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 . Page versions: R5 R4B R4 R3 R2

4.17 Resource MedicationStatement - Content

This resource maintained by the Pharmacy Work Group

A record of medication being taken by a patient, or that the medication has been given to a patient where the record is the result of a report from the patient or another clinician.

4.17.1 Scope and Usage

Common usage includes:

  • the recording of non-prescription and/or recreational drugs
  • the recording of an intake medication list upon admission to hospital
  • the summarization of a patient's "active medications" in a patient profile

4.17.2 Boundaries and Relationships

The Medication domain includes a number of related resources

MedicationPrescription An order for both supply of the medication and the instructions for administration of the medicine to a patient.
MedicationDispense Provision of a supply of a medication with the intention that it is subsequently consumed by a patient (usually in response to a prescription).
MedicationAdministration When a patient actually consumes a medicine, or it is otherwise administered to them
MedicationStatement This is a record of medication being taken by a patient, or that the medication has been given to a patient where the record is the result of a report from the patient, or another clinician. A medication statement is not a part of the prescribe->dispense->administer sequence but is a report that such a sequence (or at least a part of it) did take place resulting in a belief that the patient has received a particular medication.

This resource is distinct from MedicationPrescription, MedicationDispense and MedicationAdministration. Each of those resources refer to specific events - an individual order, an individual provisioning of medication or an individual dosing. MedicationStatement is a broader assertion covering a wider timespan and independent of specific events. The existence of resource instances of any of the preceding three types may be used to infer a Medication statement. However, medication statements can also be captured on the basis of other information including an assertion by the patient or a care-giver, the results of a lab test, etc.

This resource is referenced by Condition and Procedure

4.17.3 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationStatement DomainResourceAdministration of medication to a patient
... identifier 0..*IdentifierExternal Identifier
... patient 0..1PatientWho was/is taking medication
... informationSource 0..1Patient | Practitioner | RelatedPerson
... dateAsserted 0..1dateTimeWhen the statement was asserted?
... status 1..1codein-progress | completed | entered-in-error
MedicationStatementStatus (Required)
... wasNotGiven M0..1booleanTrue if medication is/was not being taken
... reasonNotGiven I0..*CodeableConceptTrue if asserting medication was not given
MedicationAdministrationNegationReason (Example)
Reason not given is only permitted if wasNotGiven is true
... reasonForUse[x] I
Reason for use is only permitted if wasNotGiven is false
.... reasonForUseCodeableConcept0..1CodeableConcept
.... reasonForUseReference0..1Condition
... effective[x] Over what period was medication consumed?
.... effectiveDateTime0..1dateTime
.... effectivePeriod0..1Period
... note 0..1stringFurther information about the statement
... medication 0..1MedicationWhat medication was taken?
... dosage 0..*ElementDetails of how medication was taken
.... text 0..1stringDosage Instructions
.... schedule 0..1TimingWhen/how often was medication taken?
.... asNeeded[x] Take "as needed" f(or x)
..... asNeededBoolean0..1boolean
..... asNeededCodeableConcept0..1CodeableConcept
.... site 0..1CodeableConceptWhere on body was medication administered?
MedicationAdministrationSite (Example)
.... route 0..1CodeableConceptHow did the medication enter the body?
RouteOfAdministration (Example)
.... method 0..1CodeableConceptTechnique used to administer medication
MedicationAdministrationMethod (Example)
.... quantity 0..1QuantityAmount administered in one dose
.... rate 0..1RatioDose quantity per unit of time
.... maxDosePerPeriod 0..1RatioMaximum dose that was consumed per unit of time

UML Diagram

MedicationStatement (DomainResource)External identifier - FHIR will generate its own internal IDs (probably URLs) which do not need to be explicitly managed by the resource. The identifier here is one that would be used by another non-FHIR system - for example an automated medication pump would provide a record each time it operated; an administration while the patient was off the ward might be made with a different system and entered after the event. Particularly important if these records have to be updatedidentifier : Identifier 0..*The person or animal who is /was taking the medicationpatient : Reference(Patient) 0..1The person who provided the information about the taking of this medicationinformationSource : Reference(Patient|Practitioner| RelatedPerson) 0..1The date when the medication statement was asserted by the information sourcedateAsserted : dateTime 0..1A code specifying the state of the statement. Generally this will be in-progress or completed statestatus : code 1..1 « A set of codes indicating the current status of a MedicationStatementMedicationStatementStatus »Set this to true if the record is saying that the medication was NOT taken (this element modifies the meaning of other elements)wasNotGiven : boolean 0..1A code indicating why the medication was not takenreasonNotGiven : CodeableConcept 0..* « (A set of codes indicating the reason why the MedicationAdministration is negated.MedicationAdministrationNegationReason) »A reason for why the medication is being/was takenreasonForUse[x] : CodeableConcept|Reference(Condition) 0..1The interval of time during which it is being asserted that the patient was taking the medication (or was not taking, when the 'wasNotGiven' attribute is true)effective[x] : dateTime|Period 0..1Provides extra information about the medication statement that is not conveyed by the other attributesnote : string 0..1Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medicationsmedication : Reference(Medication) 0..1DosageFree 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 medicationtext : string 0..1The 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"schedule : Timing 0..1If 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 MedicationasNeeded[x] : boolean|CodeableConcept 0..1A coded specification of the anatomic site where the medication first enters the bodysite : CodeableConcept 0..1 « (A coded concept describing the site location the medicine enters into or onto the bodyMedicationAdministrationSite) »A code specifying the route or physiological path of administration of a therapeutic agent into or onto a subjectroute : CodeableConcept 0..1 « (A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.RouteOfAdministration) »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 administrationmethod : CodeableConcept 0..1 « (A coded concept describing the technique by which the medicine is administeredMedicationAdministrationMethod) »The amount of therapeutic or other substance given at one administration eventquantity : Quantity 0..1Identifies the speed with which the substance is introduced into the subject. Typically the rate for an infusion. 200ml in 2 hoursrate : Ratio 0..1The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. E.g. 1000mg in 24 hoursmaxDosePerPeriod : Ratio 0..1Indicates how the medication is/was used by the patientdosage0..*

XML Template

<MedicationStatement xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External Identifier --></identifier>
 <patient><!-- 0..1 Reference(Patient) Who was/is taking medication --></patient>
 <informationSource><!-- 0..1 Reference(Patient|Practitioner|RelatedPerson)  --></informationSource>
 <dateAsserted value="[dateTime]"/><!-- 0..1 When the statement was asserted? -->
 <status value="[code]"/><!-- 1..1 in-progress | completed | entered-in-error -->
 <wasNotGiven value="[boolean]"/><!-- 0..1 True if medication is/was not being taken -->
 <reasonNotGiven><!-- ?? 0..* CodeableConcept True if asserting medication was not given --></reasonNotGiven>
 <reasonForUse[x]><!-- 0..1 CodeableConcept|Reference(Condition)  --></reasonForUse[x]>
 <effective[x]><!-- 0..1 dateTime|Period Over what period was medication consumed? --></effective[x]>
 <note value="[string]"/><!-- 0..1 Further information about the statement -->
 <medication><!-- 0..1 Reference(Medication) What medication was taken? --></medication>
 <dosage>  <!-- 0..* Details of how medication was taken -->
  <text value="[string]"/><!-- 0..1 Dosage Instructions -->
  <schedule><!-- 0..1 Timing When/how often was medication taken? --></schedule>
  <asNeeded[x]><!-- 0..1 boolean|CodeableConcept Take "as needed" f(or x) --></asNeeded[x]>
  <site><!-- 0..1 CodeableConcept Where on body was medication administered? --></site>
  <route><!-- 0..1 CodeableConcept How did the medication enter the body? --></route>
  <method><!-- 0..1 CodeableConcept Technique used to administer medication --></method>
  <quantity><!-- 0..1 Quantity Amount administered in one dose --></quantity>
  <rate><!-- 0..1 Ratio Dose quantity per unit of time --></rate>
  <maxDosePerPeriod><!-- 0..1 Ratio 
      Maximum dose that was consumed per unit of time --></maxDosePerPeriod>
 </dosage>
</MedicationStatement>

JSON Template

{doco
  "resourceType" : "MedicationStatement",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External Identifier
  "patient" : { Reference(Patient) }, // Who was/is taking medication
  "informationSource" : { Reference(Patient|Practitioner|RelatedPerson) }, // 
  "dateAsserted" : "<dateTime>", // When the statement was asserted?
  "status" : "<code>", // R! in-progress | completed | entered-in-error
  "wasNotGiven" : <boolean>, // True if medication is/was not being taken
  "reasonNotGiven" : [{ CodeableConcept }], // C? True if asserting medication was not given
  // reasonForUse[x]: . One of these 2:
  "reasonForUseCodeableConcept" : { CodeableConcept },
  "reasonForUseReference" : { Reference(Condition) },
  // effective[x]: Over what period was medication consumed?. One of these 2:
  "effectiveDateTime" : "<dateTime>",
  "effectivePeriod" : { Period },
  "note" : "<string>", // Further information about the statement
  "medication" : { Reference(Medication) }, // What medication was taken?
  "dosage" : [{ // Details of how medication was taken
    "text" : "<string>", // Dosage Instructions
    "schedule" : { Timing }, // When/how often was medication taken?
    // asNeeded[x]: Take "as needed" f(or x). One of these 2:
    "asNeededBoolean" : <boolean>,
    "asNeededCodeableConcept" : { CodeableConcept },
    "site" : { CodeableConcept }, // Where on body was medication administered?
    "route" : { CodeableConcept }, // How did the medication enter the body?
    "method" : { CodeableConcept }, // Technique used to administer medication
    "quantity" : { Quantity }, // Amount administered in one dose
    "rate" : { Ratio }, // Dose quantity per unit of time
    "maxDosePerPeriod" : { Ratio } // 
      Maximum dose that was consumed per unit of time
  }]
}

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationStatement DomainResourceAdministration of medication to a patient
... identifier 0..*IdentifierExternal Identifier
... patient 0..1PatientWho was/is taking medication
... informationSource 0..1Patient | Practitioner | RelatedPerson
... dateAsserted 0..1dateTimeWhen the statement was asserted?
... status 1..1codein-progress | completed | entered-in-error
MedicationStatementStatus (Required)
... wasNotGiven M0..1booleanTrue if medication is/was not being taken
... reasonNotGiven I0..*CodeableConceptTrue if asserting medication was not given
MedicationAdministrationNegationReason (Example)
Reason not given is only permitted if wasNotGiven is true
... reasonForUse[x] I
Reason for use is only permitted if wasNotGiven is false
.... reasonForUseCodeableConcept0..1CodeableConcept
.... reasonForUseReference0..1Condition
... effective[x] Over what period was medication consumed?
.... effectiveDateTime0..1dateTime
.... effectivePeriod0..1Period
... note 0..1stringFurther information about the statement
... medication 0..1MedicationWhat medication was taken?
... dosage 0..*ElementDetails of how medication was taken
.... text 0..1stringDosage Instructions
.... schedule 0..1TimingWhen/how often was medication taken?
.... asNeeded[x] Take "as needed" f(or x)
..... asNeededBoolean0..1boolean
..... asNeededCodeableConcept0..1CodeableConcept
.... site 0..1CodeableConceptWhere on body was medication administered?
MedicationAdministrationSite (Example)
.... route 0..1CodeableConceptHow did the medication enter the body?
RouteOfAdministration (Example)
.... method 0..1CodeableConceptTechnique used to administer medication
MedicationAdministrationMethod (Example)
.... quantity 0..1QuantityAmount administered in one dose
.... rate 0..1RatioDose quantity per unit of time
.... maxDosePerPeriod 0..1RatioMaximum dose that was consumed per unit of time

UML Diagram

MedicationStatement (DomainResource)External identifier - FHIR will generate its own internal IDs (probably URLs) which do not need to be explicitly managed by the resource. The identifier here is one that would be used by another non-FHIR system - for example an automated medication pump would provide a record each time it operated; an administration while the patient was off the ward might be made with a different system and entered after the event. Particularly important if these records have to be updatedidentifier : Identifier 0..*The person or animal who is /was taking the medicationpatient : Reference(Patient) 0..1The person who provided the information about the taking of this medicationinformationSource : Reference(Patient|Practitioner| RelatedPerson) 0..1The date when the medication statement was asserted by the information sourcedateAsserted : dateTime 0..1A code specifying the state of the statement. Generally this will be in-progress or completed statestatus : code 1..1 « A set of codes indicating the current status of a MedicationStatementMedicationStatementStatus »Set this to true if the record is saying that the medication was NOT taken (this element modifies the meaning of other elements)wasNotGiven : boolean 0..1A code indicating why the medication was not takenreasonNotGiven : CodeableConcept 0..* « (A set of codes indicating the reason why the MedicationAdministration is negated.MedicationAdministrationNegationReason) »A reason for why the medication is being/was takenreasonForUse[x] : CodeableConcept|Reference(Condition) 0..1The interval of time during which it is being asserted that the patient was taking the medication (or was not taking, when the 'wasNotGiven' attribute is true)effective[x] : dateTime|Period 0..1Provides extra information about the medication statement that is not conveyed by the other attributesnote : string 0..1Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medicationsmedication : Reference(Medication) 0..1DosageFree 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 medicationtext : string 0..1The 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"schedule : Timing 0..1If 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 MedicationasNeeded[x] : boolean|CodeableConcept 0..1A coded specification of the anatomic site where the medication first enters the bodysite : CodeableConcept 0..1 « (A coded concept describing the site location the medicine enters into or onto the bodyMedicationAdministrationSite) »A code specifying the route or physiological path of administration of a therapeutic agent into or onto a subjectroute : CodeableConcept 0..1 « (A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.RouteOfAdministration) »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 administrationmethod : CodeableConcept 0..1 « (A coded concept describing the technique by which the medicine is administeredMedicationAdministrationMethod) »The amount of therapeutic or other substance given at one administration eventquantity : Quantity 0..1Identifies the speed with which the substance is introduced into the subject. Typically the rate for an infusion. 200ml in 2 hoursrate : Ratio 0..1The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. E.g. 1000mg in 24 hoursmaxDosePerPeriod : Ratio 0..1Indicates how the medication is/was used by the patientdosage0..*

XML Template

<MedicationStatement xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External Identifier --></identifier>
 <patient><!-- 0..1 Reference(Patient) Who was/is taking medication --></patient>
 <informationSource><!-- 0..1 Reference(Patient|Practitioner|RelatedPerson)  --></informationSource>
 <dateAsserted value="[dateTime]"/><!-- 0..1 When the statement was asserted? -->
 <status value="[code]"/><!-- 1..1 in-progress | completed | entered-in-error -->
 <wasNotGiven value="[boolean]"/><!-- 0..1 True if medication is/was not being taken -->
 <reasonNotGiven><!-- ?? 0..* CodeableConcept True if asserting medication was not given --></reasonNotGiven>
 <reasonForUse[x]><!-- 0..1 CodeableConcept|Reference(Condition)  --></reasonForUse[x]>
 <effective[x]><!-- 0..1 dateTime|Period Over what period was medication consumed? --></effective[x]>
 <note value="[string]"/><!-- 0..1 Further information about the statement -->
 <medication><!-- 0..1 Reference(Medication) What medication was taken? --></medication>
 <dosage>  <!-- 0..* Details of how medication was taken -->
  <text value="[string]"/><!-- 0..1 Dosage Instructions -->
  <schedule><!-- 0..1 Timing When/how often was medication taken? --></schedule>
  <asNeeded[x]><!-- 0..1 boolean|CodeableConcept Take "as needed" f(or x) --></asNeeded[x]>
  <site><!-- 0..1 CodeableConcept Where on body was medication administered? --></site>
  <route><!-- 0..1 CodeableConcept How did the medication enter the body? --></route>
  <method><!-- 0..1 CodeableConcept Technique used to administer medication --></method>
  <quantity><!-- 0..1 Quantity Amount administered in one dose --></quantity>
  <rate><!-- 0..1 Ratio Dose quantity per unit of time --></rate>
  <maxDosePerPeriod><!-- 0..1 Ratio 
      Maximum dose that was consumed per unit of time --></maxDosePerPeriod>
 </dosage>
</MedicationStatement>

JSON Template

{doco
  "resourceType" : "MedicationStatement",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External Identifier
  "patient" : { Reference(Patient) }, // Who was/is taking medication
  "informationSource" : { Reference(Patient|Practitioner|RelatedPerson) }, // 
  "dateAsserted" : "<dateTime>", // When the statement was asserted?
  "status" : "<code>", // R! in-progress | completed | entered-in-error
  "wasNotGiven" : <boolean>, // True if medication is/was not being taken
  "reasonNotGiven" : [{ CodeableConcept }], // C? True if asserting medication was not given
  // reasonForUse[x]: . One of these 2:
  "reasonForUseCodeableConcept" : { CodeableConcept },
  "reasonForUseReference" : { Reference(Condition) },
  // effective[x]: Over what period was medication consumed?. One of these 2:
  "effectiveDateTime" : "<dateTime>",
  "effectivePeriod" : { Period },
  "note" : "<string>", // Further information about the statement
  "medication" : { Reference(Medication) }, // What medication was taken?
  "dosage" : [{ // Details of how medication was taken
    "text" : "<string>", // Dosage Instructions
    "schedule" : { Timing }, // When/how often was medication taken?
    // asNeeded[x]: Take "as needed" f(or x). One of these 2:
    "asNeededBoolean" : <boolean>,
    "asNeededCodeableConcept" : { CodeableConcept },
    "site" : { CodeableConcept }, // Where on body was medication administered?
    "route" : { CodeableConcept }, // How did the medication enter the body?
    "method" : { CodeableConcept }, // Technique used to administer medication
    "quantity" : { Quantity }, // Amount administered in one dose
    "rate" : { Ratio }, // Dose quantity per unit of time
    "maxDosePerPeriod" : { Ratio } // 
      Maximum dose that was consumed per unit of time
  }]
}

 

Alternate definitions: Schema/Schematron, Resource Profile (XML, JSON), Questionnaire

4.17.3.1 Terminology Bindings

PathDefinitionTypeReference
MedicationStatement.status A set of codes indicating the current status of a MedicationStatementFixedhttp://hl7.org/fhir/medication-statement-status
MedicationStatement.reasonNotGiven A set of codes indicating the reason why the MedicationAdministration is negated.Examplehttp://hl7.org/fhir/vs/reason-medication-not-given-codes
MedicationStatement.dosage.asNeeded[x] 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.UnknownNo details provided yet
MedicationStatement.dosage.site A coded concept describing the site location the medicine enters into or onto the bodyExamplehttp://hl7.org/fhir/vs/approach-site-codes
MedicationStatement.dosage.route A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.Examplehttp://hl7.org/fhir/vs/route-codes
MedicationStatement.dosage.method A coded concept describing the technique by which the medicine is administeredExamplehttp://hl7.org/fhir/vs/administration-method-codes

4.17.3.2 Constraints

  • mst-1: On MedicationStatement.reasonNotGiven: Reason not given is only permitted if wasNotGiven is true (xpath on f:MedicationStatement/f:reasonNotGiven: not(exists(f:reasonNotGiven) and f:wasNotGiven/@value='false'))
  • mst-2: On MedicationStatement.reasonForUse[x]: Reason for use is only permitted if wasNotGiven is false (xpath on f:MedicationStatement/f:reasonForUse[x]: not(exists(f:reasonForUse[x]) and f:wasNotGiven/@value='true'))

4.17.4 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionPaths
effectivedatedateDate when patient was taking (or not taking) the medicationMedicationStatement.effective[x]
identifiertokenReturn administrations with this external identityMedicationStatement.identifier
medicationreferenceCode for medicine or text in medicine nameMedicationStatement.medication
(Medication)
patientreferenceThe identity of a patient to list administrations forMedicationStatement.patient
(Patient)
statusstringReturn statements that match the given statusMedicationStatement.status