health-data-standards 0.8.1 → 1.0.0

data/lib/health-data-standards/import/green_c32/social_history_importer.rb

@@ -5,12 +5,7 @@ module HealthDataStandards
         include Singleton
         
         def import(sh_xml)
-          sh_xml.root.add_namespace_definition('gc32', "urn:hl7-org:greencda:c32")
-          sh_element = sh_xml.at_xpath("./gc32:socialHistory")
-          sh = SocialHistory.new
-          extract_entry(sh_element, sh)
-          extract_code(sh_element, sh, "./gc32:type", :type)
-          sh
+          generic_import(sh_xml, "socialHistory")
         end
       end
     end

data/lib/health-data-standards/import/green_c32/support_importer.rb

@@ -0,0 +1,22 @@
+module HealthDataStandards
+  module Import
+    module GreenC32
+      class SupportImporter < SectionImporter
+        include Singleton
+        
+        def import(support_doc)
+          support_doc.root.add_namespace_definition('gc32', "urn:hl7-org:greencda:c32")
+          support_element = support_doc.at_xpath("./gc32:support")
+          support = Support.new(type: support_element.at_xpath("./gc32:type").try(:content),
+                                relationship: support_element.at_xpath("./gc32:relationship").try(:text))
+          extract_name(support_element, support)
+          support.address = extract_address(support_element.at_xpath("./gc32:address"))
+          support.telecom = extract_telecom(support_element.at_xpath("./gc32:telecom"))
+          support.mothers_maiden_name = support_element.at_xpath("./gc32:mothersMaidenName").try(:text)
+          support
+        end
+        
+      end
+    end
+  end
+end

data/lib/health-data-standards/models/allergy.rb

@@ -1,5 +1,5 @@
 class Allergy < Entry
-  field :type, type: String
+  field :type, type: Hash
   field :reaction, type: Hash
   field :severity, type: Hash
 end

data/lib/health-data-standards/models/condition.rb

@@ -1,8 +1,10 @@
 class Condition < Entry
   field :type,          type: String
   field :causeOfDeath,  type: Boolean
+  field :priority,      type: Integer
   field :name,          type: String
-  
+  field :ordinality,    type: String
+
   embeds_many :treating_provider,  class_name: "Provider"
   
   alias   :cause_of_death         :causeOfDeath

data/lib/health-data-standards/models/encounter.rb

@@ -1,7 +1,6 @@
 class Encounter < Entry
   field :admitType, type: Hash
   field :dischargeDisposition, type: Hash
-  field :free_text, type: String
   
   embeds_one :facility, class_name: "Organization"
   embeds_one :reason, class_name: "Entry"
@@ -12,6 +11,5 @@ class Encounter < Entry
   alias :admit_type= :admitType=
   alias :discharge_disposition :dischargeDisposition
   alias :discharge_disposition= :dischargeDisposition=
-  alias :freeText :free_text
-  alias :freeText= :free_text=
+
 end

data/lib/health-data-standards/models/entry.rb

@@ -14,6 +14,8 @@ class Entry
   field :status, type: String
   field :codes, type: Hash, default: {}
   field :value, type: Hash, default: {}
+  field :free_text, type: String
+  field :mood_code, type: String, default: "EVN"
   
   attr_protected :version
   attr_protected :_id
@@ -57,32 +59,32 @@ class Entry
   
   def times_to_s
     if start_time.present? || end_time.present?
-      start_string = start_time ? Time.at(start_time).to_formatted_s(:long_ordinal) : 'UNK'
-      end_string = end_time ? Time.at(end_time).to_formatted_s(:long_ordinal) : 'UNK'
+      start_string = start_time ? Time.at(start_time).utc.to_formatted_s(:long_ordinal) : 'UNK'
+      end_string = end_time ? Time.at(end_time).utc.to_formatted_s(:long_ordinal) : 'UNK'
       "#{start_string} - #{end_string}"
     elsif time.present?
-      Time.at(time).to_formatted_s(:long_ordinal)
+      Time.at(time).utc.to_formatted_s(:long_ordinal)
     end
   end
   
-  def to_effective_time(xml)
-    if time.present?
-      xml.effectiveTime("value" => Time.at(time).utc.to_formatted_s(:number))
-    else
-      xml.effectiveTime do
-        if start_time.present?
-          xml.low("value" => Time.at(start_time).utc.to_formatted_s(:number))
-        else
-          xml.low("nullFlavor" => "UNK")
-        end
-        if end_time.present?
-          xml.high("value" => Time.at(end_time).utc.to_formatted_s(:number))          
-        else
-          xml.high("nullFlavor" => "UNK")          
-        end
-      end
-    end
-  end
+  # def to_effective_time(xml)
+  #   if time.present?
+  #     xml.effectiveTime("value" => Time.at(time).utc.to_formatted_s(:number))
+  #   else
+  #     xml.effectiveTime do
+  #       if start_time.present?
+  #         xml.low("value" => Time.at(start_time).utc.to_formatted_s(:number))
+  #       else
+  #         xml.low("nullFlavor" => "UNK")
+  #       end
+  #       if end_time.present?
+  #         xml.high("value" => Time.at(end_time).utc.to_formatted_s(:number))          
+  #       else
+  #         xml.high("nullFlavor" => "UNK")          
+  #       end
+  #     end
+  #   end
+  # end
   
   def self.from_event_hash(event)
     entry = Entry.new

data/lib/health-data-standards/models/guarantor.rb

@@ -0,0 +1,10 @@
+class Guarantor
+  include Mongoid::Document
+  
+  embeds_one :organization
+  embeds_one :person
+  
+  field :start_time, type: Integer
+  field :end_time, type: Integer
+  
+end

data/lib/health-data-standards/models/insurance_provider.rb

@@ -0,0 +1,17 @@
+class InsuranceProvider
+  include Mongoid::Document
+  
+  embeds_one :payer, class_name: "Organization"
+  embeds_many :guarantors, class_name: "Guarantor"
+  embeds_one :subscriber, class_name: "Person"
+  
+  field :type, type: String
+  field :time, type: Integer
+  field :start_time, type: Integer
+  field :end_time, type: Integer
+  field :member_id, type: String
+  field :relationship, type: Hash
+  field :financial_responsibility_type, type: Hash
+  field :name, type: String
+  
+end

data/lib/health-data-standards/models/medical_equipment.rb

@@ -0,0 +1,5 @@
+class MedicalEquipment < Entry
+  
+  field :manufacturer, type: String
+   
+end

data/lib/health-data-standards/models/medication.rb

@@ -21,8 +21,6 @@ class Medication < Entry
   
   alias :administration_timing :administrationTiming
   alias :administration_timing= :administrationTiming=
-  alias :free_text_sig :freeTextSig
-  alias :free_text_sig= :freeTextSig=
   alias :type_of_medication :typeOfMedication
   alias :type_of_medication= :typeOfMedication=
   alias :status_of_medication :statusOfMedication

data/lib/health-data-standards/models/person.rb

@@ -0,0 +1,4 @@
+class Person
+  include Personable
+  
+end

data/lib/health-data-standards/models/personable.rb

@@ -0,0 +1,13 @@
+module Personable
+
+  def self.included(receiver)
+    receiver.send(:include, Mongoid::Document)
+    
+    receiver.field :title       , type: String
+    receiver.field :given_name  , type: String
+    receiver.field :family_name , type: String
+
+    receiver.embeds_many :addresses, as: :locatable
+    receiver.embeds_many :telecoms, as: :contactable
+  end
+end

data/lib/health-data-standards/models/procedure.rb

@@ -1,7 +1,5 @@
 class Procedure < Entry
-  field :type,          type: String
   field :site,          type: Hash
-  field :description,   type: String
   
   belongs_to :performer, class_name: "Provider"
 end

data/lib/health-data-standards/models/provider.rb

@@ -1,9 +1,6 @@
 class Provider
-  include Mongoid::Document
+  include Personable
   
-  field :title       , type: String
-  field :given_name  , type: String
-  field :family_name , type: String
   field :npi         , type: String
   field :tin         , type: String
   field :specialty   , type: String
@@ -12,8 +9,6 @@ class Provider
   
   validates_uniqueness_of :npi, allow_blank: true
   
-  embeds_many :addresses, as: :locatable
-  embeds_many :telecoms, as: :contactable
   embeds_one :organization
 
 

data/lib/health-data-standards/models/record.rb

@@ -1,32 +1,38 @@
 class Record
   include Mongoid::Document
   
+  field :title, type: String # TODO
   field :first, type: String
   field :last, type: String
   field :gender, type: String
   field :birthdate, type: Integer
-  field :deathdate, type: Integer
+  field :deathdate, type: Integer # TODO
+  field :religious_affilication, type: Hash # TODO
   field :effective_time, type: Integer
   field :race, type: Hash
   field :ethnicity, type: Hash
   field :languages, type: Array
   field :test_id, type: BSON::ObjectId
+  field :marital_status, type: Hash # TODO
   field :medical_record_number, type: String
 
   embeds_many :allergies
-  embeds_many :care_goals, class_name: "Entry"
+  embeds_many :care_goals, class_name: "Entry" # This can be any number of different entry types
   embeds_many :conditions
   embeds_many :encounters
   embeds_many :immunizations
-  embeds_many :medical_equipment, class_name: "Entry"
+  embeds_many :medical_equipment
   embeds_many :medications
   embeds_many :procedures
   embeds_many :results, class_name: "LabResult"
-  embeds_many :social_history
+  embeds_many :social_history, class_name: "Entry"
   embeds_many :vital_signs
+  embeds_many :support
+  embeds_many :advance_directives, class_name: "Entry"
+  embeds_many :insurance_providers
 
   Sections = [:allergies, :care_goals, :conditions, :encounters, :immunizations, :medical_equipment,
-   :medications, :procedures, :results, :social_history, :vital_signs]
+   :medications, :procedures, :results, :social_history, :vital_signs, :support, :advanced_directives]
 
   embeds_many :provider_performances
   

data/lib/health-data-standards/models/support.rb

@@ -0,0 +1,18 @@
+class Support < Entry
+  include Mongoid::Document
+  
+  Types = ["Guardian", "Next of Kin", "Caregiver", "Emergency Contact"]
+  
+  embeds_one :address
+  embeds_one :telecom
+  
+  field :title, type: String
+  field :given_name, type: String
+  field :family_name, type: String
+  field :mothers_maiden_name, type: String
+  field :type, type: String
+  field :relationship, type: String
+  
+  # validates_inclusion_of :type, :in => Types
+  
+end

data/lib/health-data-standards.rb

@@ -22,6 +22,7 @@ require_relative 'health-data-standards/export/csv'
 require_relative 'health-data-standards/export/html'
 require_relative 'health-data-standards/export/hdata/metadata'
 
+require_relative 'health-data-standards/export/green_c32/record'
 require_relative 'health-data-standards/export/green_c32/entry'
 require_relative 'health-data-standards/export/green_c32/export_generator'
 
@@ -38,11 +39,16 @@ require_relative 'health-data-standards/models/order_information'
 require_relative 'health-data-standards/models/medication'
 require_relative 'health-data-standards/models/procedure'
 require_relative 'health-data-standards/models/lab_result'
+require_relative 'health-data-standards/models/medical_equipment'  
 require_relative 'health-data-standards/models/record'
+require_relative 'health-data-standards/models/personable'
 require_relative 'health-data-standards/models/provider'
 require_relative 'health-data-standards/models/provider_performance'
-require_relative 'health-data-standards/models/social_history'
+require_relative 'health-data-standards/models/support'
 require_relative 'health-data-standards/models/vital_sign'
+require_relative 'health-data-standards/models/insurance_provider'
+require_relative 'health-data-standards/models/guarantor'
+require_relative 'health-data-standards/models/person'
 require_relative 'health-data-standards/models/organization'
 require_relative 'health-data-standards/models/address'
 require_relative 'health-data-standards/models/telecom'
@@ -64,6 +70,9 @@ require_relative 'health-data-standards/import/c32/vital_sign_importer'
 require_relative 'health-data-standards/import/c32/patient_importer'
 require_relative 'health-data-standards/import/c32/provider_importer'
 require_relative 'health-data-standards/import/c32/organization_importer'
+require_relative 'health-data-standards/import/c32/medical_equipment_importer'
+require_relative 'health-data-standards/import/c32/insurance_provider_importer'
+require_relative 'health-data-standards/import/c32/care_goal_importer'
 
 require_relative 'health-data-standards/import/ccr/patient_importer'
 require_relative 'health-data-standards/import/ccr/provider_importer'
@@ -72,6 +81,19 @@ require_relative 'health-data-standards/import/ccr/result_importer'
 require_relative 'health-data-standards/import/ccr/simple_importer'
 require_relative 'health-data-standards/import/ccr/product_importer'
 
+require_relative 'health-data-standards/import/ccda/patient_importer'
+require_relative 'health-data-standards/import/ccda/allergy_importer'
+require_relative 'health-data-standards/import/ccda/condition_importer'
+require_relative 'health-data-standards/import/ccda/encounter_importer'
+require_relative 'health-data-standards/import/ccda/immunization_importer'
+require_relative 'health-data-standards/import/ccda/procedure_importer'
+require_relative 'health-data-standards/import/ccda/result_importer'
+require_relative 'health-data-standards/import/ccda/vital_sign_importer'
+require_relative 'health-data-standards/import/ccda/medication_importer'
+require_relative 'health-data-standards/import/ccda/care_goal_importer'
+require_relative 'health-data-standards/import/ccda/medical_equipment_importer'
+require_relative 'health-data-standards/import/ccda/insurance_provider_importer'
+
 require_relative 'health-data-standards/import/green_c32/section_importer'
 require_relative 'health-data-standards/import/green_c32/result_importer'
 require_relative 'health-data-standards/import/green_c32/condition_importer'
@@ -81,4 +103,8 @@ require_relative 'health-data-standards/import/green_c32/encounter_importer'
 require_relative 'health-data-standards/import/green_c32/medication_importer'
 require_relative 'health-data-standards/import/green_c32/allergy_importer'
 require_relative 'health-data-standards/import/green_c32/social_history_importer'
-require_relative 'health-data-standards/import/green_c32/immunization_importer'
+require_relative 'health-data-standards/import/green_c32/immunization_importer' 
+require_relative 'health-data-standards/import/green_c32/support_importer'
+require_relative 'health-data-standards/import/green_c32/advance_directive_importer'
+require_relative 'health-data-standards/import/green_c32/medical_equipment_importer'
+require_relative 'health-data-standards/import/green_c32/care_goal_importer'

data/templates/_advance_directive.gc32.erb

@@ -0,0 +1,8 @@
+<advanceDirective xmlns="urn:hl7-org:greencda:c32">
+  <%== code_display advance_directive, 'preferred_code_sets' => ['SNOMED-CT'] %>
+  <effectiveTime>
+    <start><%= time_if_not_nil(advance_directive.start_time, advance_directive.time) %></start>
+    <end><%= time_if_not_nil(advance_directive.end_time) %></end>
+  </effectiveTime>
+  <freeText><%= advance_directive.free_text %></freeText>
+</advanceDirective>

data/templates/_allergy.gc32.erb

@@ -1,13 +1,23 @@
 <allergy xmlns="urn:hl7-org:greencda:c32">
   <id><%= allergy.id%></id>
-  <status><%= allergy.status%></status>
   <%== code_display allergy, "tag_name" => "code", 'preferred_code_sets' => ['SNOMED-CT', "RxNorm", "FDA"] %>
-  <type><%= allergy.type%></type>
+  <status><%= allergy.status%></status>
+  <freeText><%= allergy.free_text %></freeText>
   <effectiveTime>
-    <start><%= time_if_not_nil(allergy.start_time, allergy.time) %></start>
+    <% if allergy.start_time || allergy.end_time %>
+    <start><%= time_if_not_nil(allergy.start_time) %></start>
     <end><%= time_if_not_nil(allergy.end_time) %></end>
+    <% else %>
+    <%= time_if_not_nil(allergy.time) %>
+    <% end %>
   </effectiveTime>
-  <%== code_display allergy, "tag_name" => "reaction", 'preferred_code_sets' => ['SNOMED-CT'] %>
-  <%== code_display allergy, "tag_name" => "severity", 'preferred_code_sets' => ['SNOMED-CT'] %>
-</allergy>
-
+  <% if allergy.type %>
+  <%== code_display allergy, "tag_name" => "type", "attribute" => "type", 'preferred_code_sets' => ['RxNorm', 'SNOMED-CT'] %>
+  <% end %>
+  <% if allergy.reaction %>
+  <%== code_display allergy, "tag_name" => "reaction", "attribute" => "reaction", 'preferred_code_sets' => ['RxNorm', 'SNOMED-CT'] %>
+  <% end %>
+  <% if allergy.severity%>
+  <%== code_display allergy, "tag_name" => "severity", "attribute" => "severity", 'preferred_code_sets' => ['RxNorm', 'SNOMED-CT'] %>
+  <% end %>
+</allergy>

data/templates/_care_goal.gc32.erb

@@ -0,0 +1,8 @@
+<%
+type = case care_goal
+       when LabResult then "result"
+       else
+         care_goal.class.name.underscore
+       end
+%>
+<%= render partial: type, locals: {type => care_goal} %>

data/templates/_condition.gc32.erb

@@ -1,11 +1,9 @@
 <condition <% unless condition.cause_of_death.nil? %>causeOfDeath="<%= condition.cause_of_death %>"<% end %> xmlns="urn:hl7-org:greencda:c32">
   <id><%= condition.id %></id>
   <%== code_display condition, "tag_name" => "code", 'preferred_code_sets' => ['SNOMED-CT'] %>
-  <% if condition.name %>
-    <name><%= condition.name %></name>
+  <%== gc32_effective_time(condition)%>
+  <% if condition.priority %>
+    <priority><%= condition.priority %></priority>
   <% end %>
-  <effectiveTime>
-    <start><%= time_if_not_nil(condition.start_time, condition.time) %></start>
-    <end><%= time_if_not_nil(condition.end_time) %></end>
-  </effectiveTime>
+  <type><%= condition.type %></type>
 </condition>

data/templates/_conditions.c32.erb

@@ -40,6 +40,9 @@
             <effectiveTime>
               <low <%= value_or_null_flavor(entry.as_point_in_time) %>/>
             </effectiveTime>
+            <% if entry.ordinality -%>
+              <priorityCode code="8319008" codeSystem="2.16.840.1.113883.6.96" displayName="Principal diagnosis" />
+            <% end -%>
             <%== code_display(entry, {'tag_name' => 'value', 'extra_content' => 'xsi:type="CD"', 'preferred_code_sets' => ['SNOMED-CT']}) %>
             <% if entry.status -%>
             <entryRelationship typeCode="REFR">

data/templates/_encounter.gc32.erb

@@ -1,16 +1,10 @@
 <encounter xmlns="urn:hl7-org:greencda:c32">
   <id><%= encounter.id %></id>
-  <code />
   <%== code_display encounter, "tag_name" => "code", 'preferred_code_sets' => ['SNOMED-CT'] %>
   <% if encounter.status %>
     <status code="completed"/>
   <% end %>
-  <effectiveTime>
-    <start><%= Time.at(encounter.start_time) %></start>
-    <% if encounter.end_time %>
-      <end><%= Time.at(encounter.end_time) %></end>
-    <% end %>
-  </effectiveTime>
+  <%== gc32_effective_time(encounter)%>
   <%== code_display encounter, "tag_name" => "dishcargeDisposition", 'attribute' => "discharge_disposition" %>
   <%== code_display encounter, "tag_name" => "admissionType", 'attribute' => "admit_type" %>
   <% if provider %>

data/templates/_entry.gc32.erb

@@ -0,0 +1,14 @@
+<entry xmlns="urn:hl7-org:greencda:c32">
+  <id><%= entry.id %></id>
+  <%== code_display entry, "tag_name" => "code", 'preferred_code_sets' => ['SNOMED-CT', "LOINC"] %>
+  <status><%= entry.status%></status>
+  <freeText><%=entry.free_text %></freeText>
+  <effectiveTime>
+    <% if entry.start_time || entry.end_time %>
+    <start><%= time_if_not_nil(entry.start_time) %></start>
+    <end><%= time_if_not_nil(entry.end_time) %></end>
+    <% else %>
+    <%= time_if_not_nil(entry.time) %>
+    <% end %>
+  </effectiveTime>
+</entry>

data/templates/_immunization.gc32.erb

@@ -1,9 +1,11 @@
 <immunization <% if refused %> refused="true" <% end %> xmlns="urn:hl7-org:greencda:c32">
   <id><%= immunization.id %></id>
-  <%== code_display immunization, "preferred_code_sets" => ["RxNorm", "SNOMED-CT"] %>
-  <administeredDate><%= Time.at(immunization.time)%></administeredDate>
+  <%== code_display immunization, "preferred_code_sets" => ["RxNorm", "CVX"] %>  
+  <%== gc32_effective_time(immunization)%>
   <% if immunization.series_number %>
     <seriesNumber><%= immunization.series_number %></seriesNumber>
   <% end %>
+  <% if immunization.refusal_reason %>
   <%== code_display immunization, "tag_name" => "refusalReason", "attribute" => "refusal_reason", "preferred_code_sets" => ["SNOMED-CT"] %>
+  <% end %>
 </immunization>

data/templates/_medical_equipment.c32.erb

@@ -25,6 +25,12 @@
             <playingDevice>
               <%== code_display(entry, {:preferred_code_sets => ['SNOMED-CT']}) %>
             </playingDevice>
+            <% if entry.manufacturer %>
+            <scopingEntity>
+              <id root="<%= UUID.generate %>"/>
+              <desc><%= entry.manufacturer %></desc>
+            </scopingEntity>
+            <% end %>
           </participantRole>
         </participant>
       </supply>

data/templates/_medical_equipment.gc32.erb

@@ -0,0 +1,7 @@
+<medicalEquipment xmlns="urn:hl7-org:greencda:c32">
+  <id><%= medical_equipment.id %></id>
+  <%== code_display medical_equipment, "tag_name" => "code", 'preferred_code_sets' => ['SNOMED-CT', "LOINC"] %>
+  <status><%= medical_equipment.status%></status>
+  <freeText><%=medical_equipment.free_text %></freeText>
+  <%== gc32_effective_time(medical_equipment)%>
+</medicalEquipment>

data/templates/_medication.gc32.erb

@@ -1,35 +1,47 @@
 <medication>
   <id><%= medication.id%></id>
-  <status>completed</status>
-  <freeTextSig><%= medication.free_text_sig%></freeTextSig>
+  <%== code_display medication, "preferred_code_sets" => ["RxNorm", "CVX"] %>
+  <freeText><%= medication.free_text%></freeText>
+  <%== gc32_effective_time(medication)%>
+  <% if medication.administration_timing %>
+    <administrationTiming institutionSpecified="<%= medication.administration_timing[:insitution_specified] %>">
+      <%== quantity_display medication.administration_timing["period"], :period %>
+    </administrationTiming>
+  <% end %>
+  <% if medication.route %>
   <%== code_display medication, "tag_name" => "route", "attribute" => "route", "preferred_code_sets" => ["NCI Thesaurus"] %>
+  <% end %> 
+  <% if medication.site %>
+  <%== code_display medication, "tag_name" => "site", "attribute" => "site", "preferred_code_sets" => ["SNOMED-CT"] %>
+  <% end %>
   <%== quantity_display medication.dose, :dose %>
   <% if medication.dose_indicator %>
   <doseIndication><%medication.dose_indicator%></doseIndication>
   <% end %>
-  
-  <%== code_display medication, "tag_name" => "site", "attribute" => "site", "preferred_code_sets" => ["SNOMED-CT"] %>
   <% if medication.dose_restriction %>
   <doseRestriction>
     <numerator><%= medication.dose_restriction["numerator"]%></numerator>
     <denominator><%= medication.dose_restriction["denominator"]%></denominator>
   </doseRestriction>
   <% end %>
-  <% if medication.administration_timing %>
-    <administrationTiming institutionSpecified="<%= medication.administration_timing[:insitution_specified] %>">
-      <start><%= Time.at(medication.start_time) %></start>
-      <end><%= Time.at(medication.end_time)%></end>
-      <%== quantity_display medication.administration_timing["period"], :period %>
-    </administrationTiming>
-  <% end %>
+  <% if medication.product_form %>
   <%== code_display medication, "tag_name" => "productForm", "attribute" => "product_form", "preferred_code_sets" => ["NCI Thesaurus"]  %>
+  <% end %>
   <% if medication.delivery_method %>
     <%== code_display medication, "tag_name" => "deliveryMethod", "attribute" => "delivery_method", "preferred_code_sets" => medication.delivery_method.keys %>
   <% end %>
+  <% if medication.type_of_medication%>
   <%== code_display medication, "tag_name" => "type", "attribute" => "type_of_medication", "preferred_code_sets" => ["SNOMED-CT"] %>
+  <% end %>
+  <% if medication.status_of_medication%>
   <%== code_display medication, "tag_name" => "statusOfMedication", "attribute" => "status_of_medication", "preferred_code_sets" => ["SNOMED-CT"] %>
+  <% end %>
+  <%if medication.indication%>
   <%== code_display medication, "tag_name" => "indication", "attribute" => "indication", "preferred_code_sets" => ["SNOMED-CT"] %>
+  <% end %>
+  <% if medication.vehicle %>
   <%== code_display medication, "tag_name" => "vehicle", "attribute" => "vehicle", "preferred_code_sets" => ["SNOMED-CT"] %>
+  <% end%>
   
   <% if medication.dose_indicator %>
     <doseIndicator><%= medication.dose_indicator %></doseIndicator>
@@ -46,15 +58,15 @@
   <fulfillmentHistory <%if (fh.fill_status) %> fillStatus="<%=fh.fill_status%>" <% end %>
     <% if fh.fill_number %> fillNumber="<%=fh.fill_number%>" <% end %>>
     <prescriptionNumber><%=fh.prescription_number%></prescriptionNumber>
-    <dispenseDate><%= Time.at(fh.dispense_date)%></dispenseDate>
+    <dispenseDate><%= Time.at(fh.dispense_date).utc%></dispenseDate>
     <%== quantity_display fh.quantity_dispensed, :quantityDispensed %>
   </fulfillmentHistory>
   <% end %>
   <% medication.order_information.each do |oi| %>
     <orderInformation <% if oi.order_number %><%= "orderNumber=\"#{oi.order_number}\"" %> <% end %> <% if oi.fills %> <%= "fills=\"#{oi.fills}\"" %> <% end %>>
       <%== quantity_display oi.quantity_ordered, "quantityOrdered" %>
-      <orderDateTime><%= Time.at(oi.order_date_time)%></orderDateTime>
-      <expirationDateTime><%= Time.at(oi.order_expiration_date_time)%></expirationDateTime>
+      <orderDateTime><%= Time.at(oi.order_date_time).utc%></orderDateTime>
+      <expirationDateTime><%= Time.at(oi.order_expiration_date_time).utc%></expirationDateTime>
     </orderInformation>
   <% end %>
 </medication>