2nd DSTU Draft For Comment

This page is part of the FHIR Specification (v0.4.0: DSTU 2 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

4.14.5 Resource MedicationPrescription - Detailed Descriptions

Detailed Descriptions for the elements in the MedicationPrescription resource.

MedicationPrescription
Definition

An order for both supply of the medication and the instructions for administration of the medicine to a patient.

Control1..1
MedicationPrescription.identifier
Definition

External identifier - one that would be used by another non-FHIR system - for example a re-imbursement system might issue its own id for each prescription that is created. This is particularly important where FHIR only provides part of an erntire workflow process where records have to be tracked through an entire system.

Control0..*
TypeIdentifier
Is Modifiertrue
MedicationPrescription.dateWritten
Definition

The date (and perhaps time) when the prescription was written.

Control0..1
TypedateTime
To DoConsider changing to "date".
MedicationPrescription.status
Definition

A code specifying the state of the order. Generally this will be active or completed state.

Control0..1
BindingMedicationPrescriptionStatus: Required: http://hl7.org/fhir/medication-prescription-status (A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.)
Typecode
Is Modifiertrue
MedicationPrescription.patient
Definition

A link to a resource representing the person to whom the medication will be given.

Control0..1
TypeReference(Patient)
Comments

SubstanceAdministration->subject->Patient.

MedicationPrescription.prescriber
Definition

The healthcare professional responsible for authorizing the prescription.

Control0..1
TypeReference(Practitioner)
MedicationPrescription.encounter
Definition

A link to a resource that identifies the particular occurrence of contact between patient and health care provider.

Control0..1
TypeReference(Encounter)
Comments

SubstanceAdministration->component->EncounterEvent.

MedicationPrescription.reason[x]
Definition

Can be the reason or the indication for writing the prescription.

Control0..1
TypeCodeableConcept|Reference(Condition)
MedicationPrescription.note
Definition

Extra information about the prescription that could not be conveyed by the other attributes.

Control0..1
Typestring
MedicationPrescription.medication
Definition

Identifies the medication being administered. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medications.

Control0..1
TypeReference(Medication)
Comments

Note: do not use Medication.name to describe the prescribed medication. When the only available information is a text description of the medication, Medication.code.text should be used.

MedicationPrescription.dosageInstruction
Definition

Indicates how the medication is to be used by the patient.

Control0..*
Comments

When the dose or rate is intended to change over the entire administration period, eg. Tapering dose prescriptions, multiple instances of dosage instructions will need to be supplied to convey the different doses/rates.

MedicationPrescription.dosageInstruction.text
Definition

Free text dosage instructions can be used for cases where the instructions are too complex to code. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication.

Control0..1
Typestring
MedicationPrescription.dosageInstruction.additionalInstructions
Definition

Additional instructions such as "Swallow with plenty of water" which may or may not be coded.

Control0..1
TypeCodeableConcept
MedicationPrescription.dosageInstruction.scheduled[x]
Definition

The timing schedule for giving the medication to the patient. The Schedule data type allows many different expressions, for example. "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013".

Control0..1
TypedateTime|Period|Timing
MedicationPrescription.dosageInstruction.asNeeded[x]
Definition

If set to true or if specified as a CodeableConcept, indicates that the medication is only taken when needed within the specified schedule rather than at every scheduled dose. If a CodeableConcept is present, it indicates the pre-condition for taking the Medication.

Control0..1
BindingMedicationAsNeededReason: A coded concept identifying the pre-condition that should hold prior to consuming a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up", etc.
Typeboolean|CodeableConcept
MedicationPrescription.dosageInstruction.site
Definition

A coded specification of the anatomic site where the medication first enters the body.

Control0..1
BindingMedicationAdministrationSite: Example: See http://hl7.org/fhir/vs/approach-site-codes (A coded concept describing the site location the medicine enters into or onto the body)
TypeCodeableConcept
MedicationPrescription.dosageInstruction.route
Definition

A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient.

Control0..1
BindingRouteOfAdministration: Example: See http://hl7.org/fhir/vs/route-codes (A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.)
TypeCodeableConcept
MedicationPrescription.dosageInstruction.method
Definition

A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. Examples: Slow Push; Deep IV.

Terminologies used often pre-coordinate this term with the route and or form of administration.

Control0..1
BindingMedicationAdministrationMethod: Example: See http://hl7.org/fhir/vs/administration-method-codes (A coded concept describing the technique by which the medicine is administered)
TypeCodeableConcept
MedicationPrescription.dosageInstruction.dose[x]
Definition

The amount of therapeutic or other substance given at one administration event.

Control0..1
TypeRange|Quantity
Comments

Note that this specifies the quantity of the specified medication, not the quantity of active ingredient(s). The prescribed strength can be calculated by multiplying the doseQuantity by the strength of each active ingredient in the prescribed Medication. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule.

MedicationPrescription.dosageInstruction.rate
Definition

Identifies the speed with which the substance is introduced into the subject. Typically the rate for an infusion. 200ml in 2 hours.

Control0..1
TypeRatio
Comments

It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, each change should be captured as a distinct "dosage" repetition, except for titration orders.

MedicationPrescription.dosageInstruction.maxDosePerPeriod
Definition

The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. E.g. 1000mg in 24 hours.

Control0..1
TypeRatio
Comments

This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets ever 4 hours to a maximum of 8/day".

MedicationPrescription.dispense
Definition

Deals with details of the dispense part of the order.

Control0..1
MedicationPrescription.dispense.medication
Definition

Identifies the medication being administered. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medications.

Control0..1
TypeReference(Medication)
MedicationPrescription.dispense.validityPeriod
Definition

Design Comments: This indicates the validity period of a prescription (stale dating the Prescription) It reflects the prescriber perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations. Rationale: Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.

Control0..1
TypePeriod
To DoCheck v2 mapping.
MedicationPrescription.dispense.numberOfRepeatsAllowed
Definition

An integer indicating the number of repeats of the Dispense. UsageNotes: For example, the number of times the prescribed quantity is to be supplied including the initial standard fill.

Control0..1
Typeinteger
Comments

If displaying "number of authorized refills", subtract 1 from this number.

To DoCan this name be shortened?.
MedicationPrescription.dispense.quantity
Definition

The amount that is to be dispensed for one fill.

Control0..1
TypeQuantity
MedicationPrescription.dispense.expectedSupplyDuration
Definition

Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last. In some situations, this attribute may be used instead of quantity to identify the amount supplied by how long it is expected to last, rather than the physical quantity issued, e.g. 90 days supply of medication (based on an ordered dosage) When possible, it is always better to specify quantity, as this tends to be more precise. expectedSupplyDuration will always be an estimate that can be influenced by external factors.

Control0..1
TypeDuration
MedicationPrescription.substitution
Definition

Indicates whether or not substitution can or should be part of the dispense. In some cases substitution must happen, in other cases substitution must not happen, and in others it does not matter. This block explains the prescriber's intent. If nothing is specified substitution may be done.

Control0..1
MedicationPrescription.substitution.type
Definition

A code signifying whether a different drug should be dispensed from what was prescribed.

Control1..1
BindingMedicationIntendedSubstitutionType: A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription (Example)
TypeCodeableConcept
MedicationPrescription.substitution.reason
Definition

Indicates the reason for the substitution, or why substitution must or must not be performed.

Control0..1
BindingMedicationIntendedSubstitutionReason: A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed. (Example)
TypeCodeableConcept