R4 Ballot #1 (Mixed Normative/Trial use)

This page is part of the FHIR Specification (v3.3.0: R4 Ballot 2). 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

11.2 Resource MedicationAdministration - Content

Pharmacy Work GroupMaturity Level: 2 Trial Use Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson

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.

11.2.1 Scope and Usage

This resource covers the administration of all medications and vaccines. Please refer to the Immunization Resource/Profile for the treatment of vaccines. It will principally be used within care settings (including inpatient) to record the capture of medication administrations, including self-administrations of oral medications, injections, intra-venous adjustments, etc. It can also be used in outpatient settings to record allergy shots and other non-immunization administrations. In some cases it might be used for home-health reporting, such as recording self-administered or even device-administered insulin.

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

11.2.2 Boundaries and Relationships

The Medication domain includes a number of related resources

MedicationRequest 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.

MedicationAdministration is intended for tracking the administration of non-vaccine medications. Administration of vaccines is intended to be handled using the Immunization resource. Some systems treat immunizations in the same way as any other medication administration. Such systems SHOULD use an immunization resource to represent these. If systems need to use a MedicationAdministration resource to capture vaccinations for workflow or other reasons, they SHOULD also create and expose an equivalent Immunization instance.

This resource is referenced by AdverseEvent, ChargeItem, MedicationStatement, Observation and Procedure

11.2.3 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationAdministration TUDomainResourceAdministration of medication to a patient
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierExternal identifier
... instantiates Σ0..*uriInstantiates protocol or definition
... partOf Σ0..*Reference(MedicationAdministration | Procedure)Part of referenced event
... status ?!Σ1..1codein-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown
MedicationAdministrationStatus (Required)
... category 0..1CodeableConceptType of medication usage
MedicationAdministrationCategory (Preferred)
... medication[x] Σ1..1What was administered
SNOMED CT Medication Codes (Example)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(Medication)
... subject Σ1..1Reference(Patient | Group)Who received medication
... context 0..1Reference(Encounter | EpisodeOfCare)Encounter or Episode of Care administered as part of
... supportingInformation 0..*Reference(Any)Additional information to support administration
... effective[x] Σ1..1Start and end time of administration
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
... performer Σ0..*BackboneElementWho performed the medication administration and what they did
.... function 0..1CodeableConceptType of performance
MedicationAdministrationPerformerFunction (Example)
.... actor Σ1..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson | Device)Who performed the medication administration
... statusReason 0..*CodeableConceptReason administration not performed
SNOMED CT Reason Medication Not Given Codes (Example)
... reasonCode 0..*CodeableConceptReason administration performed
Reason Medication Given Codes (Example)
... reasonReference 0..*Reference(Condition | Observation | DiagnosticReport)Condition or observation that supports why the medication was administered
... request 0..1Reference(MedicationRequest)Request administration performed against
... device 0..*Reference(Device)Device used to administer
... note 0..*AnnotationInformation about the administration
... dosage I0..1BackboneElementDetails of how medication was taken
+ SHALL have at least one of dosage.dose or dosage.rate[x]
.... text 0..1stringFree text dosage instructions e.g. SIG
.... site 0..1CodeableConceptBody site administered to
SNOMED CT Anatomical Structure for Administration Site Codes (Example)
.... route 0..1CodeableConceptPath of substance into body
SNOMED CT Route Codes (Example)
.... method 0..1CodeableConceptHow drug was administered
SNOMED CT Administration Method Codes (Example)
.... dose 0..1SimpleQuantityAmount of medication per dose
.... rate[x] 0..1Dose quantity per unit of time
..... rateRatioRatio
..... rateQuantitySimpleQuantity
... eventHistory 0..*Reference(Provenance)A list of events of interest in the lifecycle

doco Documentation for this format

UML Diagram (Legend)

MedicationAdministration (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. This identifier is particularly important when these records require updatesidentifier : Identifier [0..*]A protocol, guideline, orderset, or other definition that was adhered to in whole or in part by this eventinstantiates : uri [0..*]A larger event of which this particular event is a component or steppartOf : Reference [0..*] « MedicationAdministration|Procedure »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 (this element modifies the meaning of other elements)status : code [1..1] « A set of codes indicating the current status of a MedicationAdministration. (Strength=Required)MedicationAdministrationStatus! »Indicates the type of medication administration and where the medication is expected to be consumed or administeredcategory : CodeableConcept [0..1] « A coded concept describing where the medication administered is expected to occur (Strength=Preferred)MedicationAdministrationCateg...? »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 medicationsmedication[x] : Type [1..1] « CodeableConcept|Reference(Medication); Codes identifying substance or product that can be administered. (Strength=Example) SNOMED CT Medication ?? »The person or animal or group receiving the medicationsubject : Reference [1..1] « Patient|Group »The visit, admission, or other contact between patient and health care provider during which the medication administration was performedcontext : Reference [0..1] « Encounter|EpisodeOfCare »Additional information (for example, patient height and weight) that supports the administration of the medicationsupportingInformation : Reference [0..*] « Any »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 appropriateeffective[x] : Type [1..1] « dateTime|Period »A code indicating why the administration was not performedstatusReason : CodeableConcept [0..*] « A set of codes indicating the reason why the MedicationAdministration is negated. (Strength=Example)SNOMED CT Reason Medication N...?? »A code indicating why the medication was givenreasonCode : CodeableConcept [0..*] « A set of codes indicating the reason why the MedicationAdministration was made. (Strength=Example)Reason Medication Given ?? »Condition or observation that supports why the medication was administeredreasonReference : Reference [0..*] « Condition|Observation| DiagnosticReport »The original request, instruction or authority to perform the administrationrequest : Reference [0..1] « MedicationRequest »The device used in administering the medication to the patient. For example, a particular infusion pumpdevice : Reference [0..*] « Device »Extra information about the medication administration that is not conveyed by the other attributesnote : Annotation [0..*]A summary of the events of interest that have occurred, such as when the administration was verifiedeventHistory : Reference [0..*] « Provenance »PerformerDistinguishes the type of involvement of the performer in the medication administrationfunction : CodeableConcept [0..1] « A code describing the role an individual played in administering the medication (Strength=Example)MedicationAdministrationPerfo...?? »Indicates who or what performed the medication administrationactor : Reference [1..1] « Practitioner|PractitionerRole|Patient| RelatedPerson|Device »DosageFree text dosage can be used for cases where the dosage administered is too complex to code. When coded dosage is present, the free text dosage may still be present for display to humans. The dosage instructions should reflect the dosage of the medication that was administeredtext : string [0..1]A coded specification of the anatomic site where the medication first entered the body. For example, "left arm"site : CodeableConcept [0..1] « 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 the patient. For example, topical, intravenous, etcroute : 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 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 injectiondose : Quantity(SimpleQuantity) [0..1]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 hoursrate[x] : Type [0..1] « Ratio|Quantity(SimpleQuantity) »Indicates who or what performed the medication administration and how they were involvedperformer[0..*]Describes the medication dosage information details e.g. dose, rate, site, route, etcdosage[0..1]

XML Template

<MedicationAdministration 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>
 <instantiates value="[uri]"/><!-- 0..* Instantiates protocol or definition -->
 <partOf><!-- 0..* Reference(MedicationAdministration|Procedure) Part of referenced event --></partOf>
 <status value="[code]"/><!-- 1..1 in-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown -->
 <category><!-- 0..1 CodeableConcept Type of medication usage --></category>
 <medication[x]><!-- 1..1 CodeableConcept|Reference(Medication) What was administered --></medication[x]>
 <subject><!-- 1..1 Reference(Patient|Group) Who received medication --></subject>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Encounter or Episode of Care administered as part of --></context>
 <supportingInformation><!-- 0..* Reference(Any) Additional information to support administration --></supportingInformation>
 <effective[x]><!-- 1..1 dateTime|Period Start and end time of administration --></effective[x]>
 <performer>  <!-- 0..* Who performed the medication administration and what they did -->
  <function><!-- 0..1 CodeableConcept Type of performance --></function>
  <actor><!-- 1..1 Reference(Practitioner|PractitionerRole|Patient|RelatedPerson|
    Device) Who performed the medication administration --></actor>
 </performer>
 <statusReason><!-- 0..* CodeableConcept Reason administration not performed --></statusReason>
 <reasonCode><!-- 0..* CodeableConcept Reason administration performed --></reasonCode>
 <reasonReference><!-- 0..* Reference(Condition|Observation|DiagnosticReport) Condition or observation that supports why the medication was administered --></reasonReference>
 <request><!-- 0..1 Reference(MedicationRequest) Request administration performed against --></request>
 <device><!-- 0..* Reference(Device) Device used to administer --></device>
 <note><!-- 0..* Annotation Information about the administration --></note>
 <dosage>  <!-- 0..1 Details of how medication was taken -->
  <text value="[string]"/><!-- 0..1 Free text dosage instructions e.g. SIG -->
  <site><!-- 0..1 CodeableConcept Body site administered to --></site>
  <route><!-- 0..1 CodeableConcept Path of substance into body --></route>
  <method><!-- 0..1 CodeableConcept How drug was administered --></method>
  <dose><!-- 0..1 Quantity(SimpleQuantity) Amount of medication per dose --></dose>
  <rate[x]><!-- 0..1 Ratio|Quantity(SimpleQuantity) Dose quantity per unit of time --></rate[x]>
 </dosage>
 <eventHistory><!-- 0..* Reference(Provenance) A list of events of interest in the lifecycle --></eventHistory>
</MedicationAdministration>

JSON Template

{doco
  "resourceType" : "MedicationAdministration",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External identifier
  "instantiates" : ["<uri>"], // Instantiates protocol or definition
  "partOf" : [{ Reference(MedicationAdministration|Procedure) }], // Part of referenced event
  "status" : "<code>", // R!  in-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown
  "category" : { CodeableConcept }, // Type of medication usage
  // medication[x]: What was administered. One of these 2:
  "medicationCodeableConcept" : { CodeableConcept },
  "medicationReference" : { Reference(Medication) },
  "subject" : { Reference(Patient|Group) }, // R!  Who received medication
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Encounter or Episode of Care administered as part of
  "supportingInformation" : [{ Reference(Any) }], // Additional information to support administration
  // effective[x]: Start and end time of administration. One of these 2:
  "effectiveDateTime" : "<dateTime>",
  "effectivePeriod" : { Period },
  "performer" : [{ // Who performed the medication administration and what they did
    "function" : { CodeableConcept }, // Type of performance
    "actor" : { Reference(Practitioner|PractitionerRole|Patient|RelatedPerson|
    Device) } // R!  Who performed the medication administration
  }],
  "statusReason" : [{ CodeableConcept }], // Reason administration not performed
  "reasonCode" : [{ CodeableConcept }], // Reason administration performed
  "reasonReference" : [{ Reference(Condition|Observation|DiagnosticReport) }], // Condition or observation that supports why the medication was administered
  "request" : { Reference(MedicationRequest) }, // Request administration performed against
  "device" : [{ Reference(Device) }], // Device used to administer
  "note" : [{ Annotation }], // Information about the administration
  "dosage" : { // Details of how medication was taken
    "text" : "<string>", // Free text dosage instructions e.g. SIG
    "site" : { CodeableConcept }, // Body site administered to
    "route" : { CodeableConcept }, // Path of substance into body
    "method" : { CodeableConcept }, // How drug was administered
    "dose" : { Quantity(SimpleQuantity) }, // Amount of medication per dose
    // rate[x]: Dose quantity per unit of time. One of these 2:
    "rateRatio" : { Ratio }
    "rateQuantity" : { Quantity(SimpleQuantity) }
  },
  "eventHistory" : [{ Reference(Provenance) }] // A list of events of interest in the lifecycle
}

Turtle Template

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


[ a fhir:MedicationAdministration;
  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:MedicationAdministration.identifier [ Identifier ], ... ; # 0..* External identifier
  fhir:MedicationAdministration.instantiates [ uri ], ... ; # 0..* Instantiates protocol or definition
  fhir:MedicationAdministration.partOf [ Reference(MedicationAdministration|Procedure) ], ... ; # 0..* Part of referenced event
  fhir:MedicationAdministration.status [ code ]; # 1..1 in-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown
  fhir:MedicationAdministration.category [ CodeableConcept ]; # 0..1 Type of medication usage
  # MedicationAdministration.medication[x] : 1..1 What was administered. One of these 2
    fhir:MedicationAdministration.medicationCodeableConcept [ CodeableConcept ]
    fhir:MedicationAdministration.medicationReference [ Reference(Medication) ]
  fhir:MedicationAdministration.subject [ Reference(Patient|Group) ]; # 1..1 Who received medication
  fhir:MedicationAdministration.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Encounter or Episode of Care administered as part of
  fhir:MedicationAdministration.supportingInformation [ Reference(Any) ], ... ; # 0..* Additional information to support administration
  # MedicationAdministration.effective[x] : 1..1 Start and end time of administration. One of these 2
    fhir:MedicationAdministration.effectiveDateTime [ dateTime ]
    fhir:MedicationAdministration.effectivePeriod [ Period ]
  fhir:MedicationAdministration.performer [ # 0..* Who performed the medication administration and what they did
    fhir:MedicationAdministration.performer.function [ CodeableConcept ]; # 0..1 Type of performance
    fhir:MedicationAdministration.performer.actor [ Reference(Practitioner|PractitionerRole|Patient|RelatedPerson|Device) ]; # 1..1 Who performed the medication administration
  ], ...;
  fhir:MedicationAdministration.statusReason [ CodeableConcept ], ... ; # 0..* Reason administration not performed
  fhir:MedicationAdministration.reasonCode [ CodeableConcept ], ... ; # 0..* Reason administration performed
  fhir:MedicationAdministration.reasonReference [ Reference(Condition|Observation|DiagnosticReport) ], ... ; # 0..* Condition or observation that supports why the medication was administered
  fhir:MedicationAdministration.request [ Reference(MedicationRequest) ]; # 0..1 Request administration performed against
  fhir:MedicationAdministration.device [ Reference(Device) ], ... ; # 0..* Device used to administer
  fhir:MedicationAdministration.note [ Annotation ], ... ; # 0..* Information about the administration
  fhir:MedicationAdministration.dosage [ # 0..1 Details of how medication was taken
    fhir:MedicationAdministration.dosage.text [ string ]; # 0..1 Free text dosage instructions e.g. SIG
    fhir:MedicationAdministration.dosage.site [ CodeableConcept ]; # 0..1 Body site administered to
    fhir:MedicationAdministration.dosage.route [ CodeableConcept ]; # 0..1 Path of substance into body
    fhir:MedicationAdministration.dosage.method [ CodeableConcept ]; # 0..1 How drug was administered
    fhir:MedicationAdministration.dosage.dose [ Quantity(SimpleQuantity) ]; # 0..1 Amount of medication per dose
    # MedicationAdministration.dosage.rate[x] : 0..1 Dose quantity per unit of time. One of these 2
      fhir:MedicationAdministration.dosage.rateRatio [ Ratio ]
      fhir:MedicationAdministration.dosage.rateSimpleQuantity [ Quantity(SimpleQuantity) ]
  ];
  fhir:MedicationAdministration.eventHistory [ Reference(Provenance) ], ... ; # 0..* A list of events of interest in the lifecycle
]

Changes since R3

MedicationAdministration
MedicationAdministration.instantiates
  • Added Element
MedicationAdministration.medication[x]
  • Remove Reference(Medication), Add Reference(Medication)
MedicationAdministration.performer.function
  • Added Element
MedicationAdministration.performer.actor
  • Type changed from Reference(Practitioner|Patient|RelatedPerson|Device) to Reference(Practitioner|PractitionerRole|Patient|RelatedPerson|Device)
MedicationAdministration.statusReason
  • Added Element
MedicationAdministration.reasonReference
  • Type changed from Reference(Condition|Observation) to Reference(Condition|Observation|DiagnosticReport)
MedicationAdministration.request
  • Added Element
MedicationAdministration.dosage.rate[x]
  • Remove canonical(), Add canonical()
MedicationAdministration.definition
  • deleted
MedicationAdministration.performer.onBehalfOf
  • deleted
MedicationAdministration.notGiven
  • deleted
MedicationAdministration.reasonNotGiven
  • deleted
MedicationAdministration.prescription
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 3 tests that all execute ok. All tests pass round-trip testing and all r3 resources are valid.). Note: these have note yet been updated to be R3 to R4

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationAdministration TUDomainResourceAdministration of medication to a patient
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierExternal identifier
... instantiates Σ0..*uriInstantiates protocol or definition
... partOf Σ0..*Reference(MedicationAdministration | Procedure)Part of referenced event
... status ?!Σ1..1codein-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown
MedicationAdministrationStatus (Required)
... category 0..1CodeableConceptType of medication usage
MedicationAdministrationCategory (Preferred)
... medication[x] Σ1..1What was administered
SNOMED CT Medication Codes (Example)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(Medication)
... subject Σ1..1Reference(Patient | Group)Who received medication
... context 0..1Reference(Encounter | EpisodeOfCare)Encounter or Episode of Care administered as part of
... supportingInformation 0..*Reference(Any)Additional information to support administration
... effective[x] Σ1..1Start and end time of administration
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
... performer Σ0..*BackboneElementWho performed the medication administration and what they did
.... function 0..1CodeableConceptType of performance
MedicationAdministrationPerformerFunction (Example)
.... actor Σ1..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson | Device)Who performed the medication administration
... statusReason 0..*CodeableConceptReason administration not performed
SNOMED CT Reason Medication Not Given Codes (Example)
... reasonCode 0..*CodeableConceptReason administration performed
Reason Medication Given Codes (Example)
... reasonReference 0..*Reference(Condition | Observation | DiagnosticReport)Condition or observation that supports why the medication was administered
... request 0..1Reference(MedicationRequest)Request administration performed against
... device 0..*Reference(Device)Device used to administer
... note 0..*AnnotationInformation about the administration
... dosage I0..1BackboneElementDetails of how medication was taken
+ SHALL have at least one of dosage.dose or dosage.rate[x]
.... text 0..1stringFree text dosage instructions e.g. SIG
.... site 0..1CodeableConceptBody site administered to
SNOMED CT Anatomical Structure for Administration Site Codes (Example)
.... route 0..1CodeableConceptPath of substance into body
SNOMED CT Route Codes (Example)
.... method 0..1CodeableConceptHow drug was administered
SNOMED CT Administration Method Codes (Example)
.... dose 0..1SimpleQuantityAmount of medication per dose
.... rate[x] 0..1Dose quantity per unit of time
..... rateRatioRatio
..... rateQuantitySimpleQuantity
... eventHistory 0..*Reference(Provenance)A list of events of interest in the lifecycle

doco Documentation for this format

UML Diagram (Legend)

MedicationAdministration (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. This identifier is particularly important when these records require updatesidentifier : Identifier [0..*]A protocol, guideline, orderset, or other definition that was adhered to in whole or in part by this eventinstantiates : uri [0..*]A larger event of which this particular event is a component or steppartOf : Reference [0..*] « MedicationAdministration|Procedure »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 (this element modifies the meaning of other elements)status : code [1..1] « A set of codes indicating the current status of a MedicationAdministration. (Strength=Required)MedicationAdministrationStatus! »Indicates the type of medication administration and where the medication is expected to be consumed or administeredcategory : CodeableConcept [0..1] « A coded concept describing where the medication administered is expected to occur (Strength=Preferred)MedicationAdministrationCateg...? »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 medicationsmedication[x] : Type [1..1] « CodeableConcept|Reference(Medication); Codes identifying substance or product that can be administered. (Strength=Example) SNOMED CT Medication ?? »The person or animal or group receiving the medicationsubject : Reference [1..1] « Patient|Group »The visit, admission, or other contact between patient and health care provider during which the medication administration was performedcontext : Reference [0..1] « Encounter|EpisodeOfCare »Additional information (for example, patient height and weight) that supports the administration of the medicationsupportingInformation : Reference [0..*] « Any »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 appropriateeffective[x] : Type [1..1] « dateTime|Period »A code indicating why the administration was not performedstatusReason : CodeableConcept [0..*] « A set of codes indicating the reason why the MedicationAdministration is negated. (Strength=Example)SNOMED CT Reason Medication N...?? »A code indicating why the medication was givenreasonCode : CodeableConcept [0..*] « A set of codes indicating the reason why the MedicationAdministration was made. (Strength=Example)Reason Medication Given ?? »Condition or observation that supports why the medication was administeredreasonReference : Reference [0..*] « Condition|Observation| DiagnosticReport »The original request, instruction or authority to perform the administrationrequest : Reference [0..1] « MedicationRequest »The device used in administering the medication to the patient. For example, a particular infusion pumpdevice : Reference [0..*] « Device »Extra information about the medication administration that is not conveyed by the other attributesnote : Annotation [0..*]A summary of the events of interest that have occurred, such as when the administration was verifiedeventHistory : Reference [0..*] « Provenance »PerformerDistinguishes the type of involvement of the performer in the medication administrationfunction : CodeableConcept [0..1] « A code describing the role an individual played in administering the medication (Strength=Example)MedicationAdministrationPerfo...?? »Indicates who or what performed the medication administrationactor : Reference [1..1] « Practitioner|PractitionerRole|Patient| RelatedPerson|Device »DosageFree text dosage can be used for cases where the dosage administered is too complex to code. When coded dosage is present, the free text dosage may still be present for display to humans. The dosage instructions should reflect the dosage of the medication that was administeredtext : string [0..1]A coded specification of the anatomic site where the medication first entered the body. For example, "left arm"site : CodeableConcept [0..1] « 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 the patient. For example, topical, intravenous, etcroute : 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 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 injectiondose : Quantity(SimpleQuantity) [0..1]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 hoursrate[x] : Type [0..1] « Ratio|Quantity(SimpleQuantity) »Indicates who or what performed the medication administration and how they were involvedperformer[0..*]Describes the medication dosage information details e.g. dose, rate, site, route, etcdosage[0..1]

XML Template

<MedicationAdministration 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>
 <instantiates value="[uri]"/><!-- 0..* Instantiates protocol or definition -->
 <partOf><!-- 0..* Reference(MedicationAdministration|Procedure) Part of referenced event --></partOf>
 <status value="[code]"/><!-- 1..1 in-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown -->
 <category><!-- 0..1 CodeableConcept Type of medication usage --></category>
 <medication[x]><!-- 1..1 CodeableConcept|Reference(Medication) What was administered --></medication[x]>
 <subject><!-- 1..1 Reference(Patient|Group) Who received medication --></subject>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Encounter or Episode of Care administered as part of --></context>
 <supportingInformation><!-- 0..* Reference(Any) Additional information to support administration --></supportingInformation>
 <effective[x]><!-- 1..1 dateTime|Period Start and end time of administration --></effective[x]>
 <performer>  <!-- 0..* Who performed the medication administration and what they did -->
  <function><!-- 0..1 CodeableConcept Type of performance --></function>
  <actor><!-- 1..1 Reference(Practitioner|PractitionerRole|Patient|RelatedPerson|
    Device) Who performed the medication administration --></actor>
 </performer>
 <statusReason><!-- 0..* CodeableConcept Reason administration not performed --></statusReason>
 <reasonCode><!-- 0..* CodeableConcept Reason administration performed --></reasonCode>
 <reasonReference><!-- 0..* Reference(Condition|Observation|DiagnosticReport) Condition or observation that supports why the medication was administered --></reasonReference>
 <request><!-- 0..1 Reference(MedicationRequest) Request administration performed against --></request>
 <device><!-- 0..* Reference(Device) Device used to administer --></device>
 <note><!-- 0..* Annotation Information about the administration --></note>
 <dosage>  <!-- 0..1 Details of how medication was taken -->
  <text value="[string]"/><!-- 0..1 Free text dosage instructions e.g. SIG -->
  <site><!-- 0..1 CodeableConcept Body site administered to --></site>
  <route><!-- 0..1 CodeableConcept Path of substance into body --></route>
  <method><!-- 0..1 CodeableConcept How drug was administered --></method>
  <dose><!-- 0..1 Quantity(SimpleQuantity) Amount of medication per dose --></dose>
  <rate[x]><!-- 0..1 Ratio|Quantity(SimpleQuantity) Dose quantity per unit of time --></rate[x]>
 </dosage>
 <eventHistory><!-- 0..* Reference(Provenance) A list of events of interest in the lifecycle --></eventHistory>
</MedicationAdministration>

JSON Template

{doco
  "resourceType" : "MedicationAdministration",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External identifier
  "instantiates" : ["<uri>"], // Instantiates protocol or definition
  "partOf" : [{ Reference(MedicationAdministration|Procedure) }], // Part of referenced event
  "status" : "<code>", // R!  in-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown
  "category" : { CodeableConcept }, // Type of medication usage
  // medication[x]: What was administered. One of these 2:
  "medicationCodeableConcept" : { CodeableConcept },
  "medicationReference" : { Reference(Medication) },
  "subject" : { Reference(Patient|Group) }, // R!  Who received medication
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Encounter or Episode of Care administered as part of
  "supportingInformation" : [{ Reference(Any) }], // Additional information to support administration
  // effective[x]: Start and end time of administration. One of these 2:
  "effectiveDateTime" : "<dateTime>",
  "effectivePeriod" : { Period },
  "performer" : [{ // Who performed the medication administration and what they did
    "function" : { CodeableConcept }, // Type of performance
    "actor" : { Reference(Practitioner|PractitionerRole|Patient|RelatedPerson|
    Device) } // R!  Who performed the medication administration
  }],
  "statusReason" : [{ CodeableConcept }], // Reason administration not performed
  "reasonCode" : [{ CodeableConcept }], // Reason administration performed
  "reasonReference" : [{ Reference(Condition|Observation|DiagnosticReport) }], // Condition or observation that supports why the medication was administered
  "request" : { Reference(MedicationRequest) }, // Request administration performed against
  "device" : [{ Reference(Device) }], // Device used to administer
  "note" : [{ Annotation }], // Information about the administration
  "dosage" : { // Details of how medication was taken
    "text" : "<string>", // Free text dosage instructions e.g. SIG
    "site" : { CodeableConcept }, // Body site administered to
    "route" : { CodeableConcept }, // Path of substance into body
    "method" : { CodeableConcept }, // How drug was administered
    "dose" : { Quantity(SimpleQuantity) }, // Amount of medication per dose
    // rate[x]: Dose quantity per unit of time. One of these 2:
    "rateRatio" : { Ratio }
    "rateQuantity" : { Quantity(SimpleQuantity) }
  },
  "eventHistory" : [{ Reference(Provenance) }] // A list of events of interest in the lifecycle
}

Turtle Template

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


[ a fhir:MedicationAdministration;
  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:MedicationAdministration.identifier [ Identifier ], ... ; # 0..* External identifier
  fhir:MedicationAdministration.instantiates [ uri ], ... ; # 0..* Instantiates protocol or definition
  fhir:MedicationAdministration.partOf [ Reference(MedicationAdministration|Procedure) ], ... ; # 0..* Part of referenced event
  fhir:MedicationAdministration.status [ code ]; # 1..1 in-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown
  fhir:MedicationAdministration.category [ CodeableConcept ]; # 0..1 Type of medication usage
  # MedicationAdministration.medication[x] : 1..1 What was administered. One of these 2
    fhir:MedicationAdministration.medicationCodeableConcept [ CodeableConcept ]
    fhir:MedicationAdministration.medicationReference [ Reference(Medication) ]
  fhir:MedicationAdministration.subject [ Reference(Patient|Group) ]; # 1..1 Who received medication
  fhir:MedicationAdministration.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Encounter or Episode of Care administered as part of
  fhir:MedicationAdministration.supportingInformation [ Reference(Any) ], ... ; # 0..* Additional information to support administration
  # MedicationAdministration.effective[x] : 1..1 Start and end time of administration. One of these 2
    fhir:MedicationAdministration.effectiveDateTime [ dateTime ]
    fhir:MedicationAdministration.effectivePeriod [ Period ]
  fhir:MedicationAdministration.performer [ # 0..* Who performed the medication administration and what they did
    fhir:MedicationAdministration.performer.function [ CodeableConcept ]; # 0..1 Type of performance
    fhir:MedicationAdministration.performer.actor [ Reference(Practitioner|PractitionerRole|Patient|RelatedPerson|Device) ]; # 1..1 Who performed the medication administration
  ], ...;
  fhir:MedicationAdministration.statusReason [ CodeableConcept ], ... ; # 0..* Reason administration not performed
  fhir:MedicationAdministration.reasonCode [ CodeableConcept ], ... ; # 0..* Reason administration performed
  fhir:MedicationAdministration.reasonReference [ Reference(Condition|Observation|DiagnosticReport) ], ... ; # 0..* Condition or observation that supports why the medication was administered
  fhir:MedicationAdministration.request [ Reference(MedicationRequest) ]; # 0..1 Request administration performed against
  fhir:MedicationAdministration.device [ Reference(Device) ], ... ; # 0..* Device used to administer
  fhir:MedicationAdministration.note [ Annotation ], ... ; # 0..* Information about the administration
  fhir:MedicationAdministration.dosage [ # 0..1 Details of how medication was taken
    fhir:MedicationAdministration.dosage.text [ string ]; # 0..1 Free text dosage instructions e.g. SIG
    fhir:MedicationAdministration.dosage.site [ CodeableConcept ]; # 0..1 Body site administered to
    fhir:MedicationAdministration.dosage.route [ CodeableConcept ]; # 0..1 Path of substance into body
    fhir:MedicationAdministration.dosage.method [ CodeableConcept ]; # 0..1 How drug was administered
    fhir:MedicationAdministration.dosage.dose [ Quantity(SimpleQuantity) ]; # 0..1 Amount of medication per dose
    # MedicationAdministration.dosage.rate[x] : 0..1 Dose quantity per unit of time. One of these 2
      fhir:MedicationAdministration.dosage.rateRatio [ Ratio ]
      fhir:MedicationAdministration.dosage.rateSimpleQuantity [ Quantity(SimpleQuantity) ]
  ];
  fhir:MedicationAdministration.eventHistory [ Reference(Provenance) ], ... ; # 0..* A list of events of interest in the lifecycle
]

Changes since DSTU2

MedicationAdministration
MedicationAdministration.instantiates
  • Added Element
MedicationAdministration.medication[x]
  • Remove Reference(Medication), Add Reference(Medication)
MedicationAdministration.performer.function
  • Added Element
MedicationAdministration.performer.actor
  • Type changed from Reference(Practitioner|Patient|RelatedPerson|Device) to Reference(Practitioner|PractitionerRole|Patient|RelatedPerson|Device)
MedicationAdministration.statusReason
  • Added Element
MedicationAdministration.reasonReference
  • Type changed from Reference(Condition|Observation) to Reference(Condition|Observation|DiagnosticReport)
MedicationAdministration.request
  • Added Element
MedicationAdministration.dosage.rate[x]
  • Remove canonical(), Add canonical()
MedicationAdministration.definition
  • deleted
MedicationAdministration.performer.onBehalfOf
  • deleted
MedicationAdministration.notGiven
  • deleted
MedicationAdministration.reasonNotGiven
  • deleted
MedicationAdministration.prescription
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 3 tests that all execute ok. All tests pass round-trip testing and all r3 resources are valid.). Note: these have note yet been updated to be R3 to R4

 

Alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions & the dependency analysis

11.2.3.1 Terminology Bindings

PathDefinitionTypeReference
MedicationAdministration.status A set of codes indicating the current status of a MedicationAdministration.RequiredMedicationAdministrationStatus
MedicationAdministration.category A coded concept describing where the medication administered is expected to occurPreferredMedicationAdministrationCategory
MedicationAdministration.medication[x] Codes identifying substance or product that can be administered.ExampleSNOMED CT Medication Codes
MedicationAdministration.performer.function A code describing the role an individual played in administering the medicationExampleMedicationAdministrationPerformerFunction
MedicationAdministration.statusReason A set of codes indicating the reason why the MedicationAdministration is negated.ExampleSNOMED CT Reason Medication Not Given Codes
MedicationAdministration.reasonCode A set of codes indicating the reason why the MedicationAdministration was made.ExampleReason Medication Given Codes
MedicationAdministration.dosage.site A coded concept describing the site location the medicine enters into or onto the body.ExampleSNOMED CT Anatomical Structure for Administration Site Codes
MedicationAdministration.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
MedicationAdministration.dosage.method A coded concept describing the technique by which the medicine is administered.ExampleSNOMED CT Administration Method Codes

11.2.3.2 Constraints

  • mad-1: On MedicationAdministration.dosage: SHALL have at least one of dosage.dose or dosage.rate[x] (expression on MedicationAdministration.dosage: dose.exists() or rate.exists())

11.2.4 Known Issues

Issue Comments
Medication Resource A medication will typically be referred to by means of a code drawn from a suitable medication terminology. However, on occasion a product will be required for which the "recipe" must be specified. This implies a requirement to deal with a choice of either a code or a much more complete resource.
Currently that resource has not been created.
Contrast Media Is this resource adequate for administering contrast media to a patient?
Author (accountability) Authorship (and any other accountability) is assumed to be dealt with by the standard FHIR methods.

11.2.5 Search Parameters

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

NameTypeDescriptionExpressionIn Common
codetokenReturn administrations of this medication codeMedicationAdministration.medication.as(CodeableConcept)4 Resources
contextreferenceReturn administrations that share this encounter or episode of careMedicationAdministration.context
(EpisodeOfCare, Encounter)
devicereferenceReturn administrations with this administration device identityMedicationAdministration.device
(Device)
effective-timedateDate administration happened (or did not happen)MedicationAdministration.effective
identifiertokenReturn administrations with this external identifierMedicationAdministration.identifier3 Resources
medicationreferenceReturn administrations of this medication resourceMedicationAdministration.medication.as(Reference)
(Medication)		3 Resources
patientreferenceThe identity of a patient to list administrations forMedicationAdministration.subject
(Patient)		3 Resources
performerreferenceThe identity of the individual who administered the medicationMedicationAdministration.performer.actor
(Practitioner, Device, Patient, PractitionerRole, RelatedPerson)
reason-giventokenReasons for administering the medicationMedicationAdministration.reasonCode
reason-not-giventokenReasons for not administering the medicationMedicationAdministration.statusReason
requestreferenceThe identity of a request to list administrations fromMedicationAdministration.request
(MedicationRequest)
statustokenMedicationAdministration event status (for example one of active/paused/completed/nullified)MedicationAdministration.status3 Resources
subjectreferenceThe identity of the individual or group to list administrations forMedicationAdministration.subject
(Group, Patient)