FHIR Server FHIR Server Version n/a

Resource PlanDefinition/FHIR Server from package cqframework.cpg-example-anthrax#current (125 ms)

Package

Type

PlanDefinition

FHIR Version

Source

http://cqframework.org/cpg-example-anthrax/https://build.fhir.org/ig/cqframework/cpg-example-anthrax/PlanDefinition-second-vaccinedose-pregnant-pd.html

Url

http://cqframework.org/cpg-example-anthrax/PlanDefinition/second-vaccinedose-pregnant-pd

Version

1.1.0

Status

draft

Date

2024-11-18T16:44:02+00:00

Name

Anthrax_Post_Exposure_Prophylaxis_Adults

Title

Second vaccine pregnant

Experimental

True

Realm

Authority

hl7

Description

Provides information for treating patients greater than or equal to 18 years old exposed to anthrax within the past 60 days, who do not have anthrax. It is divided into two parts: \n- Part #1: For patients that may be symptomatic to flag the need to conduct a full diagnostic evaluation to rule out anthrax before proceeding with post-exposure prophylaxis (PEP) \n- Part #2: For patients who are asymptomatic (not displaying signs and symptoms of anthrax), it provides recommended PEP regimen

Purpose

Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.

Resources that use this resource

No resources found

Resources that this resource uses

No resources found

Narrative

Note: links and images are rebased to the (stated) source

Generated Narrative: PlanDefinition second-vaccinedose-pregnant-pd

url: PlanDefinition Second vaccine pregnant

identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/OrderSet

version: 1.1.0

name: Anthrax_Post_Exposure_Prophylaxis_Adults

title: Second vaccine pregnant

type: ECA Rule

status: Draft

experimental: true

date: 2024-11-18 16:44:02+0000

publisher: HL7 International - Clinical Decision Support WG

contact: HL7 International - Clinical Decision Support WG: http://www.hl7.org/Special/committees/dss/index.cfm

description:

UseContexts

Code

Value[x]

UsageContextType age: Age Range

18-?

UsageContextType venue: Clinical Venue

Outpatient environment

UsageContextType focus: Clinical Focus

Contact with and (suspected) exposure to anthrax

UsageContextType focus: Clinical Focus

Exposure to Bacillus anthracis (event)

UsageContextType focus: Clinical Focus

Asymptomatic (finding)

jurisdiction: World

purpose:

usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.

approvalDate: 2019-06-07

lastReviewDate: 2019-06-07

effectivePeriod: 2019-06-07 --> (ongoing)

topic: Anthrax, Emergency Medicine, Post-Exposure Prophylaxis

author: Alliance to Modernize Healthcare FFRDC:

endorser: Centers for Disease Control and Prevention:

library: Anthrax Post Exposure Prophylaxis (PEP) for Adults FHIRv400 Logic

action
title: Anthrax Post Exposure Prophylaxis 10
trigger
type: Data Added
data
type: Condition
codeFilter
path: code
code: International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Z20.810: Contact with and (suspected) exposure to anthrax, SNOMED CT 170475009: Exposure to Bacillus anthracis (event)
trigger
type: Data Added
data
type: Observation
codeFilter
path: code
code: International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Z20.810: Contact with and (suspected) exposure to anthrax, SNOMED CT 170475009: Exposure to Bacillus anthracis (event), SNOMED CT 84387000: Asymptomatic (finding)
condition
kind: Applicability
Expressions
- Language Expression
* CQL GenerateOrderSet
groupingBehavior: Logical Group
selectionBehavior: Any
action
title: Antimicrobial medications for anthrax post-exposure prophylaxis
groupingBehavior: Visual Group
selectionBehavior: At Most One
action
title: First line antimicrobial medications for anthrax post-exposure prophylaxis
groupingBehavior: Visual Group
selectionBehavior: At Most One
Actions
- Type Definition[x]
* Create ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Ciprofloxacin Request
* Create ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Doxycycline Request
action
title: Second line antimicrobial medications for anthrax post-exposure prophylaxis
groupingBehavior: Visual Group
selectionBehavior: At Most One
Actions
- Type Definition[x]
* Create ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Levofloxacin Request
* Create ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Moxifloxacin Request
* Create ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Clindamycin Request
action
title: Anthrax Vaccination - 2nd dose
type: Create
definition: ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Vaccine Request

Generated Narrative: ActivityDefinition #Inline-Ciprofloxacin-Request-5

url: http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Ciprofloxacin-Request-5
identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/CiprofloxacinRequest
name: Anthrax_Post_Exposure_Prophylaxis_Adults_Ciprofloxacin_Request
title: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Ciprofloxacin Request
status: Draft
experimental: true
description:
In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).

UseContexts
- Code Value[x]
* UsageContextType age: Age Range 18-?
* UsageContextType venue: Clinical Venue Outpatient environment
* UsageContextType focus: Clinical Focus Contact with and (suspected) exposure to anthrax
* UsageContextType focus: Clinical Focus Exposure to Bacillus anthracis (event)
* UsageContextType focus: Clinical Focus Asymptomatic (finding)
purpose:
Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.

usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.
approvalDate: 2019-06-07
lastReviewDate: 2019-06-07
effectivePeriod: 2019-06-07 --> (ongoing)
topic: Anthrax, Emergency Medicine, Post-Exposure Prophylaxis
author: Alliance to Modernize Healthcare FFRDC:
endorser: Centers for Disease Control and Prevention:
kind: MedicationRequest
product: FIRST CHOICE: Ciprofloxacin 500 MG Oral Tablet
quantity: 120(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: Orderable Drug Form codeORTAB = 'Oral Tablet')
Dosages
- Text AdditionalInstruction PatientInstruction Timing Route Method
* One every 12 hours for 60 days Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester., CONTRAINDICATIONS: Diagnosis of myasthenia gravis and taking tizanidine., CAUTIONS: If patient is taking blood thinners, oral antidiabetic drugs, seizure drugs, theophylline, drugs that prolong QT interval, duloxetine (Cymbalta), zolpidem (Ambien), clozapine or any other drug that may interact and cause serious side effects, consider another antibiotic regimen., Provide patient education on medications. Take with full glass of water Once per 12 hours Oral Route Swallow - dosing instruction imperative (qualifier value)

Generated Narrative: ActivityDefinition #Inline-Doxycycline-Request-5

url: http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Doxycycline-Request-5
identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/DoxycyclineRequest
name: Anthrax_Post_Exposure_Prophylaxis_Adults_Doxycycline_Request
title: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Doxycycline Request
status: Draft
experimental: true
description:
In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).

UseContexts
- Code Value[x]
* UsageContextType age: Age Range 18-?
* UsageContextType venue: Clinical Venue Outpatient environment
* UsageContextType focus: Clinical Focus Contact with and (suspected) exposure to anthrax
* UsageContextType focus: Clinical Focus Exposure to Bacillus anthracis (event)
* UsageContextType focus: Clinical Focus Asymptomatic (finding)
purpose:
Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.

usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.
approvalDate: 2019-06-07
lastReviewDate: 2019-06-07
effectivePeriod: 2019-06-07 --> (ongoing)
topic: Anthrax, Emergency Medicine, Post-Exposure Prophylaxis
author: Alliance to Modernize Healthcare FFRDC:
endorser: Centers for Disease Control and Prevention:
kind: MedicationRequest
product: SECOND CHOICE: doxycycline hyclate 100 MG Oral Tablet
quantity: 120(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: Orderable Drug Form codeORTAB = 'Oral Tablet')
Dosages
- Text AdditionalInstruction PatientInstruction Timing Route Method
* One every 12 hours for 60 days Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester., CAUTIONS: If patient is taking blood thinners, oral antidiabetic drugs, seizure drugs, or any other drug that may interact and cause serious side effects, consider another antibiotic regimen., Provide patient education on medications. Take with full glass of water Once per 12 hours Oral Route Swallow - dosing instruction imperative (qualifier value)

Generated Narrative: ActivityDefinition #Inline-Levofloxacin-Request-5

url: http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Levofloxacin-Request-5
identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/LevofloxacinRequest
name: Anthrax_Post_Exposure_Prophylaxis_Adults_Levofloxacin_Request
title: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Levofloxacin Request
status: Draft
experimental: true
description:
In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).

UseContexts
- Code Value[x]
* UsageContextType age: Age Range 18-?
* UsageContextType venue: Clinical Venue Outpatient environment
* UsageContextType focus: Clinical Focus Contact with and (suspected) exposure to anthrax
* UsageContextType focus: Clinical Focus Exposure to Bacillus anthracis (event)
* UsageContextType focus: Clinical Focus Asymptomatic (finding)
purpose:
Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.

usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.
approvalDate: 2019-06-07
lastReviewDate: 2019-06-07
effectivePeriod: 2019-06-07 --> (ongoing)
topic: Anthrax, Emergency Medicine, Post-Exposure Prophylaxis
author: Alliance to Modernize Healthcare FFRDC:
endorser: Centers for Disease Control and Prevention:
kind: MedicationRequest
product: Levofloxacin 750 MG Oral Tablet
quantity: 60(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: Orderable Drug Form codeORTAB = 'Oral Tablet')
Dosages
- Text AdditionalInstruction Timing Route Method
* One every day for 60 days Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester. Once per 1 days Oral Route Swallow - dosing instruction imperative (qualifier value)

Generated Narrative: ActivityDefinition #Inline-Moxifloxacin-Request-5

url: http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Moxifloxacin-Request-5
identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/MoxifloxacinRequest
name: Anthrax_Post_Exposure_Prophylaxis_Adults_Moxifloxacin_Request
title: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Moxifloxacin Request
status: Draft
experimental: true
description:
In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).

UseContexts
- Code Value[x]
* UsageContextType age: Age Range 18-?
* UsageContextType venue: Clinical Venue Outpatient environment
* UsageContextType focus: Clinical Focus Contact with and (suspected) exposure to anthrax
* UsageContextType focus: Clinical Focus Exposure to Bacillus anthracis (event)
* UsageContextType focus: Clinical Focus Asymptomatic (finding)
purpose:
Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.

usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.
approvalDate: 2019-06-07
lastReviewDate: 2019-06-07
effectivePeriod: 2019-06-07 --> (ongoing)
topic: Anthrax, Emergency Medicine, Post-Exposure Prophylaxis
author: Alliance to Modernize Healthcare FFRDC:
endorser: Centers for Disease Control and Prevention:
kind: MedicationRequest
product: moxifloxacin HCl 400 MG Oral Tablet
quantity: 60(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: Orderable Drug Form codeORTAB = 'Oral Tablet')
Dosages
- Text AdditionalInstruction Timing Route Method
* One every day for 60 days Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester. Once per 1 days Oral Route Swallow - dosing instruction imperative (qualifier value)

Generated Narrative: ActivityDefinition #Inline-Clindamycin-Request-5

url: http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Clindamycin-Request-5
identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/ClindamycinRequest
name: Anthrax_Post_Exposure_Prophylaxis_Adults_Clindamycin_Request
title: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Clindamycin Request
status: Draft
experimental: true
description:
In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).

UseContexts
- Code Value[x]
* UsageContextType age: Age Range 18-?
* UsageContextType venue: Clinical Venue Outpatient environment
* UsageContextType focus: Clinical Focus Contact with and (suspected) exposure to anthrax
* UsageContextType focus: Clinical Focus Exposure to Bacillus anthracis (event)
* UsageContextType focus: Clinical Focus Asymptomatic (finding)
purpose:
Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.

usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.
approvalDate: 2019-06-07
lastReviewDate: 2019-06-07
effectivePeriod: 2019-06-07 --> (ongoing)
topic: Anthrax, Emergency Medicine, Post-Exposure Prophylaxis
author: Alliance to Modernize Healthcare FFRDC:
endorser: Centers for Disease Control and Prevention:
kind: MedicationRequest
product: clindamycin HCl 300 MG Oral Capsule
quantity: 360(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: Orderable Drug Form codeORTAB = 'Oral Tablet')
Dosages
- Text AdditionalInstruction Timing Route Method
* Two tablets every 8 hours for 60 days Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester. 2 per 8 hours Oral Route Swallow - dosing instruction imperative (qualifier value)

Generated Narrative: ActivityDefinition #Inline-Vaccine-Request-5

url: http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Vaccine-Request-5
identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/VaccineRequest
name: Anthrax_Post_Exposure_Prophylaxis_Adults_Vaccine_Request
title: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Vaccine Request
status: Draft
experimental: true
description:
In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).

UseContexts
- Code Value[x]
* UsageContextType age: Age Range 18-?
* UsageContextType venue: Clinical Venue Outpatient environment
* UsageContextType focus: Clinical Focus Contact with and (suspected) exposure to anthrax
* UsageContextType focus: Clinical Focus Exposure to Bacillus anthracis (event)
* UsageContextType focus: Clinical Focus Asymptomatic (finding)
purpose:
Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.

usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.
approvalDate: 2019-06-07
lastReviewDate: 2019-06-07
effectivePeriod: 2019-06-07 --> (ongoing)
topic: Anthrax, Emergency Medicine, Post-Exposure Prophylaxis
author: Alliance to Modernize Healthcare FFRDC:
endorser: Centers for Disease Control and Prevention:
kind: ImmunizationRecommendation
code: Anthrax vaccination
product: Anthrax vaccine
dosage
text: 0.5mL
additionalInstruction: Pregnant women at risk for inhalation anthrax should receive the anthrax vaccine regardless of pregnancy trimester., Epinephrine solution (1:1000) should be available for immediate use in the event that an anaphylactic reaction occurs.
route: Subcutaneous route
DoseAndRates
- Dose[x]
* 0.5 mL (Details: UCUM codemL = 'mL')

Source

{
  "resourceType" : "PlanDefinition",
  "id" : "second-vaccinedose-pregnant-pd",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: PlanDefinition second-vaccinedose-pregnant-pd</b></p><a name=\"second-vaccinedose-pregnant-pd\"> </a><a name=\"hcsecond-vaccinedose-pregnant-pd\"> </a><a name=\"second-vaccinedose-pregnant-pd-en-US\"> </a><p><b>url</b>: <a href=\"PlanDefinition-second-vaccinedose-pregnant-pd.html\">PlanDefinition Second vaccine pregnant</a></p><p><b>identifier</b>: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/OrderSet</p><p><b>version</b>: 1.1.0</p><p><b>name</b>: Anthrax_Post_Exposure_Prophylaxis_Adults</p><p><b>title</b>: Second vaccine pregnant</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/plan-definition-type eca-rule}, {http://terminology.hl7.org/CodeSystem/plan-definition-type order-set}\">ECA Rule</span></p><p><b>status</b>: Draft</p><p><b>experimental</b>: true</p><p><b>date</b>: 2024-11-18 16:44:02+0000</p><p><b>publisher</b>: HL7 International - Clinical Decision Support WG</p><p><b>contact</b>: HL7 International - Clinical Decision Support WG: <a href=\"http://www.hl7.org/Special/committees/dss/index.cfm\">http://www.hl7.org/Special/committees/dss/index.cfm</a></p><p><b>description</b>: </p><div><p>Provides information for treating patients greater than or equal to 18 years old exposed to anthrax within the past 60 days, who do not have anthrax. It is divided into two parts: \\n- Part #1: For patients that may be symptomatic to flag the need to conduct a full diagnostic evaluation to rule out anthrax before proceeding with post-exposure prophylaxis (PEP) \\n- Part #2: For patients  who are  asymptomatic (not displaying signs and symptoms of anthrax), it provides recommended PEP regimen</p>\n</div><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-age\">UsageContextType age</a>: Age Range</td><td>18-?</td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-venue\">UsageContextType venue</a>: Clinical Venue</td><td><span title=\"Codes:{http://snomed.info/sct 440655000}\">Outpatient environment</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm Z20.810}\">Contact with and (suspected) exposure to anthrax</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 170475009}\">Exposure to Bacillus anthracis (event)</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 84387000}\">Asymptomatic (finding)</span></td></tr></table><p><b>jurisdiction</b>: <span title=\"Codes:{http://unstats.un.org/unsd/methods/m49/m49.htm 001}\">World</span></p><p><b>purpose</b>: </p><div><p>Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.</p>\n</div><p><b>usage</b>: Intended for use by clinicians caring for individuals â‰¥18 years of age in an outpatient setting.</p><p><b>approvalDate</b>: 2019-06-07</p><p><b>lastReviewDate</b>: 2019-06-07</p><p><b>effectivePeriod</b>: 2019-06-07 --&gt; (ongoing)</p><p><b>topic</b>: <span title=\"Codes:\">Anthrax</span>, <span title=\"Codes:\">Emergency Medicine</span>, <span title=\"Codes:\">Post-Exposure Prophylaxis</span></p><p><b>author</b>: Alliance to Modernize Healthcare FFRDC: </p><p><b>endorser</b>: Centers for Disease Control and Prevention: </p><p><b>library</b>: <a href=\"Library-anthrax-post-exposure-prophylaxis-library.html\">Anthrax Post Exposure Prophylaxis (PEP) for Adults FHIRv400 Logic</a></p><blockquote><p><b>action</b></p><p><b>title</b>: Anthrax Post Exposure Prophylaxis 10</p><blockquote><p><b>trigger</b></p><p><b>type</b>: Data Added</p><blockquote><p><b>data</b></p><p><b>type</b>: Condition</p><blockquote><p><b>codeFilter</b></p><p><b>path</b>: code</p><p><b>code</b>: <a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-icd10CM.html#icd10CM-Z20.46810\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Z20.810</a>: Contact with and (suspected) exposure to anthrax, <a href=\"http://snomed.info/id/170475009\">SNOMED CT 170475009</a>: Exposure to Bacillus anthracis (event)</p></blockquote></blockquote></blockquote><blockquote><p><b>trigger</b></p><p><b>type</b>: Data Added</p><blockquote><p><b>data</b></p><p><b>type</b>: Observation</p><blockquote><p><b>codeFilter</b></p><p><b>path</b>: code</p><p><b>code</b>: <a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-icd10CM.html#icd10CM-Z20.46810\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Z20.810</a>: Contact with and (suspected) exposure to anthrax, <a href=\"http://snomed.info/id/170475009\">SNOMED CT 170475009</a>: Exposure to Bacillus anthracis (event), <a href=\"http://snomed.info/id/84387000\">SNOMED CT 84387000</a>: Asymptomatic (finding)</p></blockquote></blockquote></blockquote><blockquote><p><b>condition</b></p><p><b>kind</b>: Applicability</p><h3>Expressions</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style=\"display: none\">*</td><td>CQL</td><td>GenerateOrderSet</td></tr></table></blockquote><p><b>groupingBehavior</b>: Logical Group</p><p><b>selectionBehavior</b>: Any</p><blockquote><p><b>action</b></p><p><b>title</b>: Antimicrobial medications for anthrax post-exposure prophylaxis</p><p><b>groupingBehavior</b>: Visual Group</p><p><b>selectionBehavior</b>: At Most One</p><blockquote><p><b>action</b></p><p><b>title</b>: First line antimicrobial medications for anthrax post-exposure prophylaxis</p><p><b>groupingBehavior</b>: Visual Group</p><p><b>selectionBehavior</b>: At Most One</p><h3>Actions</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Definition[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/action-type create}\">Create</span></td><td><a href=\"#hcsecond-vaccinedose-pregnant-pd/Inline-Ciprofloxacin-Request-5\">ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Ciprofloxacin Request</a></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/action-type create}\">Create</span></td><td><a href=\"#hcsecond-vaccinedose-pregnant-pd/Inline-Doxycycline-Request-5\">ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Doxycycline Request</a></td></tr></table></blockquote><blockquote><p><b>action</b></p><p><b>title</b>: Second line antimicrobial medications for anthrax post-exposure prophylaxis</p><p><b>groupingBehavior</b>: Visual Group</p><p><b>selectionBehavior</b>: At Most One</p><h3>Actions</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Definition[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/action-type create}\">Create</span></td><td><a href=\"#hcsecond-vaccinedose-pregnant-pd/Inline-Levofloxacin-Request-5\">ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Levofloxacin Request</a></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/action-type create}\">Create</span></td><td><a href=\"#hcsecond-vaccinedose-pregnant-pd/Inline-Moxifloxacin-Request-5\">ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Moxifloxacin Request</a></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/action-type create}\">Create</span></td><td><a href=\"#hcsecond-vaccinedose-pregnant-pd/Inline-Clindamycin-Request-5\">ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Clindamycin Request</a></td></tr></table></blockquote></blockquote><blockquote><p><b>action</b></p><p><b>title</b>: Anthrax Vaccination - 2nd dose</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/action-type create}\">Create</span></p><p><b>definition</b>: <a href=\"#hcsecond-vaccinedose-pregnant-pd/Inline-Vaccine-Request-5\">ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Vaccine Request</a></p></blockquote></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: ActivityDefinition  #Inline-Ciprofloxacin-Request-5</b></p><a name=\"second-vaccinedose-pregnant-pd/Inline-Ciprofloxacin-Request-5\"> </a><a name=\"hcsecond-vaccinedose-pregnant-pd/Inline-Ciprofloxacin-Request-5\"> </a><a name=\"second-vaccinedose-pregnant-pd/Inline-Ciprofloxacin-Request-5-en-US\"> </a><p><b>url</b>: <a href=\"http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Ciprofloxacin-Request-5\">http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Ciprofloxacin-Request-5</a></p><p><b>identifier</b>: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/CiprofloxacinRequest</p><p><b>name</b>: Anthrax_Post_Exposure_Prophylaxis_Adults_Ciprofloxacin_Request</p><p><b>title</b>: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Ciprofloxacin Request</p><p><b>status</b>: Draft</p><p><b>experimental</b>: true</p><p><b>description</b>: </p><div><p>In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax  in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged â‰¥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10â€“14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).</p>\n</div><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-age\">UsageContextType age</a>: Age Range</td><td>18-?</td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-venue\">UsageContextType venue</a>: Clinical Venue</td><td><span title=\"Codes:{http://snomed.info/sct 440655000}\">Outpatient environment</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm Z20.810}\">Contact with and (suspected) exposure to anthrax</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 170475009}\">Exposure to Bacillus anthracis (event)</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 84387000}\">Asymptomatic (finding)</span></td></tr></table><p><b>purpose</b>: </p><div><p>Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.</p>\n</div><p><b>usage</b>: Intended for use by clinicians caring for individuals â‰¥18 years of age in an outpatient setting.</p><p><b>approvalDate</b>: 2019-06-07</p><p><b>lastReviewDate</b>: 2019-06-07</p><p><b>effectivePeriod</b>: 2019-06-07 --&gt; (ongoing)</p><p><b>topic</b>: <span title=\"Codes:\">Anthrax</span>, <span title=\"Codes:\">Emergency Medicine</span>, <span title=\"Codes:\">Post-Exposure Prophylaxis</span></p><p><b>author</b>: Alliance to Modernize Healthcare FFRDC: </p><p><b>endorser</b>: Centers for Disease Control and Prevention: </p><p><b>kind</b>: MedicationRequest</p><p><b>product</b>: <span title=\"Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 309309}\">FIRST CHOICE: Ciprofloxacin 500 MG Oral Tablet</span></p><p><b>quantity</b>: 120(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm)<span style=\"background: LightGoldenRodYellow\"> (Details: Orderable Drug Form  codeORTAB = 'Oral Tablet')</span></p><h3>Dosages</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Text</b></td><td><b>AdditionalInstruction</b></td><td><b>PatientInstruction</b></td><td><b>Timing</b></td><td><b>Route</b></td><td><b>Method</b></td></tr><tr><td style=\"display: none\">*</td><td>One every 12 hours for 60 days</td><td><span title=\"Codes:\">Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester.</span>, <span title=\"Codes:\">CONTRAINDICATIONS: Diagnosis of myasthenia gravis and taking tizanidine.</span>, <span title=\"Codes:\">CAUTIONS: If patient is taking  blood thinners, oral antidiabetic drugs, seizure drugs, theophylline, drugs that prolong QT interval, duloxetine (Cymbalta), zolpidem (Ambien), clozapine or any other drug that may interact and cause serious side effects, consider another antibiotic regimen.</span>, <span title=\"Codes:\">Provide patient education on medications.</span></td><td>Take with full glass of water</td><td>Once per 12 hours</td><td><span title=\"Codes:{http://snomed.info/sct 26643006}\">Oral Route</span></td><td><span title=\"Codes:{http://snomed.info/sct 421521009}\">Swallow - dosing instruction imperative (qualifier value)</span></td></tr></table></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: ActivityDefinition  #Inline-Doxycycline-Request-5</b></p><a name=\"second-vaccinedose-pregnant-pd/Inline-Doxycycline-Request-5\"> </a><a name=\"hcsecond-vaccinedose-pregnant-pd/Inline-Doxycycline-Request-5\"> </a><a name=\"second-vaccinedose-pregnant-pd/Inline-Doxycycline-Request-5-en-US\"> </a><p><b>url</b>: <a href=\"http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Doxycycline-Request-5\">http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Doxycycline-Request-5</a></p><p><b>identifier</b>: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/DoxycyclineRequest</p><p><b>name</b>: Anthrax_Post_Exposure_Prophylaxis_Adults_Doxycycline_Request</p><p><b>title</b>: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Doxycycline Request</p><p><b>status</b>: Draft</p><p><b>experimental</b>: true</p><p><b>description</b>: </p><div><p>In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax  in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged â‰¥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10â€“14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).</p>\n</div><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-age\">UsageContextType age</a>: Age Range</td><td>18-?</td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-venue\">UsageContextType venue</a>: Clinical Venue</td><td><span title=\"Codes:{http://snomed.info/sct 440655000}\">Outpatient environment</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm Z20.810}\">Contact with and (suspected) exposure to anthrax</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 170475009}\">Exposure to Bacillus anthracis (event)</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 84387000}\">Asymptomatic (finding)</span></td></tr></table><p><b>purpose</b>: </p><div><p>Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.</p>\n</div><p><b>usage</b>: Intended for use by clinicians caring for individuals â‰¥18 years of age in an outpatient setting.</p><p><b>approvalDate</b>: 2019-06-07</p><p><b>lastReviewDate</b>: 2019-06-07</p><p><b>effectivePeriod</b>: 2019-06-07 --&gt; (ongoing)</p><p><b>topic</b>: <span title=\"Codes:\">Anthrax</span>, <span title=\"Codes:\">Emergency Medicine</span>, <span title=\"Codes:\">Post-Exposure Prophylaxis</span></p><p><b>author</b>: Alliance to Modernize Healthcare FFRDC: </p><p><b>endorser</b>: Centers for Disease Control and Prevention: </p><p><b>kind</b>: MedicationRequest</p><p><b>product</b>: <span title=\"Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 1650143}\">SECOND CHOICE: doxycycline hyclate 100 MG Oral Tablet</span></p><p><b>quantity</b>: 120(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm)<span style=\"background: LightGoldenRodYellow\"> (Details: Orderable Drug Form  codeORTAB = 'Oral Tablet')</span></p><h3>Dosages</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Text</b></td><td><b>AdditionalInstruction</b></td><td><b>PatientInstruction</b></td><td><b>Timing</b></td><td><b>Route</b></td><td><b>Method</b></td></tr><tr><td style=\"display: none\">*</td><td>One every 12 hours for 60 days</td><td><span title=\"Codes:\">Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester.</span>, <span title=\"Codes:\">CAUTIONS: If patient is taking  blood thinners, oral antidiabetic drugs, seizure drugs, or any other drug that may interact and cause serious side effects, consider another antibiotic regimen.</span>, <span title=\"Codes:\">Provide patient education on medications.</span></td><td>Take with full glass of water</td><td>Once per 12 hours</td><td><span title=\"Codes:{http://snomed.info/sct 26643006}\">Oral Route</span></td><td><span title=\"Codes:{http://snomed.info/sct 421521009}\">Swallow - dosing instruction imperative (qualifier value)</span></td></tr></table></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: ActivityDefinition  #Inline-Levofloxacin-Request-5</b></p><a name=\"second-vaccinedose-pregnant-pd/Inline-Levofloxacin-Request-5\"> </a><a name=\"hcsecond-vaccinedose-pregnant-pd/Inline-Levofloxacin-Request-5\"> </a><a name=\"second-vaccinedose-pregnant-pd/Inline-Levofloxacin-Request-5-en-US\"> </a><p><b>url</b>: <a href=\"http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Levofloxacin-Request-5\">http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Levofloxacin-Request-5</a></p><p><b>identifier</b>: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/LevofloxacinRequest</p><p><b>name</b>: Anthrax_Post_Exposure_Prophylaxis_Adults_Levofloxacin_Request</p><p><b>title</b>: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Levofloxacin Request</p><p><b>status</b>: Draft</p><p><b>experimental</b>: true</p><p><b>description</b>: </p><div><p>In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax  in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged â‰¥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10â€“14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).</p>\n</div><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-age\">UsageContextType age</a>: Age Range</td><td>18-?</td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-venue\">UsageContextType venue</a>: Clinical Venue</td><td><span title=\"Codes:{http://snomed.info/sct 440655000}\">Outpatient environment</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm Z20.810}\">Contact with and (suspected) exposure to anthrax</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 170475009}\">Exposure to Bacillus anthracis (event)</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 84387000}\">Asymptomatic (finding)</span></td></tr></table><p><b>purpose</b>: </p><div><p>Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.</p>\n</div><p><b>usage</b>: Intended for use by clinicians caring for individuals â‰¥18 years of age in an outpatient setting.</p><p><b>approvalDate</b>: 2019-06-07</p><p><b>lastReviewDate</b>: 2019-06-07</p><p><b>effectivePeriod</b>: 2019-06-07 --&gt; (ongoing)</p><p><b>topic</b>: <span title=\"Codes:\">Anthrax</span>, <span title=\"Codes:\">Emergency Medicine</span>, <span title=\"Codes:\">Post-Exposure Prophylaxis</span></p><p><b>author</b>: Alliance to Modernize Healthcare FFRDC: </p><p><b>endorser</b>: Centers for Disease Control and Prevention: </p><p><b>kind</b>: MedicationRequest</p><p><b>product</b>: <span title=\"Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 311296}\">Levofloxacin 750 MG Oral Tablet</span></p><p><b>quantity</b>: 60(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm)<span style=\"background: LightGoldenRodYellow\"> (Details: Orderable Drug Form  codeORTAB = 'Oral Tablet')</span></p><h3>Dosages</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Text</b></td><td><b>AdditionalInstruction</b></td><td><b>Timing</b></td><td><b>Route</b></td><td><b>Method</b></td></tr><tr><td style=\"display: none\">*</td><td>One every day for 60 days</td><td><span title=\"Codes:\">Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester.</span></td><td>Once per 1 days</td><td><span title=\"Codes:{http://snomed.info/sct 26643006}\">Oral Route</span></td><td><span title=\"Codes:{http://snomed.info/sct 421521009}\">Swallow - dosing instruction imperative (qualifier value)</span></td></tr></table></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: ActivityDefinition  #Inline-Moxifloxacin-Request-5</b></p><a name=\"second-vaccinedose-pregnant-pd/Inline-Moxifloxacin-Request-5\"> </a><a name=\"hcsecond-vaccinedose-pregnant-pd/Inline-Moxifloxacin-Request-5\"> </a><a name=\"second-vaccinedose-pregnant-pd/Inline-Moxifloxacin-Request-5-en-US\"> </a><p><b>url</b>: <a href=\"http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Moxifloxacin-Request-5\">http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Moxifloxacin-Request-5</a></p><p><b>identifier</b>: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/MoxifloxacinRequest</p><p><b>name</b>: Anthrax_Post_Exposure_Prophylaxis_Adults_Moxifloxacin_Request</p><p><b>title</b>: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Moxifloxacin Request</p><p><b>status</b>: Draft</p><p><b>experimental</b>: true</p><p><b>description</b>: </p><div><p>In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax  in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged â‰¥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10â€“14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).</p>\n</div><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-age\">UsageContextType age</a>: Age Range</td><td>18-?</td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-venue\">UsageContextType venue</a>: Clinical Venue</td><td><span title=\"Codes:{http://snomed.info/sct 440655000}\">Outpatient environment</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm Z20.810}\">Contact with and (suspected) exposure to anthrax</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 170475009}\">Exposure to Bacillus anthracis (event)</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 84387000}\">Asymptomatic (finding)</span></td></tr></table><p><b>purpose</b>: </p><div><p>Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.</p>\n</div><p><b>usage</b>: Intended for use by clinicians caring for individuals â‰¥18 years of age in an outpatient setting.</p><p><b>approvalDate</b>: 2019-06-07</p><p><b>lastReviewDate</b>: 2019-06-07</p><p><b>effectivePeriod</b>: 2019-06-07 --&gt; (ongoing)</p><p><b>topic</b>: <span title=\"Codes:\">Anthrax</span>, <span title=\"Codes:\">Emergency Medicine</span>, <span title=\"Codes:\">Post-Exposure Prophylaxis</span></p><p><b>author</b>: Alliance to Modernize Healthcare FFRDC: </p><p><b>endorser</b>: Centers for Disease Control and Prevention: </p><p><b>kind</b>: MedicationRequest</p><p><b>product</b>: <span title=\"Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 311787}\">moxifloxacin HCl 400 MG Oral Tablet</span></p><p><b>quantity</b>: 60(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm)<span style=\"background: LightGoldenRodYellow\"> (Details: Orderable Drug Form  codeORTAB = 'Oral Tablet')</span></p><h3>Dosages</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Text</b></td><td><b>AdditionalInstruction</b></td><td><b>Timing</b></td><td><b>Route</b></td><td><b>Method</b></td></tr><tr><td style=\"display: none\">*</td><td>One every day for 60 days</td><td><span title=\"Codes:\">Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester.</span></td><td>Once per 1 days</td><td><span title=\"Codes:{http://snomed.info/sct 26643006}\">Oral Route</span></td><td><span title=\"Codes:{http://snomed.info/sct 421521009}\">Swallow - dosing instruction imperative (qualifier value)</span></td></tr></table></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: ActivityDefinition  #Inline-Clindamycin-Request-5</b></p><a name=\"second-vaccinedose-pregnant-pd/Inline-Clindamycin-Request-5\"> </a><a name=\"hcsecond-vaccinedose-pregnant-pd/Inline-Clindamycin-Request-5\"> </a><a name=\"second-vaccinedose-pregnant-pd/Inline-Clindamycin-Request-5-en-US\"> </a><p><b>url</b>: <a href=\"http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Clindamycin-Request-5\">http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Clindamycin-Request-5</a></p><p><b>identifier</b>: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/ClindamycinRequest</p><p><b>name</b>: Anthrax_Post_Exposure_Prophylaxis_Adults_Clindamycin_Request</p><p><b>title</b>: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Clindamycin Request</p><p><b>status</b>: Draft</p><p><b>experimental</b>: true</p><p><b>description</b>: </p><div><p>In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax  in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged â‰¥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10â€“14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).</p>\n</div><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-age\">UsageContextType age</a>: Age Range</td><td>18-?</td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-venue\">UsageContextType venue</a>: Clinical Venue</td><td><span title=\"Codes:{http://snomed.info/sct 440655000}\">Outpatient environment</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm Z20.810}\">Contact with and (suspected) exposure to anthrax</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 170475009}\">Exposure to Bacillus anthracis (event)</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 84387000}\">Asymptomatic (finding)</span></td></tr></table><p><b>purpose</b>: </p><div><p>Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.</p>\n</div><p><b>usage</b>: Intended for use by clinicians caring for individuals â‰¥18 years of age in an outpatient setting.</p><p><b>approvalDate</b>: 2019-06-07</p><p><b>lastReviewDate</b>: 2019-06-07</p><p><b>effectivePeriod</b>: 2019-06-07 --&gt; (ongoing)</p><p><b>topic</b>: <span title=\"Codes:\">Anthrax</span>, <span title=\"Codes:\">Emergency Medicine</span>, <span title=\"Codes:\">Post-Exposure Prophylaxis</span></p><p><b>author</b>: Alliance to Modernize Healthcare FFRDC: </p><p><b>endorser</b>: Centers for Disease Control and Prevention: </p><p><b>kind</b>: MedicationRequest</p><p><b>product</b>: <span title=\"Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 284215}\">clindamycin HCl 300 MG Oral Capsule</span></p><p><b>quantity</b>: 360(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm)<span style=\"background: LightGoldenRodYellow\"> (Details: Orderable Drug Form  codeORTAB = 'Oral Tablet')</span></p><h3>Dosages</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Text</b></td><td><b>AdditionalInstruction</b></td><td><b>Timing</b></td><td><b>Route</b></td><td><b>Method</b></td></tr><tr><td style=\"display: none\">*</td><td>Two tablets every 8 hours for 60 days</td><td><span title=\"Codes:\">Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester.</span></td><td>2 per 8 hours</td><td><span title=\"Codes:{http://snomed.info/sct 26643006}\">Oral Route</span></td><td><span title=\"Codes:{http://snomed.info/sct 421521009}\">Swallow - dosing instruction imperative (qualifier value)</span></td></tr></table></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: ActivityDefinition  #Inline-Vaccine-Request-5</b></p><a name=\"second-vaccinedose-pregnant-pd/Inline-Vaccine-Request-5\"> </a><a name=\"hcsecond-vaccinedose-pregnant-pd/Inline-Vaccine-Request-5\"> </a><a name=\"second-vaccinedose-pregnant-pd/Inline-Vaccine-Request-5-en-US\"> </a><p><b>url</b>: <a href=\"http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Vaccine-Request-5\">http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Vaccine-Request-5</a></p><p><b>identifier</b>: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/VaccineRequest</p><p><b>name</b>: Anthrax_Post_Exposure_Prophylaxis_Adults_Vaccine_Request</p><p><b>title</b>: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Vaccine Request</p><p><b>status</b>: Draft</p><p><b>experimental</b>: true</p><p><b>description</b>: </p><div><p>In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax  in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged â‰¥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10â€“14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).</p>\n</div><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-age\">UsageContextType age</a>: Age Range</td><td>18-?</td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-venue\">UsageContextType venue</a>: Clinical Venue</td><td><span title=\"Codes:{http://snomed.info/sct 440655000}\">Outpatient environment</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm Z20.810}\">Contact with and (suspected) exposure to anthrax</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 170475009}\">Exposure to Bacillus anthracis (event)</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 84387000}\">Asymptomatic (finding)</span></td></tr></table><p><b>purpose</b>: </p><div><p>Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.</p>\n</div><p><b>usage</b>: Intended for use by clinicians caring for individuals â‰¥18 years of age in an outpatient setting.</p><p><b>approvalDate</b>: 2019-06-07</p><p><b>lastReviewDate</b>: 2019-06-07</p><p><b>effectivePeriod</b>: 2019-06-07 --&gt; (ongoing)</p><p><b>topic</b>: <span title=\"Codes:\">Anthrax</span>, <span title=\"Codes:\">Emergency Medicine</span>, <span title=\"Codes:\">Post-Exposure Prophylaxis</span></p><p><b>author</b>: Alliance to Modernize Healthcare FFRDC: </p><p><b>endorser</b>: Centers for Disease Control and Prevention: </p><p><b>kind</b>: ImmunizationRecommendation</p><p><b>code</b>: <span title=\"Codes:{http://snomed.info/sct 49598002}, {http://snomed.info/sct 170339008}\">Anthrax vaccination</span></p><p><b>product</b>: <span title=\"Codes:{http://hl7.org/fhir/sid/cvx 24}\">Anthrax vaccine</span></p><blockquote><p><b>dosage</b></p><p><b>text</b>: 0.5mL</p><p><b>additionalInstruction</b>: <span title=\"Codes:\">Pregnant women at risk for inhalation anthrax should receive the anthrax vaccine regardless of pregnancy trimester.</span>, <span title=\"Codes:\">Epinephrine solution (1:1000) should be available for immediate use in the event that an anaphylactic reaction occurs.</span></p><p><b>route</b>: <span title=\"Codes:{http://snomed.info/sct 34206005}\">Subcutaneous route</span></p><h3>DoseAndRates</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Dose[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>0.5 mL<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  codemL = 'mL')</span></td></tr></table></blockquote></blockquote></div>"
  },
  "contained" : [
    {
      "resourceType" : "ActivityDefinition",
      "id" : "Inline-Ciprofloxacin-Request-5",
      "url" : "http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Ciprofloxacin-Request-5",
      "identifier" : [
        {
          "value" : "Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/CiprofloxacinRequest"
        }
      ],
      "name" : "Anthrax_Post_Exposure_Prophylaxis_Adults_Ciprofloxacin_Request",
      "title" : "Anthrax Post Exposure Prophylaxis (PEP) for Adults: Ciprofloxacin Request",
      "status" : "draft",
      "experimental" : true,
      "description" : "In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax  in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged â‰¥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10â€“14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).",
      "useContext" : [
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          "code" : {
            "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
            "code" : "age",
            "display" : "Age Range"
          },
          "valueRange" : {
            "low" : {
              "value" : 18
            }
          }
        },
        {
          "code" : {
            "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
            "code" : "venue",
            "display" : "Clinical Venue"
          },
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://snomed.info/sct",
                "code" : "440655000",
                "display" : "Outpatient environment"
              }
            ]
          }
        },
        {
          "code" : {
            "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
            "code" : "focus",
            "display" : "Clinical Focus"
          },
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/sid/icd-10-cm",
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                "display" : "Contact with and (suspected) exposure to anthrax"
              }
            ]
          }
        },
        {
          "code" : {
            "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
            "code" : "focus",
            "display" : "Clinical Focus"
          },
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://snomed.info/sct",
                "code" : "170475009",
                "display" : "Exposure to Bacillus anthracis (event)"
              }
            ]
          }
        },
        {
          "code" : {
            "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
            "code" : "focus",
            "display" : "Clinical Focus"
          },
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://snomed.info/sct",
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                "display" : "Asymptomatic (finding)"
              }
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      ],
      "purpose" : "Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.",
      "usage" : "Intended for use by clinicians caring for individuals â‰¥18 years of age in an outpatient setting.",
      "approvalDate" : "2019-06-07",
      "lastReviewDate" : "2019-06-07",
      "effectivePeriod" : {
        "start" : "2019-06-07"
      },
      "topic" : [
        {
          "text" : "Anthrax"
        },
        {
          "text" : "Emergency Medicine"
        },
        {
          "text" : "Post-Exposure Prophylaxis"
        }
      ],
      "author" : [
        {
          "name" : "Alliance to Modernize Healthcare FFRDC"
        }
      ],
      "endorser" : [
        {
          "name" : "Centers for Disease Control and Prevention"
        }
      ],
      "kind" : "MedicationRequest",
      "productCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
            "code" : "309309",
            "display" : "Ciprofloxacin 500 MG Oral Tablet"
          }
        ],
        "text" : "FIRST CHOICE: Ciprofloxacin 500 MG Oral Tablet"
      },
      "quantity" : {
        "value" : 120,
        "system" : "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
        "code" : "ORTAB"
      },
      "dosage" : [
        {
          "text" : "One every 12 hours for 60 days",
          "additionalInstruction" : [
            {
              "text" : "Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester."
            },
            {
              "text" : "CONTRAINDICATIONS: Diagnosis of myasthenia gravis and taking tizanidine."
            },
            {
              "text" : "CAUTIONS: If patient is taking  blood thinners, oral antidiabetic drugs, seizure drugs, theophylline, drugs that prolong QT interval, duloxetine (Cymbalta), zolpidem (Ambien), clozapine or any other drug that may interact and cause serious side effects, consider another antibiotic regimen."
            },
            {
              "text" : "Provide patient education on medications."
            }
          ],
          "patientInstruction" : "Take with full glass of water",
          "timing" : {
            "repeat" : {
              "frequency" : 1,
              "period" : 12,
              "periodUnit" : "h"
            }
          },
          "route" : {
            "coding" : [
              {
                "system" : "http://snomed.info/sct",
                "code" : "26643006",
                "display" : "Oral Route"
              }
            ]
          },
          "method" : {
            "coding" : [
              {
                "system" : "http://snomed.info/sct",
                "code" : "421521009",
                "display" : "Swallow - dosing instruction imperative (qualifier value)"
              }
            ]
          }
        }
      ]
    },
    {
      "resourceType" : "ActivityDefinition",
      "id" : "Inline-Doxycycline-Request-5",
      "url" : "http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Doxycycline-Request-5",
      "identifier" : [
        {
          "value" : "Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/DoxycyclineRequest"
        }
      ],
      "name" : "Anthrax_Post_Exposure_Prophylaxis_Adults_Doxycycline_Request",
      "title" : "Anthrax Post Exposure Prophylaxis (PEP) for Adults: Doxycycline Request",
      "status" : "draft",
      "experimental" : true,
      "description" : "In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax  in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged â‰¥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10â€“14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).",
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          "code" : {
            "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
            "code" : "age",
            "display" : "Age Range"
          },
          "valueRange" : {
            "low" : {
              "value" : 18
            }
          }
        },
        {
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          "code" : {
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            "code" : "focus",
            "display" : "Clinical Focus"
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          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/sid/icd-10-cm",
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                "display" : "Contact with and (suspected) exposure to anthrax"
              }
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        {
          "code" : {
            "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
            "code" : "focus",
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          "valueCodeableConcept" : {
            "coding" : [
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        },
        {
          "code" : {
            "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
            "code" : "focus",
            "display" : "Clinical Focus"
          },
          "valueCodeableConcept" : {
            "coding" : [
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                "system" : "http://snomed.info/sct",
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                "display" : "Asymptomatic (finding)"
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      ],
      "purpose" : "Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.",
      "usage" : "Intended for use by clinicians caring for individuals â‰¥18 years of age in an outpatient setting.",
      "approvalDate" : "2019-06-07",
      "lastReviewDate" : "2019-06-07",
      "effectivePeriod" : {
        "start" : "2019-06-07"
      },
      "topic" : [
        {
          "text" : "Anthrax"
        },
        {
          "text" : "Emergency Medicine"
        },
        {
          "text" : "Post-Exposure Prophylaxis"
        }
      ],
      "author" : [
        {
          "name" : "Alliance to Modernize Healthcare FFRDC"
        }
      ],
      "endorser" : [
        {
          "name" : "Centers for Disease Control and Prevention"
        }
      ],
      "kind" : "MedicationRequest",
      "productCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
            "code" : "1650143",
            "display" : "doxycycline hyclate 100 MG Oral Tablet"
          }
        ],
        "text" : "SECOND CHOICE: doxycycline hyclate 100 MG Oral Tablet"
      },
      "quantity" : {
        "value" : 120,
        "system" : "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
        "code" : "ORTAB"
      },
      "dosage" : [
        {
          "text" : "One every 12 hours for 60 days",
          "additionalInstruction" : [
            {
              "text" : "Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester."
            },
            {
              "text" : "CAUTIONS: If patient is taking  blood thinners, oral antidiabetic drugs, seizure drugs, or any other drug that may interact and cause serious side effects, consider another antibiotic regimen."
            },
            {
              "text" : "Provide patient education on medications."
            }
          ],
          "patientInstruction" : "Take with full glass of water",
          "timing" : {
            "repeat" : {
              "frequency" : 1,
              "period" : 12,
              "periodUnit" : "h"
            }
          },
          "route" : {
            "coding" : [
              {
                "system" : "http://snomed.info/sct",
                "code" : "26643006",
                "display" : "Oral Route"
              }
            ]
          },
          "method" : {
            "coding" : [
              {
                "system" : "http://snomed.info/sct",
                "code" : "421521009",
                "display" : "Swallow - dosing instruction imperative (qualifier value)"
              }
            ]
          }
        }
      ]
    },
    {
      "resourceType" : "ActivityDefinition",
      "id" : "Inline-Levofloxacin-Request-5",
      "url" : "http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Levofloxacin-Request-5",
      "identifier" : [
        {
          "value" : "Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/LevofloxacinRequest"
        }
      ],
      "name" : "Anthrax_Post_Exposure_Prophylaxis_Adults_Levofloxacin_Request",
      "title" : "Anthrax Post Exposure Prophylaxis (PEP) for Adults: Levofloxacin Request",
      "status" : "draft",
      "experimental" : true,
      "description" : "In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax  in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged â‰¥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10â€“14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).",
      "useContext" : [
        {
          "code" : {
            "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
            "code" : "age",
            "display" : "Age Range"
          },
          "valueRange" : {
            "low" : {
              "value" : 18
            }
          }
        },
        {
          "code" : {
            "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
            "code" : "venue",
            "display" : "Clinical Venue"
          },
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://snomed.info/sct",
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        {
          "code" : {
            "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
            "code" : "focus",
            "display" : "Clinical Focus"
          },
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/sid/icd-10-cm",
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                "display" : "Contact with and (suspected) exposure to anthrax"
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        },
        {
          "code" : {
            "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
            "code" : "focus",
            "display" : "Clinical Focus"
          },
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://snomed.info/sct",
                "code" : "170475009",
                "display" : "Exposure to Bacillus anthracis (event)"
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        },
        {
          "code" : {
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            "code" : "focus",
            "display" : "Clinical Focus"
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            "coding" : [
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      ],
      "purpose" : "Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.",
      "usage" : "Intended for use by clinicians caring for individuals â‰¥18 years of age in an outpatient setting.",
      "approvalDate" : "2019-06-07",
      "lastReviewDate" : "2019-06-07",
      "effectivePeriod" : {
        "start" : "2019-06-07"
      },
      "topic" : [
        {
          "text" : "Anthrax"
        },
        {
          "text" : "Emergency Medicine"
        },
        {
          "text" : "Post-Exposure Prophylaxis"
        }
      ],
      "author" : [
        {
          "name" : "Alliance to Modernize Healthcare FFRDC"
        }
      ],
      "endorser" : [
        {
          "name" : "Centers for Disease Control and Prevention"
        }
      ],
      "kind" : "MedicationRequest",
      "productCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
            "code" : "311296",
            "display" : "Levofloxacin 750 MG Oral Tablet"
          }
        ],
        "text" : "Levofloxacin 750 MG Oral Tablet"
      },
      "quantity" : {
        "value" : 60,
        "system" : "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
        "code" : "ORTAB"
      },
      "dosage" : [
        {
          "text" : "One every day for 60 days",
          "additionalInstruction" : [
            {
              "text" : "Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester."
            }
          ],
          "timing" : {
            "repeat" : {
              "frequency" : 1,
              "period" : 1,
              "periodUnit" : "d"
            }
          },
          "route" : {
            "coding" : [
              {
                "system" : "http://snomed.info/sct",
                "code" : "26643006",
                "display" : "Oral Route"
              }
            ]
          },
          "method" : {
            "coding" : [
              {
                "system" : "http://snomed.info/sct",
                "code" : "421521009",
                "display" : "Swallow - dosing instruction imperative (qualifier value)"
              }
            ]
          }
        }
      ]
    },
    {
      "resourceType" : "ActivityDefinition",
      "id" : "Inline-Moxifloxacin-Request-5",
      "url" : "http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Moxifloxacin-Request-5",
      "identifier" : [
        {
          "value" : "Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/MoxifloxacinRequest"
        }
      ],
      "name" : "Anthrax_Post_Exposure_Prophylaxis_Adults_Moxifloxacin_Request",
      "title" : "Anthrax Post Exposure Prophylaxis (PEP) for Adults: Moxifloxacin Request",
      "status" : "draft",
      "experimental" : true,
      "description" : "In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax  in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged â‰¥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10â€“14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).",
      "useContext" : [
        {
          "code" : {
            "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
            "code" : "age",
            "display" : "Age Range"
          },
          "valueRange" : {
            "low" : {
              "value" : 18
            }
          }
        },
        {
          "code" : {
            "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
            "code" : "venue",
            "display" : "Clinical Venue"
          },
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://snomed.info/sct",
                "code" : "440655000",
                "display" : "Outpatient environment"
              }
            ]
          }
        },
        {
          "code" : {
            "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
            "code" : "focus",
            "display" : "Clinical Focus"
          },
          "valueCodeableConcept" : {
            "coding" : [
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                "system" : "http://hl7.org/fhir/sid/icd-10-cm",
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                "display" : "Contact with and (suspected) exposure to anthrax"
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          }
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        {
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          "valueCodeableConcept" : {
            "coding" : [
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                "system" : "http://snomed.info/sct",
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      "kind" : "MedicationRequest",
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              "text" : "Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester."
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          "value" : "Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/VaccineRequest"
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      "kind" : "ImmunizationRecommendation",
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            "system" : "http://snomed.info/sct",
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          "text" : "0.5mL",
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              "text" : "Pregnant women at risk for inhalation anthrax should receive the anthrax vaccine regardless of pregnancy trimester."
            },
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              "text" : "Epinephrine solution (1:1000) should be available for immediate use in the event that an anaphylactic reaction occurs."
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  "date" : "2024-11-18T16:44:02+00:00",
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  "topic" : [
    {
      "text" : "Anthrax"
    },
    {
      "text" : "Emergency Medicine"
    },
    {
      "text" : "Post-Exposure Prophylaxis"
    }
  ],
  "author" : [
    {
      "name" : "Alliance to Modernize Healthcare FFRDC"
    }
  ],
  "endorser" : [
    {
      "name" : "Centers for Disease Control and Prevention"
    }
  ],
  "library" : [
    "http://cqframework.org/cpg-example-anthrax/Library/anthrax-post-exposure-prophylaxis-library"
  ],
  "action" : [
    {
      "title" : "Anthrax Post Exposure Prophylaxis 10",
      "trigger" : [
        {
          "type" : "data-added",
          "data" : [
            {
              "type" : "Condition",
              "codeFilter" : [
                {
                  "path" : "code",
                  "code" : [
                    {
                      "system" : "http://hl7.org/fhir/sid/icd-10-cm",
                      "code" : "Z20.810",
                      "display" : "Contact with and (suspected) exposure to anthrax"
                    },
                    {
                      "system" : "http://snomed.info/sct",
                      "code" : "170475009",
                      "display" : "Exposure to Bacillus anthracis (event)"
                    }
                  ]
                }
              ]
            }
          ]
        },
        {
          "type" : "data-added",
          "data" : [
            {
              "type" : "Observation",
              "codeFilter" : [
                {
                  "path" : "code",
                  "code" : [
                    {
                      "system" : "http://hl7.org/fhir/sid/icd-10-cm",
                      "code" : "Z20.810",
                      "display" : "Contact with and (suspected) exposure to anthrax"
                    },
                    {
                      "system" : "http://snomed.info/sct",
                      "code" : "170475009",
                      "display" : "Exposure to Bacillus anthracis (event)"
                    },
                    {
                      "system" : "http://snomed.info/sct",
                      "code" : "84387000",
                      "display" : "Asymptomatic (finding)"
                    }
                  ]
                }
              ]
            }
          ]
        }
      ],
      "condition" : [
        {
          "kind" : "applicability",
          "expression" : {
            "language" : "text/cql",
            "expression" : "GenerateOrderSet"
          }
        }
      ],
      "groupingBehavior" : "logical-group",
      "selectionBehavior" : "any",
      "action" : [
        {
          "title" : "Antimicrobial medications for anthrax post-exposure prophylaxis",
          "groupingBehavior" : "visual-group",
          "selectionBehavior" : "at-most-one",
          "action" : [
            {
              "title" : "First line antimicrobial medications for anthrax post-exposure prophylaxis",
              "groupingBehavior" : "visual-group",
              "selectionBehavior" : "at-most-one",
              "action" : [
                {
                  "type" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/action-type",
                        "code" : "create",
                        "display" : "Create"
                      }
                    ]
                  },
                  "definitionCanonical" : "#Inline-Ciprofloxacin-Request-5"
                },
                {
                  "type" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/action-type",
                        "code" : "create",
                        "display" : "Create"
                      }
                    ]
                  },
                  "definitionCanonical" : "#Inline-Doxycycline-Request-5"
                }
              ]
            },
            {
              "title" : "Second line antimicrobial medications for anthrax post-exposure prophylaxis",
              "groupingBehavior" : "visual-group",
              "selectionBehavior" : "at-most-one",
              "action" : [
                {
                  "type" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/action-type",
                        "code" : "create",
                        "display" : "Create"
                      }
                    ]
                  },
                  "definitionCanonical" : "#Inline-Levofloxacin-Request-5"
                },
                {
                  "type" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/action-type",
                        "code" : "create",
                        "display" : "Create"
                      }
                    ]
                  },
                  "definitionCanonical" : "#Inline-Moxifloxacin-Request-5"
                },
                {
                  "type" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/action-type",
                        "code" : "create",
                        "display" : "Create"
                      }
                    ]
                  },
                  "definitionCanonical" : "#Inline-Clindamycin-Request-5"
                }
              ]
            }
          ]
        },
        {
          "title" : "Anthrax Vaccination - 2nd dose",
          "type" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/action-type",
                "code" : "create",
                "display" : "Create"
              }
            ]
          },
          "definitionCanonical" : "#Inline-Vaccine-Request-5"
        }
      ]
    }
  ]
}

XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.