StructureDefinition: QICore-MedicationAdministration - XML

QICore-MedicationAdministration

Raw XML

<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="qicore-medicationadministration"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">to do</div>
  </text>
  <url value="http://hl7.org/fhir/StructureDefinition/qicore-medicationadministration"/>
  <name value="QICore-MedicationAdministration"/>
  <status value="draft"/>
  <publisher value="Health Level Seven International (Clinical Quality Information - QICore)"/>
  <contact>
    <telecom>
      <system value="other"/>
      <value value="http://hl7.org/special/committees/CQI"/>
    </telecom>
  </contact>
  <date value="2015-02-27"/>
  <description value="Profile of MedicationAdministration for decision support/quality metrics. Defines the
   core set of elements and extensions for quality rule and measure authors."/>
  <mapping>
    <identity value="qdm"/>
    <uri value="http://www.healthit.gov/quality-data-model"/>
    <name value="Quality Data Model"/>
  </mapping>
  <kind value="resource"/>
  <constrainedType value="MedicationAdministration"/>
  <abstract value="false"/>
  <base value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration"/>
  <snapshot>
    <element>
      <path value="MedicationAdministration"/>
      <name value="QICore-MedicationAdministration"/>
      <short value="Administration of medication to a patient"/>
      <definition value="Describes the event of a patient consuming or otherwise being administered a medication.
        This may be as simple as swallowing a tablet or it may be a long running infusion.  Related
       resources tie this event to the authorizing prescription, and the specific encounter between
       patient and health care practitioner."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="MedicationAdministration"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="MedicationAdministration"/>
      </type>
      <isSummary value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="SubstanceAdministration"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="clinical.medication"/>
      </mapping>
      <mapping>
        <identity value="qdm"/>
        <map value="Medication, Administered"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.id"/>
      <short value="Logical id of this artifact"/>
      <definition value="The logical id of the resource, as used in the url for the resource. Once assigned, this
       value never changes."/>
      <comments value="The only time that a resource does not have an id is when it is being submitted to the
       server using a create operation. Bundles always have an id, though it is usually a generated
       UUID."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="id"/>
      </type>
      <isSummary value="true"/>
    </element>
    <element>
      <path value="MedicationAdministration.meta"/>
      <short value="Metadata about the resource"/>
      <definition value="The metadata about the resource. This is content that is maintained by the infrastructure.
       Changes to the content may not always be associated with version changes to the resource."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.meta"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Meta"/>
      </type>
      <isSummary value="true"/>
    </element>
    <element>
      <path value="MedicationAdministration.implicitRules"/>
      <short value="A set of rules under which this content was created"/>
      <definition value="A reference to a set of rules that were followed when the resource was constructed, and
       which must be understood when processing the content."/>
      <comments value="Asserting this rule set restricts the content to be only understood by a limited set of
       trading partners. This inherently limits the usefulness of the data in the long term.
       However the existing health eco-system is highly fractured, and not yet ready to define,
       collect, and exchange data in a generally computable sense. Wherever possible, implementers
       and/or specification writers should avoid using this element as much as possible."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.implicitRules"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="uri"/>
      </type>
      <isModifier value="true"/>
      <isSummary value="true"/>
    </element>
    <element>
      <path value="MedicationAdministration.language"/>
      <short value="Language of the resource content"/>
      <definition value="The base language in which the resource is written."/>
      <comments value="Language is provided to support indexing and accessibility (typically, services such as
       text to speech use the language tag). The html language tag in the narrative applies 
       to the narrative. The language tag on the resource may be used to specify the language
       of other presentations generated from the data in the resource  Not all the content has
       to be in the base language. The Resource.language should not be assumed to apply to the
       narrative automatically. If a language is specified, it should it also be specified on
       the div element in the html (see rules in HTML5 for information about the relationship
       between xml:lang and the html lang attribute)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.language"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <binding>
        <strength value="required"/>
        <description value="A human language"/>
        <valueSetUri value="http://tools.ietf.org/html/bcp47"/>
      </binding>
    </element>
    <element>
      <path value="MedicationAdministration.text"/>
      <short value="Text summary of the resource, for human interpretation"/>
      <definition value="A human-readable narrative that contains a summary of the resource, and may be used to
       represent the content of the resource to a human. The narrative need not encode all the
       structured data, but is required to contain sufficient detail to make it &quot;clinically
       safe&quot; for a human to just read the narrative. Resource definitions may define what
       content should be represented in the narrative to ensure clinical safety."/>
      <comments value="Contained resources do not have narrative. Resources that are not contained SHOULD have
       a narrative."/>
      <alias value="narrative"/>
      <alias value="html"/>
      <alias value="xhtml"/>
      <alias value="display"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.text"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Narrative"/>
      </type>
      <condition value="dom-1"/>
      <mapping>
        <identity value="rim"/>
        <map value="Act.text?"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.contained"/>
      <short value="Contained, inline Resources"/>
      <definition value="These resources do not have an independent existence apart from the resource that contains
       them - they cannot be identified independently, and nor can they have their own independent
       transaction scope."/>
      <comments value="This should never be done when the content can be identified properly, as once identification
       is lost, it is extremely difficult (and context dependent) to restore it again."/>
      <alias value="inline resources"/>
      <alias value="anonymous resources"/>
      <alias value="contained resources"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="MedicationAdministration.contained"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Resource"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.extension"/>
      <short value="Additional Content defined by implementations"/>
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the resource. In order to make the use of extensions safe and manageable, there is
       a strict set of governance  applied to the definition and use of extensions. Though any
       implementer is allowed to define an extension, there is a set of requirements that SHALL
       be met as part of the definition of the extension."/>
      <comments value="There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="MedicationAdministration.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.modifierExtension"/>
      <short value="Extensions that cannot be ignored"/>
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the resource, and that modifies the understanding of the element that contains it.
       Usually modifier elements provide negation or qualification. In order to make the use
       of extensions safe and manageable, there is a strict set of governance applied to the
       definition and use of extensions. Though any implementer is allowed to define an extension,
       there is a set of requirements that SHALL be met as part of the definition of the extension.
       Applications processing a resource are required to check for modifier extensions."/>
      <comments value="There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="MedicationAdministration.modifierExtension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.identifier"/>
      <short value="External identifier"/>
      <definition value="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 updated."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="MedicationAdministration.identifier"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Identifier"/>
      </type>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="RXA-25-Administered Barcode Identifier? (V2 def'n of RXA-25 refers to the 'give' occurrence;
         appears not to discuss 'administer' cardinality which would seem to be 0..*)"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="id"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="id"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.status"/>
      <short value="in-progress | on-hold | completed | entered-in-error | stopped"/>
      <definition value="Will generally be set to show that the administration has been completed.  For some long
       running administrations such as infusions it is possible for an administration to be started
       but not completed or it may be paused while some other process is under way."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.status"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <mustSupport value="true"/>
      <isModifier value="true"/>
      <isSummary value="true"/>
      <binding>
        <strength value="required"/>
        <description value="A set of codes indicating the current status of a MedicationAdministration"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/medication-admin-status"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="RXA-20-Completion Status"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="statusCode"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="status"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.patient"/>
      <short value="Who received medication?"/>
      <definition value="The person or animal to whom the medication was given."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.patient"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/qicore-patient"/>
      </type>
      <mustSupport value="true"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="PID-3-Patient ID List"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="subject-&gt;Patient"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="who.focus"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.practitioner"/>
      <short value="Who administered substance?"/>
      <definition value="The individual who was responsible for giving the medication to the patient."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.practitioner"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/qicore-practitioner"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/qicore-patient"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/qicore-relatedperson"/>
      </type>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="RXA-10-Administering Provider / PRT-5-Participation Person: PRT-4-Participation='AP' (RXA-10
         is deprecated)"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="performer-&gt;Role"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="who.actor"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.encounter"/>
      <short value="Encounter administered as part of"/>
      <definition value="The visit or admission the or other contact between patient and health care provider the
       medication administration was performed as part of."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.encounter"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/qicore-encounter"/>
      </type>
      <mustSupport value="true"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="PV1-19-Visit Number"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="component-&gt;EncounterEvent"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="context"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.prescription"/>
      <short value="Order administration performed against"/>
      <definition value="The original request, instruction or authority to perform the administration."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.prescription"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/qicore-medicationorder"/>
      </type>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="ORC-3-Filler Order Number / ORC-2-Placer Order Number"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="InFullfillmentOf-&gt;SubstanceAdministration"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.wasNotGiven"/>
      <short value="True if medication not administered"/>
      <definition value="Set this to true if the record is saying that the medication was NOT administered."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.wasNotGiven"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="boolean"/>
      </type>
      <meaningWhenMissing value="If this is missing, then the medication was administered"/>
      <mustSupport value="true"/>
      <isModifier value="true"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="RXA-20-Completion Status='NA'"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="actionNegationInd"/>
      </mapping>
      <mapping>
        <identity value="qdm"/>
        <map value="negation rationale"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.reasonNotGiven"/>
      <short value="Reason administration not performed"/>
      <definition value="A code indicating why the administration was not performed."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="MedicationAdministration.reasonNotGiven"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <condition value="mad-2"/>
      <constraint>
        <key value="mad-2"/>
        <severity value="error"/>
        <human value="Reason not given is only permitted if wasNotGiven is true"/>
        <xpath value="not(exists(f:reasonNotGiven) and f:wasNotGiven/@value='false')"/>
      </constraint>
      <mustSupport value="true"/>
      <isSummary value="true"/>
      <binding>
        <strength value="example"/>
        <description value="A set of codes indicating the reason why the MedicationAdministration is negated."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/reason-medication-not-given-codes"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="RXA-9-Administration Notes:RXA-20-Completion Status='NA'"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="Reason-&gt;Observation-&gt;Value"/>
      </mapping>
      <mapping>
        <identity value="qdm"/>
        <map value="negation rationale"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.reasonGiven"/>
      <short value="Reason administration performed"/>
      <definition value="A code indicating why the medication was given."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="MedicationAdministration.reasonGiven"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <condition value="mad-3"/>
      <constraint>
        <key value="mad-3"/>
        <severity value="error"/>
        <human value="Reason given is only permitted if wasNotGiven is false"/>
        <xpath value="not(exists(f:reasonGiven) and f:wasNotGiven/@value='true')"/>
      </constraint>
      <mustSupport value="true"/>
      <isSummary value="true"/>
      <binding>
        <strength value="example"/>
        <description value="A set of codes indicating the reason why the MedicationAdministration was made."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/reason-medication-given-codes"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="qdm"/>
        <map value="reason"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.effectiveTime[x]"/>
      <short value="Start and end time of administration"/>
      <definition value="A specific date/time or interval of time during which the administration took place (or
       did not take place, when the 'notGiven' attribute is true). For many administrations,
       such as swallowing a tablet the use of dateTime is more appropriate."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.effectiveTime[x]"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="dateTime"/>
      </type>
      <type>
        <code value="Period"/>
      </type>
      <mustSupport value="true"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="RXA-3-Date/Time Start of Administration / RXA-4-Date/Time End of Administration"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="effectiveTime"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="when.done"/>
      </mapping>
      <mapping>
        <identity value="qdm"/>
        <map value="start and stop datetime"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.medication[x]"/>
      <short value="What was administered?"/>
      <definition value="Identifies the medication that was 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 medications."/>
      <comments value="If only a code is specified, then it needs to be a code for a specific product.  If more
       information is required, then the use of the medication resource is recommended.  Note:
       do not use Medication.name to describe the administered medication. When the only available
       information is a text description of the medication, Medication.code.text should be used."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.medication[x]"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/qicore-medication"/>
      </type>
      <mustSupport value="true"/>
      <isSummary value="true"/>
      <binding>
        <strength value="preferred"/>
        <description value="The set of RxNorm codes to represent medications"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/daf-medication-codes"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="RXA-5-Administered Code"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="Consumeable-&gt;AdministerableMedication"/>
      </mapping>
      <mapping>
        <identity value="qdm"/>
        <map value="primary code"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.device"/>
      <short value="Device used to administer"/>
      <definition value="The device used in administering the medication to the patient.  E.g. a particular infusion
       pump."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="MedicationAdministration.device"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/qicore-device"/>
      </type>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="PRT-10-Participation Device"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="device-&gt;Access  OR device-&gt;AssignedDevice"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.note"/>
      <short value="Information about the administration"/>
      <definition value="Extra information about the medication administration that is not conveyed by the other
       attributes."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.note"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="string"/>
      </type>
      <isSummary value="true"/>
    </element>
    <element>
      <path value="MedicationAdministration.dosage"/>
      <short value="Details of how medication was taken"/>
      <definition value="Describes the medication dosage information details e.g. dose, rate, site, route, etc."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.dosage"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="BackboneElement"/>
      </type>
      <constraint>
        <key value="mad-1"/>
        <severity value="error"/>
        <human value="SHALL have at least one of dosage.quantity and dosage.rate"/>
        <xpath value="exists(f:quantity) or exists(f:rate)"/>
      </constraint>
      <isSummary value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="component-&gt;SubstanceAdministrationEvent"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.dosage.id"/>
      <representation value="xmlAttr"/>
      <short value="xml:id (or equivalent in JSON)"/>
      <definition value="unique id for the element within a resource (for internal references)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.dosage.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="id"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.dosage.extension"/>
      <short value="Additional Content defined by implementations"/>
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element. In order to make the use of extensions safe and manageable, there is a
       strict set of governance  applied to the definition and use of extensions. Though any
       implementer is allowed to define an extension, there is a set of requirements that SHALL
       be met as part of the definition of the extension."/>
      <comments value="There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="MedicationAdministration.dosage.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.dosage.modifierExtension"/>
      <short value="Extensions that cannot be ignored"/>
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element, and that modifies the understanding of the element that contains it. Usually
       modifier elements provide negation or qualification. In order to make the use of extensions
       safe and manageable, there is a strict set of governance applied to the definition and
       use of extensions. Though any implementer is allowed to define an extension, there is
       a set of requirements that SHALL be met as part of the definition of the extension. Applications
       processing a resource are required to check for modifier extensions."/>
      <comments value="There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <alias value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="MedicationAdministration.dosage.modifierExtension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.dosage.text"/>
      <short value="Dosage Instructions"/>
      <definition value="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."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.dosage.text"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="string"/>
      </type>
      <isSummary value="true"/>
    </element>
    <element>
      <path value="MedicationAdministration.dosage.site[x]"/>
      <short value="Body site administered to"/>
      <definition value="A coded specification of the anatomic site where the medication first entered the body.
        E.g. &quot;left arm&quot;."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.dosage.site[x]"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/BodySite"/>
      </type>
      <isSummary value="true"/>
      <binding>
        <strength value="example"/>
        <description value="A coded concept describing the site location the medicine enters into or onto the body"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/approach-site-codes"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="RXR-2-Administration Site"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="approachSiteCode"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.dosage.route"/>
      <short value="Path of substance into body"/>
      <definition value="A code specifying the route or physiological path of administration of a therapeutic agent
       into or onto the patient.   E.g. topical, intravenous, etc."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.dosage.route"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <mustSupport value="true"/>
      <isSummary value="true"/>
      <binding>
        <strength value="example"/>
        <description value="A coded concept describing the route or physiological path of administration of a therapeutic
         agent into or onto the body of a subject"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/route-codes"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="RXR-1-Route"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="routeCode"/>
      </mapping>
      <mapping>
        <identity value="qdm"/>
        <map value="route"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.dosage.method"/>
      <short value="How drug was administered"/>
      <definition value="A coded value indicating the method by which the medication is intended to be or was introduced
       into or on the body.  This attribute will most often NOT be populated.  It is most commonly
       used for injections.  Examples: Slow Push, Deep IV.  One of the reasons this attribute
       is not used often, is that the method is often pre-coordinated with the route and/or form
       of administration.  This means the codes used in route or form may pre-coordinate the
       method in the route code or the form code.  The implementation decision about what coding
       system to use for route or form code will determine how frequently the method code will
       be populated e.g. if route or form code pre-coordinate method code, then this attribute
       will not be populated often; if there is no pre-coordination then method code may  be
       used frequently."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.dosage.method"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isSummary value="true"/>
      <binding>
        <strength value="required"/>
        <description value="A coded concept describing the technique by which the medicine is administered"/>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="RXR-4-Administration Method"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="methodCode"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.dosage.quantity"/>
      <short value="Amount administered in one dose"/>
      <definition value="The amount of the medication given at one administration event.   Use this value when
       the administration is essentially an instantaneous event such as a swallowing a tablet
       or giving an injection."/>
      <comments value="If the administration is not instantaneous (rate is present or timing has a duration),
       this can be specified to convey the total amount administered over period of time of a
       single administration (as indicated by schedule)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.dosage.quantity"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Quantity"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/>
      </type>
      <mustSupport value="true"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="RXA-6-Administered Amount / RXA-7.1-Administered Units.code / RXA-7.3-Administered Units.name
         of coding system (uri&lt;-&gt;code system mapping required)"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="doseQuantity"/>
      </mapping>
      <mapping>
        <identity value="qdm"/>
        <map value="dose"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.dosage.rate[x]"/>
      <short value="Dose quantity per unit of time"/>
      <definition value="Identifies the speed with which the medication was or will be introduced into the patient.
        Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr.  May also be
       expressed as a rate per unit of time e.g. 500 ml per 2 hours.  Currently we do not specify
       a default of '1' in the denominator, but this is being discussed.  Other examples:  200
       mcg/min or 200 mcg/1 minute; 1 liter/8 hours."/>
      <comments value="If the rate changes over time, and you want to capture this in Medication Administration,
       then each change should be captured as a distinct Medication Administration, with a specific
       MedicationAdministration.dosage.rate, and the date time when the rate change occurred.
       Typically, the MedicationAdministration.dosage.rate element is not used to convey an average
       rate."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationAdministration.dosage.rate[x]"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Ratio"/>
      </type>
      <type>
        <code value="Range"/>
      </type>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="RXA-12-Administered Per (Time Unit)"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="rateQuantity"/>
      </mapping>
    </element>
  </snapshot>
  <differential>
    <element>
      <path value="MedicationAdministration"/>
      <name value="QICore-MedicationAdministration"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="MedicationAdministration"/>
      </type>
      <mapping>
        <identity value="qdm"/>
        <map value="Medication, Administered"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.status"/>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="MedicationAdministration.patient"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/qicore-patient"/>
      </type>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="MedicationAdministration.practitioner"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/qicore-practitioner"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/qicore-patient"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/qicore-relatedperson"/>
      </type>
    </element>
    <element>
      <path value="MedicationAdministration.encounter"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/qicore-encounter"/>
      </type>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="MedicationAdministration.prescription"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/qicore-medicationorder"/>
      </type>
    </element>
    <element>
      <path value="MedicationAdministration.wasNotGiven"/>
      <mustSupport value="true"/>
      <mapping>
        <identity value="qdm"/>
        <map value="negation rationale"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.reasonNotGiven"/>
      <mustSupport value="true"/>
      <mapping>
        <identity value="qdm"/>
        <map value="negation rationale"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.reasonGiven"/>
      <mustSupport value="true"/>
      <mapping>
        <identity value="qdm"/>
        <map value="reason"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.effectiveTime[x]"/>
      <mustSupport value="true"/>
      <mapping>
        <identity value="qdm"/>
        <map value="start and stop datetime"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.medication[x]"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/qicore-medication"/>
      </type>
      <mustSupport value="true"/>
      <binding>
        <strength value="preferred"/>
        <description value="The set of RxNorm codes to represent medications"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/daf-medication-codes"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="qdm"/>
        <map value="primary code"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.device"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/qicore-device"/>
      </type>
    </element>
    <element>
      <path value="MedicationAdministration.dosage"/>
    </element>
    <element>
      <path value="MedicationAdministration.dosage.route"/>
      <mustSupport value="true"/>
      <mapping>
        <identity value="qdm"/>
        <map value="route"/>
      </mapping>
    </element>
    <element>
      <path value="MedicationAdministration.dosage.quantity"/>
      <mustSupport value="true"/>
      <mapping>
        <identity value="qdm"/>
        <map value="dose"/>
      </mapping>
    </element>
  </differential>
</StructureDefinition>