction>
          <definition>
            <reference value="#2222"/>
          </definition>
        </action> <!--  end of regimen entries  -->
      </action> <!--  end of cycle definitions  -->
    </action> <!--  end of regimen parts  -->
  </action> <!--  end of regimen options  -->
</action>

</PlanDefinition>