STU 3 Ballot

This page is part of the FHIR Specification (v1.6.0: STU 3 Ballot 4). 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

11.5 Resource MedicationStatement - Content

Pharmacy Work GroupMaturity Level: 1Compartments: Patient, Practitioner, RelatedPerson

A record of a medication that is being consumed by a patient. A MedicationStatement 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 patient's 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.

11.5.1 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

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., MedicationOrder, MedicationAdministration).

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.

MedicationStatement is an event resource from a FHIR workflow perspective - see Workflow Event

11.5.2 Boundaries and Relationships

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 a medication being taken by a patient or that a 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 is 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

11.5.3 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationStatement IDomainResourceRecord of medication being taken by a patient
Reason for use reference is only permitted if notTaken is false
Reason not taken is only permitted if notTaken is true
Reason for use code is only permitted if notTaken is false
... identifier 0..*IdentifierExternal identifier
... status ?!Σ1..1codeactive | completed | entered-in-error | intended | stopped | on-hold
MedicationStatementStatus (Required)
... medication[x] Σ1..1What medication was taken
SNOMED CT Medication Codes (Example)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(Medication)
... patient Σ1..1Reference(Patient)Who is/was taking the medication
... effective[x] Σ0..1Over what period was medication consumed?
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
... informationSource 0..1Reference(Patient | Practitioner | RelatedPerson)Person who provided the information about the taking of this medication
... supportingInformation 0..*Reference(Any)Additional supporting information
... dateAsserted Σ0..1dateTimeWhen the statement was asserted?
... notTaken ?!Σ0..1booleanTrue if medication is/was not being taken
... reasonNotTaken I0..*CodeableConceptTrue if asserting medication was not given
... reasonForUseCode 0..*CodeableConceptReason for why the medication is being/was taken
Condition/Problem/Diagnosis Codes (Example)
... reasonForUseReference 0..*Reference(Condition)Condition that supports why the medication is being/was taken
... note 0..*AnnotationFurther information about the statement
... category 0..1codeType of medication usage
MedicationStatementCategory (Example)
... dosage 0..*BackboneElementDetails of how medication was taken
.... text 0..1stringFree text dosage instructions as reported by the information source
.... additionalInstructions 0..*CodeableConceptSupplemental instructions - e.g. "with meals"
SNOMED CT Additional Dosage Instructions (Example)
.... timing 0..1TimingWhen/how often was medication taken
.... asNeeded[x] 0..1Take "as needed" (for x)
SNOMED CT Medication As Needed Reason Codes (Example)
..... asNeededBooleanboolean
..... asNeededCodeableConceptCodeableConcept
.... site[x] 0..1Where (on body) medication is/was administered
SNOMED CT Anatomical Structure for Administration Site Codes (Example)
..... siteCodeableConceptCodeableConcept
..... siteReferenceReference(BodySite)
.... route 0..1CodeableConceptHow the medication entered the body
SNOMED CT Route Codes (Example)
.... method 0..1CodeableConceptTechnique used to administer medication
SNOMED CT Administration Method Codes (Example)
.... dose[x] 0..1Amount of medication per dose
..... doseQuantitySimpleQuantity
..... doseRangeRange
.... rate[x] 0..1Dose quantity per unit of time
..... rateRatioRatio
..... rateRangeRange
..... rateQuantitySimpleQuantity
.... maxDosePerPeriod 0..1RatioMaximum dose that was consumed per unit of time

doco Documentation for this format

UML Diagram (Legend)

MedicationStatement (DomainResource)External identifier - FHIR will generate its own internal identifiers (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..*]A code representing the patient or other source's judgment about the state of the medication used that this statement is about. Generally this will be active or completed (this element modifies the meaning of other elements)status : code [1..1] « A coded concept indicating the current status of a MedicationStatement. (Strength=Required)MedicationStatementStatus! »Identifies 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[x] : Type [1..1] « CodeableConcept|Reference(Medication); A coded concept identifying the substance or product being taken. (Strength=Example) SNOMED CT Medication ?? »The person or animal who is/was taking the medicationpatient : Reference [1..1] « Patient »The interval of time during which it is being asserted that the patient was taking the medication (or was not taking, when the wasNotGiven element is true)effective[x] : Type [0..1] « dateTime|Period »The person who provided the information about the taking of this medication. Note: A MedicationStatement may be derived from supportingInformation e.g claims or medicationOrderinformationSource : Reference [0..1] « Patient|Practitioner| RelatedPerson »Allows linking the MedicationStatement to the underlying MedicationOrder, or to other information that supports or is used to derive the MedicationStatementsupportingInformation : Reference [0..*] « Any »The date when the medication statement was asserted by the information sourcedateAsserted : dateTime [0..1]Set this to true if the record is saying that the medication was NOT taken (this element modifies the meaning of other elements)notTaken : boolean [0..1]A code indicating why the medication was not takenreasonNotTaken : CodeableConcept [0..*]A reason for why the medication is being/was takenreasonForUseCode : CodeableConcept [0..*] « A coded concept identifying why the medication is being taken. (Strength=Example) Condition/Problem/Diagnosis ?? »Condition that supports why the medication is being/was takenreasonForUseReference : Reference [0..*] « Condition »Provides extra information about the medication statement that is not conveyed by the other attributesnote : Annotation [0..*]Indicates where type of medication statement and where the medication is expected to be consumed or administeredcategory : code [0..1] « A coded concept identifying where the medication included in the is expected to be consumed or administered (Strength=Example)MedicationStatementCategory?? »DosageFree text dosage information as reported about a patient's medication use. When coded dosage information is present, the free text may still be present for display to humanstext : string [0..1]Additional instructions such as "Swallow with plenty of water" which may or may not be codedadditionalInstructions : CodeableConcept [0..*] « A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery". (Strength=Example)SNOMED CT Additional Dosage I...?? »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". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time periodtiming : Timing [0..1]Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept). Specifically if 'boolean' datatype is selected, then the following logic applies: If set to True, this indicates that the medication is only taken when needed, within the specified scheduleasNeeded[x] : Type [0..1] « boolean|CodeableConcept; 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. (Strength=Example)SNOMED CT Medication As Neede...?? »A coded specification of or a reference to the anatomic site where the medication first enters the bodysite[x] : Type [0..1] « CodeableConcept|Reference(BodySite); A coded concept describing the site location the medicine enters into or onto the body. (Strength=Example)SNOMED CT Anatomical Structur...?? »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. (Strength=Example)SNOMED CT Route ?? »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. For example, Slow Push, Deep IVmethod : CodeableConcept [0..1] « A coded concept describing the technique by which the medicine is administered. (Strength=Example)SNOMED CT Administration Meth...?? »The amount of therapeutic or other substance given at one administration eventdose[x] : Type [0..1] « Quantity(SimpleQuantity)|Range »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. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time periodrate[x] : Type [0..1] « Ratio|Range|Quantity(SimpleQuantity) »The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hoursmaxDosePerPeriod : Ratio [0..1]Indicates how the medication is/was used by the patientdosage[0..*]

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>
 <status value="[code]"/><!-- 1..1 active | completed | entered-in-error | intended | stopped | on-hold -->
 <medication[x]><!-- 1..1 CodeableConcept|Reference(Medication) What medication was taken --></medication[x]>
 <patient><!-- 1..1 Reference(Patient) Who is/was taking  the medication --></patient>
 <effective[x]><!-- 0..1 dateTime|Period Over what period was medication consumed? --></effective[x]>
 <informationSource><!-- 0..1 Reference(Patient|Practitioner|RelatedPerson) Person who provided the information about the taking of this medication --></informationSource>
 <supportingInformation><!-- 0..* Reference(Any) Additional supporting information --></supportingInformation>
 <dateAsserted value="[dateTime]"/><!-- 0..1 When the statement was asserted? -->
 <notTaken value="[boolean]"/><!-- 0..1 True if medication is/was not being taken -->
 <reasonNotTaken><!-- ?? 0..* CodeableConcept True if asserting medication was not given --></reasonNotTaken>
 <reasonForUseCode><!-- 0..* CodeableConcept Reason for why the medication is being/was taken --></reasonForUseCode>
 <reasonForUseReference><!-- 0..* Reference(Condition) Condition that supports why the medication is being/was taken --></reasonForUseReference>
 <note><!-- 0..* Annotation Further information about the statement --></note>
 <category value="[code]"/><!-- 0..1 Type of medication usage -->
 <dosage>  <!-- 0..* Details of how medication was taken -->
  <text value="[string]"/><!-- 0..1 Free text dosage instructions as reported by the information source -->
  <additionalInstructions><!-- 0..* CodeableConcept Supplemental instructions - e.g. "with meals" --></additionalInstructions>
  <timing><!-- 0..1 Timing When/how often was medication taken --></timing>
  <asNeeded[x]><!-- 0..1 boolean|CodeableConcept Take "as needed" (for x) --></asNeeded[x]>
  <site[x]><!-- 0..1 CodeableConcept|Reference(BodySite) Where (on body) medication is/was administered --></site[x]>
  <route><!-- 0..1 CodeableConcept How the medication entered the body --></route>
  <method><!-- 0..1 CodeableConcept Technique used to administer medication --></method>
  <dose[x]><!-- 0..1 Quantity(SimpleQuantity)|Range Amount of medication per dose --></dose[x]>
  <rate[x]><!-- 0..1 Ratio|Range|Quantity(SimpleQuantity) 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

{doco
  "resourceType" : "MedicationStatement",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External identifier
  "status" : "<code>", // R!  active | completed | entered-in-error | intended | stopped | on-hold
  // medication[x]: What medication was taken. One of these 2:
  "medicationCodeableConcept" : { CodeableConcept },
  "medicationReference" : { Reference(Medication) },
  "patient" : { Reference(Patient) }, // R!  Who is/was taking  the medication
  // effective[x]: Over what period was medication consumed?. One of these 2:
  "effectiveDateTime" : "<dateTime>",
  "effectivePeriod" : { Period },
  "informationSource" : { Reference(Patient|Practitioner|RelatedPerson) }, // Person who provided the information about the taking of this medication
  "supportingInformation" : [{ Reference(Any) }], // Additional supporting information
  "dateAsserted" : "<dateTime>", // When the statement was asserted?
  "notTaken" : <boolean>, // True if medication is/was not being taken
  "reasonNotTaken" : [{ CodeableConcept }], // C? True if asserting medication was not given
  "reasonForUseCode" : [{ CodeableConcept }], // Reason for why the medication is being/was taken
  "reasonForUseReference" : [{ Reference(Condition) }], // Condition that supports why the medication is being/was taken
  "note" : [{ Annotation }], // Further information about the statement
  "category" : "<code>", // Type of medication usage
  "dosage" : [{ // Details of how medication was taken
    "text" : "<string>", // Free text dosage instructions as reported by the information source
    "additionalInstructions" : [{ CodeableConcept }], // Supplemental instructions - e.g. "with meals"
    "timing" : { Timing }, // When/how often was medication taken
    // asNeeded[x]: Take "as needed" (for x). One of these 2:
    "asNeededBoolean" : <boolean>,
    "asNeededCodeableConcept" : { CodeableConcept },
    // site[x]: Where (on body) medication is/was administered. One of these 2:
    "siteCodeableConcept" : { CodeableConcept },
    "siteReference" : { Reference(BodySite) },
    "route" : { CodeableConcept }, // How the medication entered the body
    "method" : { CodeableConcept }, // Technique used to administer medication
    // dose[x]: Amount of medication per dose. One of these 2:
    "doseQuantity" : { Quantity(SimpleQuantity) },
    "doseRange" : { Range },
    // rate[x]: Dose quantity per unit of time. One of these 3:
    "rateRatio" : { Ratio },
    "rateRange" : { Range },
    "rateQuantity" : { Quantity(SimpleQuantity) },
    "maxDosePerPeriod" : { Ratio } // Maximum dose that was consumed per unit of time
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:MedicationStatement;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:MedicationStatement.identifier [ Identifier ], ... ; # 0..* External identifier
  fhir:MedicationStatement.status [ code ]; # 1..1 active | completed | entered-in-error | intended | stopped | on-hold
  # MedicationStatement.medication[x] : 1..1 What medication was taken. One of these 2
    fhir:MedicationStatement.medicationCodeableConcept [ CodeableConcept ]
    fhir:MedicationStatement.medicationReference [ Reference(Medication) ]
  fhir:MedicationStatement.patient [ Reference(Patient) ]; # 1..1 Who is/was taking  the medication
  # MedicationStatement.effective[x] : 0..1 Over what period was medication consumed?. One of these 2
    fhir:MedicationStatement.effectiveDateTime [ dateTime ]
    fhir:MedicationStatement.effectivePeriod [ Period ]
  fhir:MedicationStatement.informationSource [ Reference(Patient|Practitioner|RelatedPerson) ]; # 0..1 Person who provided the information about the taking of this medication
  fhir:MedicationStatement.supportingInformation [ Reference(Any) ], ... ; # 0..* Additional supporting information
  fhir:MedicationStatement.dateAsserted [ dateTime ]; # 0..1 When the statement was asserted?
  fhir:MedicationStatement.notTaken [ boolean ]; # 0..1 True if medication is/was not being taken
  fhir:MedicationStatement.reasonNotTaken [ CodeableConcept ], ... ; # 0..* True if asserting medication was not given
  fhir:MedicationStatement.reasonForUseCode [ CodeableConcept ], ... ; # 0..* Reason for why the medication is being/was taken
  fhir:MedicationStatement.reasonForUseReference [ Reference(Condition) ], ... ; # 0..* Condition that supports why the medication is being/was taken
  fhir:MedicationStatement.note [ Annotation ], ... ; # 0..* Further information about the statement
  fhir:MedicationStatement.category [ code ]; # 0..1 Type of medication usage
  fhir:MedicationStatement.dosage [ # 0..* Details of how medication was taken
    fhir:MedicationStatement.dosage.text [ string ]; # 0..1 Free text dosage instructions as reported by the information source
    fhir:MedicationStatement.dosage.additionalInstructions [ CodeableConcept ], ... ; # 0..* Supplemental instructions - e.g. "with meals"
    fhir:MedicationStatement.dosage.timing [ Timing ]; # 0..1 When/how often was medication taken
    # MedicationStatement.dosage.asNeeded[x] : 0..1 Take "as needed" (for x). One of these 2
      fhir:MedicationStatement.dosage.asNeededBoolean [ boolean ]
      fhir:MedicationStatement.dosage.asNeededCodeableConcept [ CodeableConcept ]
    # MedicationStatement.dosage.site[x] : 0..1 Where (on body) medication is/was administered. One of these 2
      fhir:MedicationStatement.dosage.siteCodeableConcept [ CodeableConcept ]
      fhir:MedicationStatement.dosage.siteReference [ Reference(BodySite) ]
    fhir:MedicationStatement.dosage.route [ CodeableConcept ]; # 0..1 How the medication entered the body
    fhir:MedicationStatement.dosage.method [ CodeableConcept ]; # 0..1 Technique used to administer medication
    # MedicationStatement.dosage.dose[x] : 0..1 Amount of medication per dose. One of these 2
      fhir:MedicationStatement.dosage.doseSimpleQuantity [ Quantity(SimpleQuantity) ]
      fhir:MedicationStatement.dosage.doseRange [ Range ]
    # MedicationStatement.dosage.rate[x] : 0..1 Dose quantity per unit of time. One of these 3
      fhir:MedicationStatement.dosage.rateRatio [ Ratio ]
      fhir:MedicationStatement.dosage.rateRange [ Range ]
      fhir:MedicationStatement.dosage.rateSimpleQuantity [ Quantity(SimpleQuantity) ]
    fhir:MedicationStatement.dosage.maxDosePerPeriod [ Ratio ]; # 0..1 Maximum dose that was consumed per unit of time
  ], ...;
]

Changes since DSTU2

MedicationStatement
MedicationStatement.notTaken Renamed from wasNotTaken to notTaken
MedicationStatement.reasonForUseCode added
MedicationStatement.reasonForUseReference added
MedicationStatement.note Max Cardinality changed from 1 to *
Type changed from string to Annotation
MedicationStatement.category added
MedicationStatement.dosage.additionalInstructions added
MedicationStatement.dosage.dose[x] added
MedicationStatement.dosage.rate[x] Add Quantity{http://hl7.org/fhir/StructureDefinition/SimpleQuantity}
MedicationStatement.reasonForUse[x] deleted
MedicationStatement.dosage.quantity[x] deleted

See the Full Difference for further information

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationStatement IDomainResourceRecord of medication being taken by a patient
Reason for use reference is only permitted if notTaken is false
Reason not taken is only permitted if notTaken is true
Reason for use code is only permitted if notTaken is false
... identifier 0..*IdentifierExternal identifier
... status ?!Σ1..1codeactive | completed | entered-in-error | intended | stopped | on-hold
MedicationStatementStatus (Required)
... medication[x] Σ1..1What medication was taken
SNOMED CT Medication Codes (Example)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(Medication)
... patient Σ1..1Reference(Patient)Who is/was taking the medication
... effective[x] Σ0..1Over what period was medication consumed?
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
... informationSource 0..1Reference(Patient | Practitioner | RelatedPerson)Person who provided the information about the taking of this medication
... supportingInformation 0..*Reference(Any)Additional supporting information
... dateAsserted Σ0..1dateTimeWhen the statement was asserted?
... notTaken ?!Σ0..1booleanTrue if medication is/was not being taken
... reasonNotTaken I0..*CodeableConceptTrue if asserting medication was not given
... reasonForUseCode 0..*CodeableConceptReason for why the medication is being/was taken
Condition/Problem/Diagnosis Codes (Example)
... reasonForUseReference 0..*Reference(Condition)Condition that supports why the medication is being/was taken
... note 0..*AnnotationFurther information about the statement
... category 0..1codeType of medication usage
MedicationStatementCategory (Example)
... dosage 0..*BackboneElementDetails of how medication was taken
.... text 0..1stringFree text dosage instructions as reported by the information source
.... additionalInstructions 0..*CodeableConceptSupplemental instructions - e.g. "with meals"
SNOMED CT Additional Dosage Instructions (Example)
.... timing 0..1TimingWhen/how often was medication taken
.... asNeeded[x] 0..1Take "as needed" (for x)
SNOMED CT Medication As Needed Reason Codes (Example)
..... asNeededBooleanboolean
..... asNeededCodeableConceptCodeableConcept
.... site[x] 0..1Where (on body) medication is/was administered
SNOMED CT Anatomical Structure for Administration Site Codes (Example)
..... siteCodeableConceptCodeableConcept
..... siteReferenceReference(BodySite)
.... route 0..1CodeableConceptHow the medication entered the body
SNOMED CT Route Codes (Example)
.... method 0..1CodeableConceptTechnique used to administer medication
SNOMED CT Administration Method Codes (Example)
.... dose[x] 0..1Amount of medication per dose
..... doseQuantitySimpleQuantity
..... doseRangeRange
.... rate[x] 0..1Dose quantity per unit of time
..... rateRatioRatio
..... rateRangeRange
..... rateQuantitySimpleQuantity
.... maxDosePerPeriod 0..1RatioMaximum dose that was consumed per unit of time

doco Documentation for this format

UML Diagram (Legend)

MedicationStatement (DomainResource)External identifier - FHIR will generate its own internal identifiers (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..*]A code representing the patient or other source's judgment about the state of the medication used that this statement is about. Generally this will be active or completed (this element modifies the meaning of other elements)status : code [1..1] « A coded concept indicating the current status of a MedicationStatement. (Strength=Required)MedicationStatementStatus! »Identifies 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[x] : Type [1..1] « CodeableConcept|Reference(Medication); A coded concept identifying the substance or product being taken. (Strength=Example) SNOMED CT Medication ?? »The person or animal who is/was taking the medicationpatient : Reference [1..1] « Patient »The interval of time during which it is being asserted that the patient was taking the medication (or was not taking, when the wasNotGiven element is true)effective[x] : Type [0..1] « dateTime|Period »The person who provided the information about the taking of this medication. Note: A MedicationStatement may be derived from supportingInformation e.g claims or medicationOrderinformationSource : Reference [0..1] « Patient|Practitioner| RelatedPerson »Allows linking the MedicationStatement to the underlying MedicationOrder, or to other information that supports or is used to derive the MedicationStatementsupportingInformation : Reference [0..*] « Any »The date when the medication statement was asserted by the information sourcedateAsserted : dateTime [0..1]Set this to true if the record is saying that the medication was NOT taken (this element modifies the meaning of other elements)notTaken : boolean [0..1]A code indicating why the medication was not takenreasonNotTaken : CodeableConcept [0..*]A reason for why the medication is being/was takenreasonForUseCode : CodeableConcept [0..*] « A coded concept identifying why the medication is being taken. (Strength=Example) Condition/Problem/Diagnosis ?? »Condition that supports why the medication is being/was takenreasonForUseReference : Reference [0..*] « Condition »Provides extra information about the medication statement that is not conveyed by the other attributesnote : Annotation [0..*]Indicates where type of medication statement and where the medication is expected to be consumed or administeredcategory : code [0..1] « A coded concept identifying where the medication included in the is expected to be consumed or administered (Strength=Example)MedicationStatementCategory?? »DosageFree text dosage information as reported about a patient's medication use. When coded dosage information is present, the free text may still be present for display to humanstext : string [0..1]Additional instructions such as "Swallow with plenty of water" which may or may not be codedadditionalInstructions : CodeableConcept [0..*] « A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery". (Strength=Example)SNOMED CT Additional Dosage I...?? »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". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time periodtiming : Timing [0..1]Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept). Specifically if 'boolean' datatype is selected, then the following logic applies: If set to True, this indicates that the medication is only taken when needed, within the specified scheduleasNeeded[x] : Type [0..1] « boolean|CodeableConcept; 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. (Strength=Example)SNOMED CT Medication As Neede...?? »A coded specification of or a reference to the anatomic site where the medication first enters the bodysite[x] : Type [0..1] « CodeableConcept|Reference(BodySite); A coded concept describing the site location the medicine enters into or onto the body. (Strength=Example)SNOMED CT Anatomical Structur...?? »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. (Strength=Example)SNOMED CT Route ?? »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. For example, Slow Push, Deep IVmethod : CodeableConcept [0..1] « A coded concept describing the technique by which the medicine is administered. (Strength=Example)SNOMED CT Administration Meth...?? »The amount of therapeutic or other substance given at one administration eventdose[x] : Type [0..1] « Quantity(SimpleQuantity)|Range »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. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time periodrate[x] : Type [0..1] « Ratio|Range|Quantity(SimpleQuantity) »The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hoursmaxDosePerPeriod : Ratio [0..1]Indicates how the medication is/was used by the patientdosage[0..*]

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>
 <status value="[code]"/><!-- 1..1 active | completed | entered-in-error | intended | stopped | on-hold -->
 <medication[x]><!-- 1..1 CodeableConcept|Reference(Medication) What medication was taken --></medication[x]>
 <patient><!-- 1..1 Reference(Patient) Who is/was taking  the medication --></patient>
 <effective[x]><!-- 0..1 dateTime|Period Over what period was medication consumed? --></effective[x]>
 <informationSource><!-- 0..1 Reference(Patient|Practitioner|RelatedPerson) Person who provided the information about the taking of this medication --></informationSource>
 <supportingInformation><!-- 0..* Reference(Any) Additional supporting information --></supportingInformation>
 <dateAsserted value="[dateTime]"/><!-- 0..1 When the statement was asserted? -->
 <notTaken value="[boolean]"/><!-- 0..1 True if medication is/was not being taken -->
 <reasonNotTaken><!-- ?? 0..* CodeableConcept True if asserting medication was not given --></reasonNotTaken>
 <reasonForUseCode><!-- 0..* CodeableConcept Reason for why the medication is being/was taken --></reasonForUseCode>
 <reasonForUseReference><!-- 0..* Reference(Condition) Condition that supports why the medication is being/was taken --></reasonForUseReference>
 <note><!-- 0..* Annotation Further information about the statement --></note>
 <category value="[code]"/><!-- 0..1 Type of medication usage -->
 <dosage>  <!-- 0..* Details of how medication was taken -->
  <text value="[string]"/><!-- 0..1 Free text dosage instructions as reported by the information source -->
  <additionalInstructions><!-- 0..* CodeableConcept Supplemental instructions - e.g. "with meals" --></additionalInstructions>
  <timing><!-- 0..1 Timing When/how often was medication taken --></timing>
  <asNeeded[x]><!-- 0..1 boolean|CodeableConcept Take "as needed" (for x) --></asNeeded[x]>
  <site[x]><!-- 0..1 CodeableConcept|Reference(BodySite) Where (on body) medication is/was administered --></site[x]>
  <route><!-- 0..1 CodeableConcept How the medication entered the body --></route>
  <method><!-- 0..1 CodeableConcept Technique used to administer medication --></method>
  <dose[x]><!-- 0..1 Quantity(SimpleQuantity)|Range Amount of medication per dose --></dose[x]>
  <rate[x]><!-- 0..1 Ratio|Range|Quantity(SimpleQuantity) 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

{doco
  "resourceType" : "MedicationStatement",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External identifier
  "status" : "<code>", // R!  active | completed | entered-in-error | intended | stopped | on-hold
  // medication[x]: What medication was taken. One of these 2:
  "medicationCodeableConcept" : { CodeableConcept },
  "medicationReference" : { Reference(Medication) },
  "patient" : { Reference(Patient) }, // R!  Who is/was taking  the medication
  // effective[x]: Over what period was medication consumed?. One of these 2:
  "effectiveDateTime" : "<dateTime>",
  "effectivePeriod" : { Period },
  "informationSource" : { Reference(Patient|Practitioner|RelatedPerson) }, // Person who provided the information about the taking of this medication
  "supportingInformation" : [{ Reference(Any) }], // Additional supporting information
  "dateAsserted" : "<dateTime>", // When the statement was asserted?
  "notTaken" : <boolean>, // True if medication is/was not being taken
  "reasonNotTaken" : [{ CodeableConcept }], // C? True if asserting medication was not given
  "reasonForUseCode" : [{ CodeableConcept }], // Reason for why the medication is being/was taken
  "reasonForUseReference" : [{ Reference(Condition) }], // Condition that supports why the medication is being/was taken
  "note" : [{ Annotation }], // Further information about the statement
  "category" : "<code>", // Type of medication usage
  "dosage" : [{ // Details of how medication was taken
    "text" : "<string>", // Free text dosage instructions as reported by the information source
    "additionalInstructions" : [{ CodeableConcept }], // Supplemental instructions - e.g. "with meals"
    "timing" : { Timing }, // When/how often was medication taken
    // asNeeded[x]: Take "as needed" (for x). One of these 2:
    "asNeededBoolean" : <boolean>,
    "asNeededCodeableConcept" : { CodeableConcept },
    // site[x]: Where (on body) medication is/was administered. One of these 2:
    "siteCodeableConcept" : { CodeableConcept },
    "siteReference" : { Reference(BodySite) },
    "route" : { CodeableConcept }, // How the medication entered the body
    "method" : { CodeableConcept }, // Technique used to administer medication
    // dose[x]: Amount of medication per dose. One of these 2:
    "doseQuantity" : { Quantity(SimpleQuantity) },
    "doseRange" : { Range },
    // rate[x]: Dose quantity per unit of time. One of these 3:
    "rateRatio" : { Ratio },
    "rateRange" : { Range },
    "rateQuantity" : { Quantity(SimpleQuantity) },
    "maxDosePerPeriod" : { Ratio } // Maximum dose that was consumed per unit of time
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:MedicationStatement;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:MedicationStatement.identifier [ Identifier ], ... ; # 0..* External identifier
  fhir:MedicationStatement.status [ code ]; # 1..1 active | completed | entered-in-error | intended | stopped | on-hold
  # MedicationStatement.medication[x] : 1..1 What medication was taken. One of these 2
    fhir:MedicationStatement.medicationCodeableConcept [ CodeableConcept ]
    fhir:MedicationStatement.medicationReference [ Reference(Medication) ]
  fhir:MedicationStatement.patient [ Reference(Patient) ]; # 1..1 Who is/was taking  the medication
  # MedicationStatement.effective[x] : 0..1 Over what period was medication consumed?. One of these 2
    fhir:MedicationStatement.effectiveDateTime [ dateTime ]
    fhir:MedicationStatement.effectivePeriod [ Period ]
  fhir:MedicationStatement.informationSource [ Reference(Patient|Practitioner|RelatedPerson) ]; # 0..1 Person who provided the information about the taking of this medication
  fhir:MedicationStatement.supportingInformation [ Reference(Any) ], ... ; # 0..* Additional supporting information
  fhir:MedicationStatement.dateAsserted [ dateTime ]; # 0..1 When the statement was asserted?
  fhir:MedicationStatement.notTaken [ boolean ]; # 0..1 True if medication is/was not being taken
  fhir:MedicationStatement.reasonNotTaken [ CodeableConcept ], ... ; # 0..* True if asserting medication was not given
  fhir:MedicationStatement.reasonForUseCode [ CodeableConcept ], ... ; # 0..* Reason for why the medication is being/was taken
  fhir:MedicationStatement.reasonForUseReference [ Reference(Condition) ], ... ; # 0..* Condition that supports why the medication is being/was taken
  fhir:MedicationStatement.note [ Annotation ], ... ; # 0..* Further information about the statement
  fhir:MedicationStatement.category [ code ]; # 0..1 Type of medication usage
  fhir:MedicationStatement.dosage [ # 0..* Details of how medication was taken
    fhir:MedicationStatement.dosage.text [ string ]; # 0..1 Free text dosage instructions as reported by the information source
    fhir:MedicationStatement.dosage.additionalInstructions [ CodeableConcept ], ... ; # 0..* Supplemental instructions - e.g. "with meals"
    fhir:MedicationStatement.dosage.timing [ Timing ]; # 0..1 When/how often was medication taken
    # MedicationStatement.dosage.asNeeded[x] : 0..1 Take "as needed" (for x). One of these 2
      fhir:MedicationStatement.dosage.asNeededBoolean [ boolean ]
      fhir:MedicationStatement.dosage.asNeededCodeableConcept [ CodeableConcept ]
    # MedicationStatement.dosage.site[x] : 0..1 Where (on body) medication is/was administered. One of these 2
      fhir:MedicationStatement.dosage.siteCodeableConcept [ CodeableConcept ]
      fhir:MedicationStatement.dosage.siteReference [ Reference(BodySite) ]
    fhir:MedicationStatement.dosage.route [ CodeableConcept ]; # 0..1 How the medication entered the body
    fhir:MedicationStatement.dosage.method [ CodeableConcept ]; # 0..1 Technique used to administer medication
    # MedicationStatement.dosage.dose[x] : 0..1 Amount of medication per dose. One of these 2
      fhir:MedicationStatement.dosage.doseSimpleQuantity [ Quantity(SimpleQuantity) ]
      fhir:MedicationStatement.dosage.doseRange [ Range ]
    # MedicationStatement.dosage.rate[x] : 0..1 Dose quantity per unit of time. One of these 3
      fhir:MedicationStatement.dosage.rateRatio [ Ratio ]
      fhir:MedicationStatement.dosage.rateRange [ Range ]
      fhir:MedicationStatement.dosage.rateSimpleQuantity [ Quantity(SimpleQuantity) ]
    fhir:MedicationStatement.dosage.maxDosePerPeriod [ Ratio ]; # 0..1 Maximum dose that was consumed per unit of time
  ], ...;
]

Changes since DSTU2

MedicationStatement
MedicationStatement.notTaken Renamed from wasNotTaken to notTaken
MedicationStatement.reasonForUseCode added
MedicationStatement.reasonForUseReference added
MedicationStatement.note Max Cardinality changed from 1 to *
Type changed from string to Annotation
MedicationStatement.category added
MedicationStatement.dosage.additionalInstructions added
MedicationStatement.dosage.dose[x] added
MedicationStatement.dosage.rate[x] Add Quantity{http://hl7.org/fhir/StructureDefinition/SimpleQuantity}
MedicationStatement.reasonForUse[x] deleted
MedicationStatement.dosage.quantity[x] deleted

See the Full Difference for further information

 

Alternate definitions: Master Definition (XML, JSON), XML Schema/Schematron (for ) + JSON Schema, ShEx (for Turtle)

11.5.3.1 Terminology Bindings

PathDefinitionTypeReference
MedicationStatement.status A coded concept indicating the current status of a MedicationStatement.RequiredMedicationStatementStatus
MedicationStatement.medication[x] A coded concept identifying the substance or product being taken.ExampleSNOMED CT Medication Codes
MedicationStatement.reasonNotTaken A coded concept indicating the reason why the MedicationStatement is negated.UnknownNo details provided yet
MedicationStatement.reasonForUseCode A coded concept identifying why the medication is being taken.ExampleCondition/Problem/Diagnosis Codes
MedicationStatement.category A coded concept identifying where the medication included in the is expected to be consumed or administeredExampleMedicationStatementCategory
MedicationStatement.dosage.additionalInstructions A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".ExampleSNOMED CT Additional Dosage Instructions
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.ExampleSNOMED CT Medication As Needed Reason Codes
MedicationStatement.dosage.site[x] A coded concept describing the site location the medicine enters into or onto the body.ExampleSNOMED 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.ExampleSNOMED CT Route Codes
MedicationStatement.dosage.method A coded concept describing the technique by which the medicine is administered.ExampleSNOMED CT Administration Method Codes

11.5.3.2 Constraints

  • mst-1: Reason not taken is only permitted if notTaken is true (expression : reasonNotTaken.empty() or notTaken = true)
  • mst-2: Reason for use code is only permitted if notTaken is false (expression : reasonForUseCode.empty() or notTaken = false)
  • mst-3: Reason for use reference is only permitted if notTaken is false (expression : reasonForUseReference.empty() or notTaken = false)

11.5.4 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
codetokenReturn statements of this medication codeMedicationStatement.medicationCodeableConcept
effectivedateDate when patient was taking (or not taking) the medicationMedicationStatement.effective[x]
identifiertokenReturn statements with this external identifierMedicationStatement.identifier
medicationreferenceReturn statements of this medication referenceMedicationStatement.medicationReference
(Medication)
patientreferenceThe identity of a patient to list statements forMedicationStatement.patient
(Patient)
sourcereferenceWho the information in the statement came fromMedicationStatement.informationSource
(Practitioner, Patient, RelatedPerson)
statustokenReturn statements that match the given statusMedicationStatement.status