This page is part of the FHIR Specification (v1.0.0: DSTU 2 Ballot 3). 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
Pharmacy Work Group | Maturity Level: 0 | Compartments: Patient, Practitioner, RelatedPerson |
A record of a medication that is being consumed by a patient. A medication statements may indicate that the patient may be taking the medication now, or has taken the medication in the past or will be taking the medication in the future. The source of this information can be the patient, significant other (such as a family member or spouse), or a clinician. A common scenario where this information is captured is during the history taking process during a patient visit or stay. The medication information may come from e.g. the patients’ memory, from a prescription bottle, or from a list of medications the patient, clinician or other party maintains. The primary difference between a medication statement and a medication administration is that the medication administration has complete administration information and is based on actual administration information from the person who administered the medication. A medication statement is often, if not always less specific. There is no required date/time when the medication was administered, in fact we only know that a source has reported the patient is taking this medication, where details such as time, quantity, or rate or even medication product may be incomplete or missing or less precise. As stated earlier, the Medication Statement information may come from the patient’s memory, from a prescription bottle or from a list of medications the patient, clinician or other party maintains. Medication Administration is more formal and is not missing detailed information.
Common usage includes:
This resource does not produce a medication list, but it does produce individual medication statements that may be used in the List resource to construct various types of medication lists. Note that other medication lists can also be constructed from the other Pharmacy resources e.g. Medication Order, Medication Administration.
A medication statement is not a part of the prescribe –> dispense -> administer sequence, but is a report by a patient, significant other or a clinician that one or more of the prescribe, dispense or administer actions has occurred, resulting is a belief that the patient is, has, or will be using a particular medication.
The Medication domain includes a number of related resources
MedicationOrder | 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 MedicationOrder, 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 goal
Structure
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
MedicationStatement | Σ I | DomainResource | Record of medication being taken by a patient Reason for use is only permitted if wasNotTaken is false Reason not taken is only permitted if wasNotTaken is true | |
identifier | Σ | 0..* | Identifier | External Identifier |
patient | Σ | 1..1 | Reference(Patient) | Who was/is taking medication |
informationSource | Σ | 0..1 | Reference(Patient | Practitioner | RelatedPerson) | |
dateAsserted | Σ | 0..1 | dateTime | When the statement was asserted? |
status | ?! Σ | 1..1 | code | active | completed | entered-in-error | intended MedicationStatementStatus (Required) |
wasNotTaken | ?! Σ | 0..1 | boolean | True if medication is/was not being taken |
reasonNotTaken | Σ I | 0..* | CodeableConcept | True if asserting medication was not given Reason Medication Not Given Codes (Example) |
reasonForUse[x] | Σ | 0..1 | ||
reasonForUseCodeableConcept | CodeableConcept | |||
reasonForUseReference | Reference(Condition) | |||
effective[x] | Σ | 0..1 | Over what period was medication consumed? | |
effectiveDateTime | dateTime | |||
effectivePeriod | Period | |||
note | Σ | 0..1 | string | Further information about the statement |
supportingInformation | Σ | 0..* | Reference(Any) | Additional supporting information |
medication[x] | Σ | 1..1 | What medication was taken? | |
medicationCodeableConcept | CodeableConcept | |||
medicationReference | Reference(Medication) | |||
dosage | Σ | 0..* | BackboneElement | Details of how medication was taken |
text | Σ | 0..1 | string | Reported dosage information |
timing | Σ | 0..1 | Timing | When/how often was medication taken? |
asNeeded[x] | Σ | 0..1 | Take "as needed" f(or x) | |
asNeededBoolean | boolean | |||
asNeededCodeableConcept | CodeableConcept | |||
site[x] | Σ | 0..1 | Where on body was medication administered? SNOMED CT Anatomical Structure for Administration Site Codes (Example) | |
siteCodeableConcept | CodeableConcept | |||
siteReference | Reference(BodySite) | |||
route | Σ | 0..1 | CodeableConcept | How did the medication enter the body? SNOMED CT Route Codes (Example) |
method | Σ | 0..1 | CodeableConcept | Technique used to administer medication |
quantity[x] | Σ | 0..1 | Amount administered in one dose | |
quantityQuantity | SimpleQuantity | |||
quantityRange | Range | |||
rate[x] | Σ | 0..1 | Dose quantity per unit of time | |
rateRatio | Ratio | |||
rateRange | Range | |||
maxDosePerPeriod | Σ | 0..1 | Ratio | Maximum dose that was consumed per unit of time |
Documentation for this format |
UML Diagram
XML Template
<MedicationStatement xmlns="http://hl7.org/fhir"> <!-- from Resource: id, meta, implicitRules, and language --> <!-- from DomainResource: text, contained, extension, and modifierExtension --> <identifier><!-- 0..* Identifier External Identifier --></identifier> <patient><!-- 1..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 active | completed | entered-in-error | intended --> <wasNotTaken value="[boolean]"/><!-- 0..1 True if medication is/was not being taken --> <reasonNotTaken><!-- 0..* CodeableConcept True if asserting medication was not given --></reasonNotTaken> <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 --> <supportingInformation><!-- 0..* Reference(Any) Additional supporting information --></supportingInformation> <medication[x]><!-- 1..1 CodeableConcept|Reference(Medication) What medication was taken? --></medication[x]> <dosage> <!-- 0..* Details of how medication was taken --> <text value="[string]"/><!-- 0..1 Reported dosage information --> <timing><!-- 0..1 Timing When/how often was medication taken? --></timing> <asNeeded[x]><!-- 0..1 boolean|CodeableConcept Take "as needed" f(or x) --></asNeeded[x]> <site[x]><!-- 0..1 CodeableConcept|Reference(BodySite) Where on body was medication administered? --></site[x]> <route><!-- 0..1 CodeableConcept How did the medication enter the body? --></route> <method><!-- 0..1 CodeableConcept Technique used to administer medication --></method> <quantity[x]><!-- 0..1 Quantity(SimpleQuantity)|Range Amount administered in one dose --></quantity[x]> <rate[x]><!-- 0..1 Ratio|Range Dose quantity per unit of time --></rate[x]> <maxDosePerPeriod><!-- 0..1 Ratio Maximum dose that was consumed per unit of time --></maxDosePerPeriod> </dosage> </MedicationStatement>
JSON Template
{ "resourceType" : "MedicationStatement", // from Resource: id, meta, implicitRules, and language // from DomainResource: text, contained, extension, and modifierExtension "identifier" : [{ Identifier }], // External Identifier "patient" : { Reference(Patient) }, // R! Who was/is taking medication "informationSource" : { Reference(Patient|Practitioner|RelatedPerson) }, // "dateAsserted" : "<dateTime>", // When the statement was asserted? "status" : "<code>", // R! active | completed | entered-in-error | intended "wasNotTaken" : <boolean>, // True if medication is/was not being taken "reasonNotTaken" : [{ 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 "supportingInformation" : [{ Reference(Any) }], // Additional supporting information // medication[x]: What medication was taken?. One of these 2: "medicationCodeableConcept" : { CodeableConcept }, "medicationReference" : { Reference(Medication) }, "dosage" : [{ // Details of how medication was taken "text" : "<string>", // Reported dosage information "timing" : { Timing }, // When/how often was medication taken? // asNeeded[x]: Take "as needed" f(or x). One of these 2: "asNeededBoolean" : <boolean>, "asNeededCodeableConcept" : { CodeableConcept }, // site[x]: Where on body was medication administered?. One of these 2: "siteCodeableConcept" : { CodeableConcept }, "siteReference" : { Reference(BodySite) }, "route" : { CodeableConcept }, // How did the medication enter the body? "method" : { CodeableConcept }, // Technique used to administer medication // quantity[x]: Amount administered in one dose. One of these 2: "quantityQuantity" : { Quantity(SimpleQuantity) }, "quantityRange" : { Range }, // rate[x]: Dose quantity per unit of time. One of these 2: "rateRatio" : { Ratio }, "rateRange" : { Range }, "maxDosePerPeriod" : { Ratio } // Maximum dose that was consumed per unit of time }] }
Structure
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
MedicationStatement | Σ I | DomainResource | Record of medication being taken by a patient Reason for use is only permitted if wasNotTaken is false Reason not taken is only permitted if wasNotTaken is true | |
identifier | Σ | 0..* | Identifier | External Identifier |
patient | Σ | 1..1 | Reference(Patient) | Who was/is taking medication |
informationSource | Σ | 0..1 | Reference(Patient | Practitioner | RelatedPerson) | |
dateAsserted | Σ | 0..1 | dateTime | When the statement was asserted? |
status | ?! Σ | 1..1 | code | active | completed | entered-in-error | intended MedicationStatementStatus (Required) |
wasNotTaken | ?! Σ | 0..1 | boolean | True if medication is/was not being taken |
reasonNotTaken | Σ I | 0..* | CodeableConcept | True if asserting medication was not given Reason Medication Not Given Codes (Example) |
reasonForUse[x] | Σ | 0..1 | ||
reasonForUseCodeableConcept | CodeableConcept | |||
reasonForUseReference | Reference(Condition) | |||
effective[x] | Σ | 0..1 | Over what period was medication consumed? | |
effectiveDateTime | dateTime | |||
effectivePeriod | Period | |||
note | Σ | 0..1 | string | Further information about the statement |
supportingInformation | Σ | 0..* | Reference(Any) | Additional supporting information |
medication[x] | Σ | 1..1 | What medication was taken? | |
medicationCodeableConcept | CodeableConcept | |||
medicationReference | Reference(Medication) | |||
dosage | Σ | 0..* | BackboneElement | Details of how medication was taken |
text | Σ | 0..1 | string | Reported dosage information |
timing | Σ | 0..1 | Timing | When/how often was medication taken? |
asNeeded[x] | Σ | 0..1 | Take "as needed" f(or x) | |
asNeededBoolean | boolean | |||
asNeededCodeableConcept | CodeableConcept | |||
site[x] | Σ | 0..1 | Where on body was medication administered? SNOMED CT Anatomical Structure for Administration Site Codes (Example) | |
siteCodeableConcept | CodeableConcept | |||
siteReference | Reference(BodySite) | |||
route | Σ | 0..1 | CodeableConcept | How did the medication enter the body? SNOMED CT Route Codes (Example) |
method | Σ | 0..1 | CodeableConcept | Technique used to administer medication |
quantity[x] | Σ | 0..1 | Amount administered in one dose | |
quantityQuantity | SimpleQuantity | |||
quantityRange | Range | |||
rate[x] | Σ | 0..1 | Dose quantity per unit of time | |
rateRatio | Ratio | |||
rateRange | Range | |||
maxDosePerPeriod | Σ | 0..1 | Ratio | Maximum dose that was consumed per unit of time |
Documentation for this format |
XML Template
<MedicationStatement xmlns="http://hl7.org/fhir"> <!-- from Resource: id, meta, implicitRules, and language --> <!-- from DomainResource: text, contained, extension, and modifierExtension --> <identifier><!-- 0..* Identifier External Identifier --></identifier> <patient><!-- 1..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 active | completed | entered-in-error | intended --> <wasNotTaken value="[boolean]"/><!-- 0..1 True if medication is/was not being taken --> <reasonNotTaken><!-- 0..* CodeableConcept True if asserting medication was not given --></reasonNotTaken> <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 --> <supportingInformation><!-- 0..* Reference(Any) Additional supporting information --></supportingInformation> <medication[x]><!-- 1..1 CodeableConcept|Reference(Medication) What medication was taken? --></medication[x]> <dosage> <!-- 0..* Details of how medication was taken --> <text value="[string]"/><!-- 0..1 Reported dosage information --> <timing><!-- 0..1 Timing When/how often was medication taken? --></timing> <asNeeded[x]><!-- 0..1 boolean|CodeableConcept Take "as needed" f(or x) --></asNeeded[x]> <site[x]><!-- 0..1 CodeableConcept|Reference(BodySite) Where on body was medication administered? --></site[x]> <route><!-- 0..1 CodeableConcept How did the medication enter the body? --></route> <method><!-- 0..1 CodeableConcept Technique used to administer medication --></method> <quantity[x]><!-- 0..1 Quantity(SimpleQuantity)|Range Amount administered in one dose --></quantity[x]> <rate[x]><!-- 0..1 Ratio|Range Dose quantity per unit of time --></rate[x]> <maxDosePerPeriod><!-- 0..1 Ratio Maximum dose that was consumed per unit of time --></maxDosePerPeriod> </dosage> </MedicationStatement>
JSON Template
{ "resourceType" : "MedicationStatement", // from Resource: id, meta, implicitRules, and language // from DomainResource: text, contained, extension, and modifierExtension "identifier" : [{ Identifier }], // External Identifier "patient" : { Reference(Patient) }, // R! Who was/is taking medication "informationSource" : { Reference(Patient|Practitioner|RelatedPerson) }, // "dateAsserted" : "<dateTime>", // When the statement was asserted? "status" : "<code>", // R! active | completed | entered-in-error | intended "wasNotTaken" : <boolean>, // True if medication is/was not being taken "reasonNotTaken" : [{ 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 "supportingInformation" : [{ Reference(Any) }], // Additional supporting information // medication[x]: What medication was taken?. One of these 2: "medicationCodeableConcept" : { CodeableConcept }, "medicationReference" : { Reference(Medication) }, "dosage" : [{ // Details of how medication was taken "text" : "<string>", // Reported dosage information "timing" : { Timing }, // When/how often was medication taken? // asNeeded[x]: Take "as needed" f(or x). One of these 2: "asNeededBoolean" : <boolean>, "asNeededCodeableConcept" : { CodeableConcept }, // site[x]: Where on body was medication administered?. One of these 2: "siteCodeableConcept" : { CodeableConcept }, "siteReference" : { Reference(BodySite) }, "route" : { CodeableConcept }, // How did the medication enter the body? "method" : { CodeableConcept }, // Technique used to administer medication // quantity[x]: Amount administered in one dose. One of these 2: "quantityQuantity" : { Quantity(SimpleQuantity) }, "quantityRange" : { Range }, // rate[x]: Dose quantity per unit of time. One of these 2: "rateRatio" : { Ratio }, "rateRange" : { Range }, "maxDosePerPeriod" : { Ratio } // Maximum dose that was consumed per unit of time }] }
Alternate definitions: Schema/Schematron, Resource Profile (XML, JSON), Questionnaire
Path | Definition | Type | Reference |
---|---|---|---|
MedicationStatement.status | A set of codes indicating the current status of a MedicationStatement | Required | MedicationStatementStatus |
MedicationStatement.reasonNotTaken | A set of codes indicating the reason why the MedicationAdministration is negated | Example | Reason Medication Not Given Codes |
MedicationStatement.dosage.asNeeded[x] | A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc. | Unknown | No details provided yet |
MedicationStatement.dosage.site[x] | A coded concept describing the site location the medicine enters into or onto the body | Example | SNOMED CT Anatomical Structure for Administration 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 | Example | SNOMED CT Route Codes |
MedicationStatement.dosage.method | A coded concept describing the technique by which the medicine is administered | Unknown | No details provided yet |
Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.
Name | Type | Description | Paths |
code | token | Return administrations of this medication code | MedicationStatement.medicationCodeableConcept |
effectivedate | date | Date when patient was taking (or not taking) the medication | MedicationStatement.effective[x] |
identifier | token | Return statements with this external identity | MedicationStatement.identifier |
medication | reference | Return administrations of this medication reference | MedicationStatement.medicationReference (Medication) |
patient | reference | The identity of a patient to list statements for | MedicationStatement.patient (Patient) |
source | reference | Who the information in the statement came from | MedicationStatement.informationSource (Patient, Practitioner, RelatedPerson) |
status | token | Return statements that match the given status | MedicationStatement.status |