Clinical Practice Guidelines Example Implementation Guide - Anthrax Post-Exposure Prophylaxis
1.1.0 - ci-build
Clinical Practice Guidelines Example Implementation Guide - Anthrax Post-Exposure Prophylaxis
1.1.0 - ci-build
Clinical Practice Guidelines Example Implementation Guide - Anthrax Post-Exposure Prophylaxis, published by HL7 International - Clinical Decision Support WG. This guide is not an authorized publication; it is the continuous build for version 1.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/cpg-example-anthrax/ and changes regularly. See the Directory of published versions
Contents:
This page provides a list of the FHIR artifacts defined as part of this implementation guide.
These define activities that can be performed as part of content in this implementation guide.
| Ciprofloxacin Request |
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). |
| Clindamycin Request |
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). |
| Doxycycline Request |
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). |
| Levofloxacin Request |
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). |
| Moxifloxacin Request |
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). |
| Vaccine Request |
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). |
These define workflows, rules, strategies, or protocols as part of content in this implementation guide.
| Antimicrobial not pregnant |
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 |
| Antimicrobial pregnant |
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 |
| First vaccine antimicrobial not pregnant |
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 |
| First vaccine antimicrobial pregnant |
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 |
| First vaccine not pregnant |
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 |
| First vaccine not pregnant |
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 |
| First vaccine pregnant |
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 |
| Second vaccine antimicrobial not pregnant |
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 |
| Second vaccine antimicrobial pregnant |
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 |
| Second vaccine pregnant |
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 |
| Third vaccine antimicrobial not pregnant |
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 |
| Third vaccine antimicrobial pregnant |
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 |
| Third vaccine not pregnant |
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 |
| Third vaccine pregnant |
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 |
These define logic, asset collections and other libraries as part of content in this implementation guide.
| Anthrax Post Exposure Prophylaxis (PEP) for Adults FHIRv400 Logic |
Clinical decision support logic for Anthrax Post Exposure Prophylaxis (PEP) for Adults based on the following Centers for Disease Control and Prevention reports: \n- Hendricks, K.A. et al., Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults. Emerg Infect Dis, 20(20), Feb 2014. \n - Hendricks, K.A. et al., Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults: Technical Report. Emerg Infect Dis. 20(20), Feb 2014. \n- Emergent BioSolutions, BioThrax Anthrax Vaccine Adsorbed (http://www.biothrax.com/whatisbiothrax/). \n- Centers for Disease Control and Prevention, Ciprofloxacin for Post-Exposure Prophylaxis of Anthrax: Emergency Use Instructions for Healthcare Providers, 2017. \n- Centers for Disease Control and Prevention. Doxycyxcline for Post-Exposure Prophylaxis of Anthrax: Emergency Use Instructions for Healthcare Providers, 2017. \n- Public Health Information Network Vocabulary Access and Distribution System (PHIN VADS), PHVS_SignsSymptoms_Anthrax (OID 2.16.840.1.114222.4.11.3212), 2009. \n- Meanye-Delman D et al., Special Considerations for Prophylaxis for and Treatment of Anthrax in Pregnant and Postpartum Women, Emerg Infect Dis, 20(2), 2014. \n- Meanye-Delman D et al., Special Considerations for Prophylaxis for and Treatment of Anthrax in Pregnant and Postpartum Women: Technical Report, Emerg Infect Dis, 20(2), 2014. \n- Wright, J.G et al., Use of Anthrax Vaccine in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009, Morbidity and Mortality Weeklly Report, July 23, 2010 / 59(RR06); 1-30. |
| CDC Common Logic for FHIRv400 |
A library containing common logic used by CDC CDS artifacts |
| CDS Connect Commons for FHIRv400 |
A library containing common methods used by CDS Connect-developed artifacts |
These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.
| allergy-1 |
Test Case |
| allergy-10 |
Test Case |
| allergy-11 |
Test Case |
| allergy-12 |
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| allergy-13 |
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| allergy-14 |
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| allergy-2 |
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| allergy-3 |
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| allergy-4 |
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| allergy-5 |
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| allergy-6 |
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| allergy-7 |
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| allergy-8 |
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| allergy-9 |
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| bundle-1 |
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| bundle-10 |
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| bundle-11 |
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| bundle-12 |
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| bundle-13 |
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| bundle-14 |
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| bundle-15 |
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| bundle-16 |
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| bundle-17 |
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| bundle-18 |
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| bundle-19 |
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| bundle-2 |
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| bundle-20 |
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| bundle-21 |
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| bundle-22 |
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| bundle-23 |
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| bundle-24 |
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| bundle-25 |
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| bundle-26 |
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| bundle-27 |
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| bundle-28 |
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| bundle-29 |
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| bundle-3 |
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| bundle-30 |
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| bundle-31 |
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| bundle-32 |
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| bundle-33 |
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| bundle-34 |
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| bundle-35 |
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| bundle-36 |
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| bundle-37 |
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| bundle-38 |
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| bundle-39 |
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| bundle-4 |
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| bundle-40 |
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| bundle-41 |
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| bundle-42 |
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| bundle-44 |
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| bundle-45 |
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| bundle-46 |
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| bundle-47 |
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| bundle-48 |
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| bundle-49 |
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| bundle-5 |
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| bundle-50 |
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| bundle-51 |
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| bundle-52 |
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| bundle-53 |
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| bundle-54 |
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| bundle-55 |
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| bundle-56 |
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| bundle-57 |
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| bundle-58 |
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| bundle-59 |
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| bundle-6 |
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| bundle-60 |
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| bundle-61 |
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| bundle-62 |
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| bundle-7 |
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| bundle-8 |
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| bundle-9 |
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| condition-1 |
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| condition-10 |
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| condition-11 |
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| condition-12 |
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| condition-2 |
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| condition-3 |
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| condition-4 |
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| condition-5 |
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| condition-6 |
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| condition-7 |
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| condition-8 |
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| condition-9 |
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| med-request-1 |
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| med-request-2 |
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| med-request-3 |
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| med-request-4 |
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| med-request-5 |
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| medication-statement-1 |
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| observation-1 |
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| observation-10 |
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| observation-11 |
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| observation-12 |
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| observation-13 |
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| observation-14 |
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| observation-15 |
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| observation-16 |
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| observation-17 |
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| observation-18 |
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| observation-19 |
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| observation-2 |
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| observation-20 |
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| observation-21 |
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| observation-22 |
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| observation-23 |
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| observation-24 |
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| observation-25 |
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| observation-26 |
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| observation-3 |
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| observation-4 |
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| observation-5 |
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| observation-6 |
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| observation-7 |
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| observation-8 |
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| observation-9 |
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| patient-1 |
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| patient-2 |
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| patient-3 |
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| patient-4 |
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| procedure-1 |
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| procedure-10 |
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| procedure-11 |
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| procedure-12 |
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| procedure-13 |
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| procedure-14 |
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| procedure-2 |
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| procedure-3 |
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| procedure-4 |
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| procedure-5 |
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| procedure-6 |
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| procedure-7 |
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| procedure-8 |
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| procedure-9 |
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These are resources that are used within this implementation guide that do not fit into one of the other categories.
| Anthrax Example Device |
Example device |
| Antimicrobial Allergy Flag |
Flag indicating patient allergy to an antimicrobial |
| Existing Antimicrobial Detected Issue |
Detected active antimicrobial prescription |
| Latex Allergy Flag |
Flag indicating patient has latex allergy |
| No Asymptomatic Observation Flag |
Asymptomatic flag example |
| Vaccine Allergy Flag |
Flag indicating patient has allergy to a vaccine |
| Vaccine History Inconsistencies Detected Issue |
Detected that the patient has inconsistent vaccine history |
IG © (c) 2019 The MITRE Corporation HL7 International - Clinical Decision Support WG. Package hl7.fhir.uv.cpg.anthrax#1.1.0 based on FHIR 4.0.1. Generated 2024-03-01
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