Release 5 Draft Ballot

This page is part of the FHIR Specification (v4.6.0: R5 Draft Ballot - see ballot notes). 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

11.1 Resource MedicationRequest - Content

Pharmacy Work GroupMaturity Level: 3 Trial UseSecurity Category: Patient Compartments: Encounter, Patient, Practitioner

This resource has been identified by it's owning workgroup as a normative candidate for R5. Ballot comment is requested on this.

An order or request for both supply of the medication and the instructions for administration of the medication to a patient. The resource is called "MedicationRequest" rather than "MedicationPrescription" or "MedicationOrder" to generalize the use across inpatient and outpatient settings, including care plans, etc., and to harmonize with workflow patterns.

11.1.1 Scope and Usage

This resource covers all type of orders for medications for a patient. This includes inpatient medication orders as well as community orders (whether filled by the prescriber or by a pharmacy). It also includes orders for over-the-counter medications (e.g. Aspirin), total parenteral nutrition and diet/ vitamin supplements. It may be used to support the order of medication-related devices. It is not intended for use in prescribing particular diets, or for ordering non-medication-related items (eyeglasses, supplies, etc.). In addition, the MedicationRequest may be used to report orders/request from external systems that have been reported for informational purposes and are not authoritative and are not expected to be acted upon (e.g. dispensed or administered).

The MedicationRequest resource is a "request" resource from a FHIR workflow perspective - see Workflow Request.

The MedicationRequest resource allows requesting only a single medication. If a workflow requires requesting multiple items simultaneously, this is done using multiple instances of this resource. These instances can be linked in different ways, depending on the needs of the workflow. For guidance, refer to the Request pattern

11.1.2 Boundaries and Relationships

The MedicationRequest resource is used to request or order medication for a subject. It may also be used to report a medication request or order from one organization or source to another. When requesting supplies or devices when there is a patient focus or instructions regarding their use, SupplyRequest or DeviceRequest should be used instead. When reporting on the usage of a medication by a patient, the MedicationUsage resource should be used.

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
MedicationUsage This is a record of medication being taken by a patient, or that the medication has been given to a patient where the record is the result of a report from the patient, or another clinician. A medication statement is not a part of the prescribe->dispense->administer sequence but is a report that such a sequence (or at least a part of it) did take place resulting in a belief that the patient has received a particular medication.

11.1.3 References

This resource is referenced by AdverseEvent, AuditEvent, CarePlan, Claim, DiagnosticReport, ExplanationOfBenefit, Goal, Immunization, MedicationAdministration, MedicationDispense, itself, MedicationUsage, Observation, Provenance and ServiceRequest.

This resource implements the Request pattern.

11.1.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest TUDomainResourceOrdering of medication for patient or group
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierExternal ids for this request
... status ?!Σ1..1codeactive | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
medicationrequest Status (Required)
... statusReason 0..1CodeableConceptReason for current status
medicationRequest Status Reason Codes (Example)
... intent ?!Σ1..1codeproposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
medicationRequest Intent (Required)
... category 0..*CodeableConceptGrouping or category of medication request
medicationRequest Administration Location Codes (Example)
... priority Σ0..1coderoutine | urgent | asap | stat
RequestPriority (Required)
... doNotPerform ?!Σ0..1booleanTrue if patient is to stop taking or not to start taking the medication
... reported Σ0..1booleanReported rather than primary record
... informationSource 0..1Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization)The person or organization who provided the information about this request, if the source is someone other than the requestor
... medication Σ1..1CodeableReference(Medication)Medication to be taken
SNOMED CT Medication Codes (Example)
... subject Σ1..1Reference(Patient | Group)Who or group medication request is for
... encounter 0..1Reference(Encounter)Encounter created as part of encounter/admission/stay
... supportingInformation 0..*Reference(Any)Information to support ordering of the medication
... authoredOn Σ0..1dateTimeWhen request was initially authored
... requester Σ0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)Who/What requested the Request
... performer 0..1Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam | HealthcareService)Intended performer of administration
... performerType Σ0..1CodeableConceptDesired kind of performer of the medication administration
Procedure Performer Role Codes (Example)
... recorder 0..1Reference(Practitioner | PractitionerRole)Person who entered the request
... reason 0..*CodeableReference(Condition | Observation)Reason or indication for ordering or not ordering the medication
Condition/Problem/Diagnosis Codes (Example)
... instantiatesCanonical Σ0..*canonical(PlanDefinition | ActivityDefinition)Instantiates FHIR protocol or definition
... instantiatesUri Σ0..*uriInstantiates external protocol or definition
... basedOn Σ0..*Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation)What request fulfills
... groupIdentifier Σ0..1IdentifierComposite request this is part of
... courseOfTherapyType 0..1CodeableConceptOverall pattern of medication administration
medicationRequest Course of Therapy Codes (Example)
... insurance 0..*Reference(Coverage | ClaimResponse)Associated insurance coverage
... note 0..*AnnotationInformation about the prescription
... renderedDosageInstruction 0..1stringFull representation of the dosage instructions
... dosageInstruction 0..*DosageHow the medication should be taken
... dispenseRequest 0..1BackboneElementMedication supply authorization
.... initialFill 0..1BackboneElementFirst fill details
..... quantity 0..1SimpleQuantityFirst fill quantity
..... duration 0..1DurationFirst fill duration
.... dispenseInterval 0..1DurationMinimum period of time between dispenses
.... validityPeriod 0..1PeriodTime period supply is authorized for
.... numberOfRepeatsAllowed 0..1unsignedIntNumber of refills authorized
.... quantity 0..1SimpleQuantityAmount of medication to supply per dispense
.... expectedSupplyDuration 0..1DurationNumber of days supply per dispense
.... dispenser 0..1Reference(Organization)Intended performer of dispense
.... dispenserInstruction 0..*AnnotationAdditional information for the dispenser
.... doseAdministrationAid 0..1CodeableConceptType of adherence packaging to use for the dispense
Medication Dose Aids (Example)
... substitution 0..1BackboneElementAny restrictions on medication substitution
.... allowed[x] 1..1Whether substitution is allowed or not
ActSubstanceAdminSubstitutionCode (Example)
..... allowedBooleanboolean
..... allowedCodeableConceptCodeableConcept
.... reason 0..1CodeableConceptWhy should (not) substitution be made
SubstanceAdminSubstitutionReason (Example)
... priorPrescription 0..1Reference(MedicationRequest)An order/prescription that is being replaced
... detectedIssue 0..*Reference(DetectedIssue)Clinical Issue with action
... eventHistory 0..*Reference(Provenance)A list of events of interest in the lifecycle

doco Documentation for this format

UML Diagram (Legend)

MedicationRequest (DomainResource)Identifiers associated with this medication request that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to serveridentifier : Identifier [0..*]A code specifying the current state of the order. Generally, this will be active or completed state (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)medicationrequest Status! »Captures the reason for the current state of the MedicationRequeststatusReason : CodeableConcept [0..1] « null (Strength=Example)medicationRequest Status Reas...?? »Whether the request is a proposal, plan, or an original order (this element modifies the meaning of other elements)intent : code [1..1] « null (Strength=Required)medicationRequest Intent! »Indicates the grouping or category of medication request (for example, drug classification like ATC, where meds would be administered, legal category of the medication.)category : CodeableConcept [0..*] « null (Strength=Example)medicationRequest Administrat...?? »Indicates how quickly the Medication Request should be addressed with respect to other requestspriority : code [0..1] « null (Strength=Required)RequestPriority! »If true, indicates that the provider is asking for the patient to either stop taking or to not start taking the specified medication. For example, the patient is taking an existing medication and the provider is changing their medication. They want to create two seperate requests: one to stop using the current medication and another to start the new medication (this element modifies the meaning of other elements)doNotPerform : boolean [0..1]Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the reportreported : boolean [0..1]The person or organization who provided the information about this request, if the source is someone other than the requestor. This is often used when the MedicationRequest is reported by another personinformationSource : Reference [0..1] « Patient|Practitioner| PractitionerRole|RelatedPerson|Organization »Identifies the medication being requested. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medicationsmedication : DataType [1..1] « Medication; null (Strength=Example)SNOMEDCTMedicationCodes?? »A link to a resource representing the person or set of individuals to whom the medication will be givensubject : Reference [1..1] « Patient|Group »The Encounter during which this [x] was created or to which the creation of this record is tightly associatedencounter : Reference [0..1] « Encounter »Include additional information (for example, patient height and weight, a MedicationUsage for the patient) that supports the ordering of the medicationsupportingInformation : Reference [0..*] « Any »The date (and perhaps time) when the prescription was initially written or authored onauthoredOn : dateTime [0..1]The individual, organization, or device that initiated the request and has responsibility for its activationrequester : Reference [0..1] « Practitioner|PractitionerRole| Organization|Patient|RelatedPerson|Device »The specified desired performer of the medication treatment (e.g. the performer of the medication administration)performer : Reference [0..1] « Practitioner|PractitionerRole| Organization|Patient|Device|RelatedPerson|CareTeam| HealthcareService »Indicates the type of performer of the administration of the medicationperformerType : CodeableConcept [0..1] « null (Strength=Example)ProcedurePerformerRoleCodes?? »The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone orderrecorder : Reference [0..1] « Practitioner|PractitionerRole »The reason or the indication for ordering or not ordering the medicationreason : DataType [0..*] « Condition|Observation; null (Strength=Example) Condition/Problem/DiagnosisCo...?? »The URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequestinstantiatesCanonical : canonical [0..*] « PlanDefinition| ActivityDefinition »The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this MedicationRequestinstantiatesUri : uri [0..*]A plan or request that is fulfilled in whole or in part by this medication requestbasedOn : Reference [0..*] « CarePlan|MedicationRequest| ServiceRequest|ImmunizationRecommendation »A shared identifier common to all requests that were authorized more or less simultaneously by a single author, representing the identifier of the requisition or prescriptiongroupIdentifier : Identifier [0..1]The description of the overall pattern of the administration of the medication to the patientcourseOfTherapyType : CodeableConcept [0..1] « null (Strength=Example)medicationRequest Course of T...?? »Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested serviceinsurance : Reference [0..*] « Coverage|ClaimResponse »Extra information about the prescription that could not be conveyed by the other attributesnote : Annotation [0..*]The full representation of the dose of the medication included in all dosage instructions. To be used when multiple dosage instructions are included to represent complex dosing such as increasing or tapering dosesrenderedDosageInstruction : string [0..1]Indicates how the medication is to be used by the patientdosageInstruction : Dosage [0..*]A link to a resource representing an earlier order related order or prescriptionpriorPrescription : Reference [0..1] « MedicationRequest »Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etcdetectedIssue : Reference [0..*] « DetectedIssue »Links to Provenance records for past versions of this resource or fulfilling request or event resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resourceeventHistory : Reference [0..*] « Provenance »DispenseRequestThe minimum period of time that must occur between dispenses of the medicationdispenseInterval : Duration [0..1]This indicates the validity period of a prescription (stale dating the Prescription)validityPeriod : Period [0..1]An integer indicating the number of times, in addition to the original dispense, (aka refills or repeats) that the patient can receive the prescribed medication. Usage Notes: This integer does not include the original order dispense. This means that if an order indicates dispense 30 tablets plus "3 repeats", then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets. A prescriber may explicitly say that zero refills are permitted after the initial dispensenumberOfRepeatsAllowed : unsignedInt [0..1]The amount that is to be dispensed for one fillquantity : Quantity(SimpleQuantity) [0..1]Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to lastexpectedSupplyDuration : Duration [0..1]Indicates the intended performing Organization that will dispense the medication as specified by the prescriberdispenser : Reference [0..1] « Organization »Provides additional information to the dispenser, for example, counselling to be provided to the patientdispenserInstruction : Annotation [0..*]Provides information about the type of adherence packaging to be supplied for the medication dispensedoseAdministrationAid : CodeableConcept [0..1] « null (Strength=Example)Medication Dose Aids?? »InitialFillThe amount or quantity to provide as part of the first dispensequantity : Quantity(SimpleQuantity) [0..1]The length of time that the first dispense is expected to lastduration : Duration [0..1]SubstitutionTrue if the prescriber allows a different drug to be dispensed from what was prescribedallowed[x] : DataType [1..1] « boolean|CodeableConcept; null (Strength=Example) ActSubstanceAdminSubstitution...?? »Indicates the reason for the substitution, or why substitution must or must not be performedreason : CodeableConcept [0..1] « A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed. (Strength=Example)SubstanceAdminSubstitutionRea...?? »Indicates the quantity or duration for the first dispense of the medicationinitialFill[0..1]Indicates the specific details for the dispense or medication supply part of a medication request (also known as a Medication Prescription or Medication Order). Note that this information is not always sent with the order. There may be in some settings (e.g. hospitals) institutional or system support for completing the dispense details in the pharmacy departmentdispenseRequest[0..1]Indicates whether or not substitution can or should be part of the dispense. In some cases, substitution must happen, in other cases substitution must not happen. This block explains the prescriber's intent. If nothing is specified substitution may be donesubstitution[0..1]

XML Template

<MedicationRequest xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External ids for this request --></identifier>
 <status value="[code]"/><!-- 1..1 active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown -->
 <statusReason><!-- 0..1 CodeableConcept Reason for current status --></statusReason>
 <intent value="[code]"/><!-- 1..1 proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option -->
 <category><!-- 0..* CodeableConcept Grouping or category of medication request --></category>
 <priority value="[code]"/><!-- 0..1 routine | urgent | asap | stat -->
 <doNotPerform value="[boolean]"/><!-- 0..1 True if patient is to stop taking or not to start taking the medication -->
 <reported value="[boolean]"/><!-- 0..1 Reported rather than primary record -->
 <informationSource><!-- 0..1 Reference(Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) The person or organization who provided the information about this request, if the source is someone other than the requestor --></informationSource>
 <medication><!-- 1..1 CodeableReference(Medication) Medication to be taken --></medication>
 <subject><!-- 1..1 Reference(Group|Patient) Who or group medication request is for --></subject>
 <encounter><!-- 0..1 Reference(Encounter) Encounter created as part of encounter/admission/stay --></encounter>
 <supportingInformation><!-- 0..* Reference(Any) Information to support ordering of the medication --></supportingInformation>
 <authoredOn value="[dateTime]"/><!-- 0..1 When request was initially authored -->
 <requester><!-- 0..1 Reference(Device|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) Who/What requested the Request --></requester>
 <performer><!-- 0..1 Reference(CareTeam|Device|HealthcareService|Organization|
   Patient|Practitioner|PractitionerRole|RelatedPerson) Intended performer of administration --></performer>
 <performerType><!-- 0..1 CodeableConcept Desired kind of performer of the medication administration --></performerType>
 <recorder><!-- 0..1 Reference(Practitioner|PractitionerRole) Person who entered the request --></recorder>
 <reason><!-- 0..* CodeableReference(Condition|Observation) Reason or indication for ordering or not ordering the medication --></reason>
 <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|PlanDefinition) Instantiates FHIR protocol or definition --></instantiatesCanonical>
 <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition -->
 <basedOn><!-- 0..* Reference(CarePlan|ImmunizationRecommendation|
   MedicationRequest|ServiceRequest) What request fulfills --></basedOn>
 <groupIdentifier><!-- 0..1 Identifier Composite request this is part of --></groupIdentifier>
 <courseOfTherapyType><!-- 0..1 CodeableConcept Overall pattern of medication administration --></courseOfTherapyType>
 <insurance><!-- 0..* Reference(ClaimResponse|Coverage) Associated insurance coverage --></insurance>
 <note><!-- 0..* Annotation Information about the prescription --></note>
 <renderedDosageInstruction value="[string]"/><!-- 0..1 Full representation of the dosage instructions -->
 <dosageInstruction><!-- 0..* Dosage How the medication should be taken --></dosageInstruction>
 <dispenseRequest>  <!-- 0..1 Medication supply authorization -->
  <initialFill>  <!-- 0..1 First fill details -->
   <quantity><!-- 0..1 Quantity(SimpleQuantity) First fill quantity --></quantity>
   <duration><!-- 0..1 Duration First fill duration --></duration>
  </initialFill>
  <dispenseInterval><!-- 0..1 Duration Minimum period of time between dispenses --></dispenseInterval>
  <validityPeriod><!-- 0..1 Period Time period supply is authorized for --></validityPeriod>
  <numberOfRepeatsAllowed value="[unsignedInt]"/><!-- 0..1 Number of refills authorized -->
  <quantity><!-- 0..1 Quantity(SimpleQuantity) Amount of medication to supply per dispense --></quantity>
  <expectedSupplyDuration><!-- 0..1 Duration Number of days supply per dispense --></expectedSupplyDuration>
  <dispenser><!-- 0..1 Reference(Organization) Intended performer of dispense --></dispenser>
  <dispenserInstruction><!-- 0..* Annotation Additional information for the dispenser --></dispenserInstruction>
  <doseAdministrationAid><!-- 0..1 CodeableConcept Type of adherence packaging to use for the dispense --></doseAdministrationAid>
 </dispenseRequest>
 <substitution>  <!-- 0..1 Any restrictions on medication substitution -->
  <allowed[x]><!-- 1..1 boolean|CodeableConcept Whether substitution is allowed or not  --></allowed[x]>
  <reason><!-- 0..1 CodeableConcept Why should (not) substitution be made  --></reason>
 </substitution>
 <priorPrescription><!-- 0..1 Reference(MedicationRequest) An order/prescription that is being replaced --></priorPrescription>
 <detectedIssue><!-- 0..* Reference(DetectedIssue) Clinical Issue with action --></detectedIssue>
 <eventHistory><!-- 0..* Reference(Provenance) A list of events of interest in the lifecycle --></eventHistory>
</MedicationRequest>

JSON Template

{doco
  "resourceType" : "MedicationRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External ids for this request
  "status" : "<code>", // R!  active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
  "statusReason" : { CodeableConcept }, // Reason for current status
  "intent" : "<code>", // R!  proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
  "category" : [{ CodeableConcept }], // Grouping or category of medication request
  "priority" : "<code>", // routine | urgent | asap | stat
  "doNotPerform" : <boolean>, // True if patient is to stop taking or not to start taking the medication
  "reported" : <boolean>, // Reported rather than primary record
  "informationSource" : { Reference(Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) }, // The person or organization who provided the information about this request, if the source is someone other than the requestor
  "medication" : { CodeableReference(Medication) }, // R!  Medication to be taken
  "subject" : { Reference(Group|Patient) }, // R!  Who or group medication request is for
  "encounter" : { Reference(Encounter) }, // Encounter created as part of encounter/admission/stay
  "supportingInformation" : [{ Reference(Any) }], // Information to support ordering of the medication
  "authoredOn" : "<dateTime>", // When request was initially authored
  "requester" : { Reference(Device|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) }, // Who/What requested the Request
  "performer" : { Reference(CareTeam|Device|HealthcareService|Organization|
   Patient|Practitioner|PractitionerRole|RelatedPerson) }, // Intended performer of administration
  "performerType" : { CodeableConcept }, // Desired kind of performer of the medication administration
  "recorder" : { Reference(Practitioner|PractitionerRole) }, // Person who entered the request
  "reason" : [{ CodeableReference(Condition|Observation) }], // Reason or indication for ordering or not ordering the medication
  "instantiatesCanonical" : [{ canonical(ActivityDefinition|PlanDefinition) }], // Instantiates FHIR protocol or definition
  "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
  "basedOn" : [{ Reference(CarePlan|ImmunizationRecommendation|
   MedicationRequest|ServiceRequest) }], // What request fulfills
  "groupIdentifier" : { Identifier }, // Composite request this is part of
  "courseOfTherapyType" : { CodeableConcept }, // Overall pattern of medication administration
  "insurance" : [{ Reference(ClaimResponse|Coverage) }], // Associated insurance coverage
  "note" : [{ Annotation }], // Information about the prescription
  "renderedDosageInstruction" : "<string>", // Full representation of the dosage instructions
  "dosageInstruction" : [{ Dosage }], // How the medication should be taken
  "dispenseRequest" : { // Medication supply authorization
    "initialFill" : { // First fill details
      "quantity" : { Quantity(SimpleQuantity) }, // First fill quantity
      "duration" : { Duration } // First fill duration
    },
    "dispenseInterval" : { Duration }, // Minimum period of time between dispenses
    "validityPeriod" : { Period }, // Time period supply is authorized for
    "numberOfRepeatsAllowed" : "<unsignedInt>", // Number of refills authorized
    "quantity" : { Quantity(SimpleQuantity) }, // Amount of medication to supply per dispense
    "expectedSupplyDuration" : { Duration }, // Number of days supply per dispense
    "dispenser" : { Reference(Organization) }, // Intended performer of dispense
    "dispenserInstruction" : [{ Annotation }], // Additional information for the dispenser
    "doseAdministrationAid" : { CodeableConcept } // Type of adherence packaging to use for the dispense
  },
  "substitution" : { // Any restrictions on medication substitution
    // allowed[x]: Whether substitution is allowed or not. One of these 2:
    "allowedBoolean" : <boolean>,
    "allowedCodeableConcept" : { CodeableConcept },
    "reason" : { CodeableConcept } // Why should (not) substitution be made 
  },
  "priorPrescription" : { Reference(MedicationRequest) }, // An order/prescription that is being replaced
  "detectedIssue" : [{ Reference(DetectedIssue) }], // Clinical Issue with action
  "eventHistory" : [{ Reference(Provenance) }] // A list of events of interest in the lifecycle
}

Turtle Template

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


[ a fhir:MedicationRequest;
  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:MedicationRequest.identifier [ Identifier ], ... ; # 0..* External ids for this request
  fhir:MedicationRequest.status [ code ]; # 1..1 active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
  fhir:MedicationRequest.statusReason [ CodeableConcept ]; # 0..1 Reason for current status
  fhir:MedicationRequest.intent [ code ]; # 1..1 proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
  fhir:MedicationRequest.category [ CodeableConcept ], ... ; # 0..* Grouping or category of medication request
  fhir:MedicationRequest.priority [ code ]; # 0..1 routine | urgent | asap | stat
  fhir:MedicationRequest.doNotPerform [ boolean ]; # 0..1 True if patient is to stop taking or not to start taking the medication
  fhir:MedicationRequest.reported [ boolean ]; # 0..1 Reported rather than primary record
  fhir:MedicationRequest.informationSource [ Reference(Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 0..1 The person or organization who provided the information about this request, if the source is someone other than the requestor
  fhir:MedicationRequest.medication [ CodeableReference(Medication) ]; # 1..1 Medication to be taken
  fhir:MedicationRequest.subject [ Reference(Group|Patient) ]; # 1..1 Who or group medication request is for
  fhir:MedicationRequest.encounter [ Reference(Encounter) ]; # 0..1 Encounter created as part of encounter/admission/stay
  fhir:MedicationRequest.supportingInformation [ Reference(Any) ], ... ; # 0..* Information to support ordering of the medication
  fhir:MedicationRequest.authoredOn [ dateTime ]; # 0..1 When request was initially authored
  fhir:MedicationRequest.requester [ Reference(Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 0..1 Who/What requested the Request
  fhir:MedicationRequest.performer [ Reference(CareTeam|Device|HealthcareService|Organization|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ]; # 0..1 Intended performer of administration
  fhir:MedicationRequest.performerType [ CodeableConcept ]; # 0..1 Desired kind of performer of the medication administration
  fhir:MedicationRequest.recorder [ Reference(Practitioner|PractitionerRole) ]; # 0..1 Person who entered the request
  fhir:MedicationRequest.reason [ CodeableReference(Condition|Observation) ], ... ; # 0..* Reason or indication for ordering or not ordering the medication
  fhir:MedicationRequest.instantiatesCanonical [ canonical(ActivityDefinition|PlanDefinition) ], ... ; # 0..* Instantiates FHIR protocol or definition
  fhir:MedicationRequest.instantiatesUri [ uri ], ... ; # 0..* Instantiates external protocol or definition
  fhir:MedicationRequest.basedOn [ Reference(CarePlan|ImmunizationRecommendation|MedicationRequest|ServiceRequest) ], ... ; # 0..* What request fulfills
  fhir:MedicationRequest.groupIdentifier [ Identifier ]; # 0..1 Composite request this is part of
  fhir:MedicationRequest.courseOfTherapyType [ CodeableConcept ]; # 0..1 Overall pattern of medication administration
  fhir:MedicationRequest.insurance [ Reference(ClaimResponse|Coverage) ], ... ; # 0..* Associated insurance coverage
  fhir:MedicationRequest.note [ Annotation ], ... ; # 0..* Information about the prescription
  fhir:MedicationRequest.renderedDosageInstruction [ string ]; # 0..1 Full representation of the dosage instructions
  fhir:MedicationRequest.dosageInstruction [ Dosage ], ... ; # 0..* How the medication should be taken
  fhir:MedicationRequest.dispenseRequest [ # 0..1 Medication supply authorization
    fhir:MedicationRequest.dispenseRequest.initialFill [ # 0..1 First fill details
      fhir:MedicationRequest.dispenseRequest.initialFill.quantity [ Quantity(SimpleQuantity) ]; # 0..1 First fill quantity
      fhir:MedicationRequest.dispenseRequest.initialFill.duration [ Duration ]; # 0..1 First fill duration
    ];
    fhir:MedicationRequest.dispenseRequest.dispenseInterval [ Duration ]; # 0..1 Minimum period of time between dispenses
    fhir:MedicationRequest.dispenseRequest.validityPeriod [ Period ]; # 0..1 Time period supply is authorized for
    fhir:MedicationRequest.dispenseRequest.numberOfRepeatsAllowed [ unsignedInt ]; # 0..1 Number of refills authorized
    fhir:MedicationRequest.dispenseRequest.quantity [ Quantity(SimpleQuantity) ]; # 0..1 Amount of medication to supply per dispense
    fhir:MedicationRequest.dispenseRequest.expectedSupplyDuration [ Duration ]; # 0..1 Number of days supply per dispense
    fhir:MedicationRequest.dispenseRequest.dispenser [ Reference(Organization) ]; # 0..1 Intended performer of dispense
    fhir:MedicationRequest.dispenseRequest.dispenserInstruction [ Annotation ], ... ; # 0..* Additional information for the dispenser
    fhir:MedicationRequest.dispenseRequest.doseAdministrationAid [ CodeableConcept ]; # 0..1 Type of adherence packaging to use for the dispense
  ];
  fhir:MedicationRequest.substitution [ # 0..1 Any restrictions on medication substitution
    # MedicationRequest.substitution.allowed[x] : 1..1 Whether substitution is allowed or not. One of these 2
      fhir:MedicationRequest.substitution.allowedBoolean [ boolean ]
      fhir:MedicationRequest.substitution.allowedCodeableConcept [ CodeableConcept ]
    fhir:MedicationRequest.substitution.reason [ CodeableConcept ]; # 0..1 Why should (not) substitution be made
  ];
  fhir:MedicationRequest.priorPrescription [ Reference(MedicationRequest) ]; # 0..1 An order/prescription that is being replaced
  fhir:MedicationRequest.detectedIssue [ Reference(DetectedIssue) ], ... ; # 0..* Clinical Issue with action
  fhir:MedicationRequest.eventHistory [ Reference(Provenance) ], ... ; # 0..* A list of events of interest in the lifecycle
]

Changes since R3

MedicationRequest
MedicationRequest.status
  • Change value set from http://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.0 to http://hl7.org/fhir/ValueSet/medicationrequest-status|4.6.0
MedicationRequest.intent
  • Change value set from http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.0 to http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.6.0
MedicationRequest.priority
  • Change value set from http://hl7.org/fhir/ValueSet/request-priority|4.0.0 to http://hl7.org/fhir/ValueSet/request-priority|4.6.0
MedicationRequest.reported
  • Added Element
MedicationRequest.informationSource
  • Added Element
MedicationRequest.medication
  • Added Mandatory Element
MedicationRequest.performer
  • Type Reference: Added Target Type HealthcareService
MedicationRequest.reason
  • Added Element
MedicationRequest.instantiatesCanonical
  • Type changed from canonical to canonical(PlanDefinition | ActivityDefinition)
MedicationRequest.renderedDosageInstruction
  • Added Element
MedicationRequest.dispenseRequest.dispenser
  • Added Element
MedicationRequest.dispenseRequest.dispenserInstruction
  • Added Element
MedicationRequest.dispenseRequest.doseAdministrationAid
  • Added Element
MedicationRequest.reported[x]
  • deleted
MedicationRequest.medication[x]
  • deleted
MedicationRequest.reasonCode
  • deleted
MedicationRequest.reasonReference
  • deleted
MedicationRequest.dispenseRequest.performer
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 36 tests that all execute ok. 8 fail round-trip testing and 36 r3 resources are invalid (0 errors).)

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest TUDomainResourceOrdering of medication for patient or group
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierExternal ids for this request
... status ?!Σ1..1codeactive | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
medicationrequest Status (Required)
... statusReason 0..1CodeableConceptReason for current status
medicationRequest Status Reason Codes (Example)
... intent ?!Σ1..1codeproposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
medicationRequest Intent (Required)
... category 0..*CodeableConceptGrouping or category of medication request
medicationRequest Administration Location Codes (Example)
... priority Σ0..1coderoutine | urgent | asap | stat
RequestPriority (Required)
... doNotPerform ?!Σ0..1booleanTrue if patient is to stop taking or not to start taking the medication
... reported Σ0..1booleanReported rather than primary record
... informationSource 0..1Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization)The person or organization who provided the information about this request, if the source is someone other than the requestor
... medication Σ1..1CodeableReference(Medication)Medication to be taken
SNOMED CT Medication Codes (Example)
... subject Σ1..1Reference(Patient | Group)Who or group medication request is for
... encounter 0..1Reference(Encounter)Encounter created as part of encounter/admission/stay
... supportingInformation 0..*Reference(Any)Information to support ordering of the medication
... authoredOn Σ0..1dateTimeWhen request was initially authored
... requester Σ0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)Who/What requested the Request
... performer 0..1Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam | HealthcareService)Intended performer of administration
... performerType Σ0..1CodeableConceptDesired kind of performer of the medication administration
Procedure Performer Role Codes (Example)
... recorder 0..1Reference(Practitioner | PractitionerRole)Person who entered the request
... reason 0..*CodeableReference(Condition | Observation)Reason or indication for ordering or not ordering the medication
Condition/Problem/Diagnosis Codes (Example)
... instantiatesCanonical Σ0..*canonical(PlanDefinition | ActivityDefinition)Instantiates FHIR protocol or definition
... instantiatesUri Σ0..*uriInstantiates external protocol or definition
... basedOn Σ0..*Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation)What request fulfills
... groupIdentifier Σ0..1IdentifierComposite request this is part of
... courseOfTherapyType 0..1CodeableConceptOverall pattern of medication administration
medicationRequest Course of Therapy Codes (Example)
... insurance 0..*Reference(Coverage | ClaimResponse)Associated insurance coverage
... note 0..*AnnotationInformation about the prescription
... renderedDosageInstruction 0..1stringFull representation of the dosage instructions
... dosageInstruction 0..*DosageHow the medication should be taken
... dispenseRequest 0..1BackboneElementMedication supply authorization
.... initialFill 0..1BackboneElementFirst fill details
..... quantity 0..1SimpleQuantityFirst fill quantity
..... duration 0..1DurationFirst fill duration
.... dispenseInterval 0..1DurationMinimum period of time between dispenses
.... validityPeriod 0..1PeriodTime period supply is authorized for
.... numberOfRepeatsAllowed 0..1unsignedIntNumber of refills authorized
.... quantity 0..1SimpleQuantityAmount of medication to supply per dispense
.... expectedSupplyDuration 0..1DurationNumber of days supply per dispense
.... dispenser 0..1Reference(Organization)Intended performer of dispense
.... dispenserInstruction 0..*AnnotationAdditional information for the dispenser
.... doseAdministrationAid 0..1CodeableConceptType of adherence packaging to use for the dispense
Medication Dose Aids (Example)
... substitution 0..1BackboneElementAny restrictions on medication substitution
.... allowed[x] 1..1Whether substitution is allowed or not
ActSubstanceAdminSubstitutionCode (Example)
..... allowedBooleanboolean
..... allowedCodeableConceptCodeableConcept
.... reason 0..1CodeableConceptWhy should (not) substitution be made
SubstanceAdminSubstitutionReason (Example)
... priorPrescription 0..1Reference(MedicationRequest)An order/prescription that is being replaced
... detectedIssue 0..*Reference(DetectedIssue)Clinical Issue with action
... eventHistory 0..*Reference(Provenance)A list of events of interest in the lifecycle

doco Documentation for this format

UML Diagram (Legend)

MedicationRequest (DomainResource)Identifiers associated with this medication request that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to serveridentifier : Identifier [0..*]A code specifying the current state of the order. Generally, this will be active or completed state (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)medicationrequest Status! »Captures the reason for the current state of the MedicationRequeststatusReason : CodeableConcept [0..1] « null (Strength=Example)medicationRequest Status Reas...?? »Whether the request is a proposal, plan, or an original order (this element modifies the meaning of other elements)intent : code [1..1] « null (Strength=Required)medicationRequest Intent! »Indicates the grouping or category of medication request (for example, drug classification like ATC, where meds would be administered, legal category of the medication.)category : CodeableConcept [0..*] « null (Strength=Example)medicationRequest Administrat...?? »Indicates how quickly the Medication Request should be addressed with respect to other requestspriority : code [0..1] « null (Strength=Required)RequestPriority! »If true, indicates that the provider is asking for the patient to either stop taking or to not start taking the specified medication. For example, the patient is taking an existing medication and the provider is changing their medication. They want to create two seperate requests: one to stop using the current medication and another to start the new medication (this element modifies the meaning of other elements)doNotPerform : boolean [0..1]Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the reportreported : boolean [0..1]The person or organization who provided the information about this request, if the source is someone other than the requestor. This is often used when the MedicationRequest is reported by another personinformationSource : Reference [0..1] « Patient|Practitioner| PractitionerRole|RelatedPerson|Organization »Identifies the medication being requested. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medicationsmedication : DataType [1..1] « Medication; null (Strength=Example)SNOMEDCTMedicationCodes?? »A link to a resource representing the person or set of individuals to whom the medication will be givensubject : Reference [1..1] « Patient|Group »The Encounter during which this [x] was created or to which the creation of this record is tightly associatedencounter : Reference [0..1] « Encounter »Include additional information (for example, patient height and weight, a MedicationUsage for the patient) that supports the ordering of the medicationsupportingInformation : Reference [0..*] « Any »The date (and perhaps time) when the prescription was initially written or authored onauthoredOn : dateTime [0..1]The individual, organization, or device that initiated the request and has responsibility for its activationrequester : Reference [0..1] « Practitioner|PractitionerRole| Organization|Patient|RelatedPerson|Device »The specified desired performer of the medication treatment (e.g. the performer of the medication administration)performer : Reference [0..1] « Practitioner|PractitionerRole| Organization|Patient|Device|RelatedPerson|CareTeam| HealthcareService »Indicates the type of performer of the administration of the medicationperformerType : CodeableConcept [0..1] « null (Strength=Example)ProcedurePerformerRoleCodes?? »The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone orderrecorder : Reference [0..1] « Practitioner|PractitionerRole »The reason or the indication for ordering or not ordering the medicationreason : DataType [0..*] « Condition|Observation; null (Strength=Example) Condition/Problem/DiagnosisCo...?? »The URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequestinstantiatesCanonical : canonical [0..*] « PlanDefinition| ActivityDefinition »The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this MedicationRequestinstantiatesUri : uri [0..*]A plan or request that is fulfilled in whole or in part by this medication requestbasedOn : Reference [0..*] « CarePlan|MedicationRequest| ServiceRequest|ImmunizationRecommendation »A shared identifier common to all requests that were authorized more or less simultaneously by a single author, representing the identifier of the requisition or prescriptiongroupIdentifier : Identifier [0..1]The description of the overall pattern of the administration of the medication to the patientcourseOfTherapyType : CodeableConcept [0..1] « null (Strength=Example)medicationRequest Course of T...?? »Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested serviceinsurance : Reference [0..*] « Coverage|ClaimResponse »Extra information about the prescription that could not be conveyed by the other attributesnote : Annotation [0..*]The full representation of the dose of the medication included in all dosage instructions. To be used when multiple dosage instructions are included to represent complex dosing such as increasing or tapering dosesrenderedDosageInstruction : string [0..1]Indicates how the medication is to be used by the patientdosageInstruction : Dosage [0..*]A link to a resource representing an earlier order related order or prescriptionpriorPrescription : Reference [0..1] « MedicationRequest »Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etcdetectedIssue : Reference [0..*] « DetectedIssue »Links to Provenance records for past versions of this resource or fulfilling request or event resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resourceeventHistory : Reference [0..*] « Provenance »DispenseRequestThe minimum period of time that must occur between dispenses of the medicationdispenseInterval : Duration [0..1]This indicates the validity period of a prescription (stale dating the Prescription)validityPeriod : Period [0..1]An integer indicating the number of times, in addition to the original dispense, (aka refills or repeats) that the patient can receive the prescribed medication. Usage Notes: This integer does not include the original order dispense. This means that if an order indicates dispense 30 tablets plus "3 repeats", then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets. A prescriber may explicitly say that zero refills are permitted after the initial dispensenumberOfRepeatsAllowed : unsignedInt [0..1]The amount that is to be dispensed for one fillquantity : Quantity(SimpleQuantity) [0..1]Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to lastexpectedSupplyDuration : Duration [0..1]Indicates the intended performing Organization that will dispense the medication as specified by the prescriberdispenser : Reference [0..1] « Organization »Provides additional information to the dispenser, for example, counselling to be provided to the patientdispenserInstruction : Annotation [0..*]Provides information about the type of adherence packaging to be supplied for the medication dispensedoseAdministrationAid : CodeableConcept [0..1] « null (Strength=Example)Medication Dose Aids?? »InitialFillThe amount or quantity to provide as part of the first dispensequantity : Quantity(SimpleQuantity) [0..1]The length of time that the first dispense is expected to lastduration : Duration [0..1]SubstitutionTrue if the prescriber allows a different drug to be dispensed from what was prescribedallowed[x] : DataType [1..1] « boolean|CodeableConcept; null (Strength=Example) ActSubstanceAdminSubstitution...?? »Indicates the reason for the substitution, or why substitution must or must not be performedreason : CodeableConcept [0..1] « A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed. (Strength=Example)SubstanceAdminSubstitutionRea...?? »Indicates the quantity or duration for the first dispense of the medicationinitialFill[0..1]Indicates the specific details for the dispense or medication supply part of a medication request (also known as a Medication Prescription or Medication Order). Note that this information is not always sent with the order. There may be in some settings (e.g. hospitals) institutional or system support for completing the dispense details in the pharmacy departmentdispenseRequest[0..1]Indicates whether or not substitution can or should be part of the dispense. In some cases, substitution must happen, in other cases substitution must not happen. This block explains the prescriber's intent. If nothing is specified substitution may be donesubstitution[0..1]

XML Template

<MedicationRequest xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External ids for this request --></identifier>
 <status value="[code]"/><!-- 1..1 active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown -->
 <statusReason><!-- 0..1 CodeableConcept Reason for current status --></statusReason>
 <intent value="[code]"/><!-- 1..1 proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option -->
 <category><!-- 0..* CodeableConcept Grouping or category of medication request --></category>
 <priority value="[code]"/><!-- 0..1 routine | urgent | asap | stat -->
 <doNotPerform value="[boolean]"/><!-- 0..1 True if patient is to stop taking or not to start taking the medication -->
 <reported value="[boolean]"/><!-- 0..1 Reported rather than primary record -->
 <informationSource><!-- 0..1 Reference(Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) The person or organization who provided the information about this request, if the source is someone other than the requestor --></informationSource>
 <medication><!-- 1..1 CodeableReference(Medication) Medication to be taken --></medication>
 <subject><!-- 1..1 Reference(Group|Patient) Who or group medication request is for --></subject>
 <encounter><!-- 0..1 Reference(Encounter) Encounter created as part of encounter/admission/stay --></encounter>
 <supportingInformation><!-- 0..* Reference(Any) Information to support ordering of the medication --></supportingInformation>
 <authoredOn value="[dateTime]"/><!-- 0..1 When request was initially authored -->
 <requester><!-- 0..1 Reference(Device|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) Who/What requested the Request --></requester>
 <performer><!-- 0..1 Reference(CareTeam|Device|HealthcareService|Organization|
   Patient|Practitioner|PractitionerRole|RelatedPerson) Intended performer of administration --></performer>
 <performerType><!-- 0..1 CodeableConcept Desired kind of performer of the medication administration --></performerType>
 <recorder><!-- 0..1 Reference(Practitioner|PractitionerRole) Person who entered the request --></recorder>
 <reason><!-- 0..* CodeableReference(Condition|Observation) Reason or indication for ordering or not ordering the medication --></reason>
 <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|PlanDefinition) Instantiates FHIR protocol or definition --></instantiatesCanonical>
 <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition -->
 <basedOn><!-- 0..* Reference(CarePlan|ImmunizationRecommendation|
   MedicationRequest|ServiceRequest) What request fulfills --></basedOn>
 <groupIdentifier><!-- 0..1 Identifier Composite request this is part of --></groupIdentifier>
 <courseOfTherapyType><!-- 0..1 CodeableConcept Overall pattern of medication administration --></courseOfTherapyType>
 <insurance><!-- 0..* Reference(ClaimResponse|Coverage) Associated insurance coverage --></insurance>
 <note><!-- 0..* Annotation Information about the prescription --></note>
 <renderedDosageInstruction value="[string]"/><!-- 0..1 Full representation of the dosage instructions -->
 <dosageInstruction><!-- 0..* Dosage How the medication should be taken --></dosageInstruction>
 <dispenseRequest>  <!-- 0..1 Medication supply authorization -->
  <initialFill>  <!-- 0..1 First fill details -->
   <quantity><!-- 0..1 Quantity(SimpleQuantity) First fill quantity --></quantity>
   <duration><!-- 0..1 Duration First fill duration --></duration>
  </initialFill>
  <dispenseInterval><!-- 0..1 Duration Minimum period of time between dispenses --></dispenseInterval>
  <validityPeriod><!-- 0..1 Period Time period supply is authorized for --></validityPeriod>
  <numberOfRepeatsAllowed value="[unsignedInt]"/><!-- 0..1 Number of refills authorized -->
  <quantity><!-- 0..1 Quantity(SimpleQuantity) Amount of medication to supply per dispense --></quantity>
  <expectedSupplyDuration><!-- 0..1 Duration Number of days supply per dispense --></expectedSupplyDuration>
  <dispenser><!-- 0..1 Reference(Organization) Intended performer of dispense --></dispenser>
  <dispenserInstruction><!-- 0..* Annotation Additional information for the dispenser --></dispenserInstruction>
  <doseAdministrationAid><!-- 0..1 CodeableConcept Type of adherence packaging to use for the dispense --></doseAdministrationAid>
 </dispenseRequest>
 <substitution>  <!-- 0..1 Any restrictions on medication substitution -->
  <allowed[x]><!-- 1..1 boolean|CodeableConcept Whether substitution is allowed or not  --></allowed[x]>
  <reason><!-- 0..1 CodeableConcept Why should (not) substitution be made  --></reason>
 </substitution>
 <priorPrescription><!-- 0..1 Reference(MedicationRequest) An order/prescription that is being replaced --></priorPrescription>
 <detectedIssue><!-- 0..* Reference(DetectedIssue) Clinical Issue with action --></detectedIssue>
 <eventHistory><!-- 0..* Reference(Provenance) A list of events of interest in the lifecycle --></eventHistory>
</MedicationRequest>

JSON Template

{doco
  "resourceType" : "MedicationRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External ids for this request
  "status" : "<code>", // R!  active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
  "statusReason" : { CodeableConcept }, // Reason for current status
  "intent" : "<code>", // R!  proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
  "category" : [{ CodeableConcept }], // Grouping or category of medication request
  "priority" : "<code>", // routine | urgent | asap | stat
  "doNotPerform" : <boolean>, // True if patient is to stop taking or not to start taking the medication
  "reported" : <boolean>, // Reported rather than primary record
  "informationSource" : { Reference(Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) }, // The person or organization who provided the information about this request, if the source is someone other than the requestor
  "medication" : { CodeableReference(Medication) }, // R!  Medication to be taken
  "subject" : { Reference(Group|Patient) }, // R!  Who or group medication request is for
  "encounter" : { Reference(Encounter) }, // Encounter created as part of encounter/admission/stay
  "supportingInformation" : [{ Reference(Any) }], // Information to support ordering of the medication
  "authoredOn" : "<dateTime>", // When request was initially authored
  "requester" : { Reference(Device|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) }, // Who/What requested the Request
  "performer" : { Reference(CareTeam|Device|HealthcareService|Organization|
   Patient|Practitioner|PractitionerRole|RelatedPerson) }, // Intended performer of administration
  "performerType" : { CodeableConcept }, // Desired kind of performer of the medication administration
  "recorder" : { Reference(Practitioner|PractitionerRole) }, // Person who entered the request
  "reason" : [{ CodeableReference(Condition|Observation) }], // Reason or indication for ordering or not ordering the medication
  "instantiatesCanonical" : [{ canonical(ActivityDefinition|PlanDefinition) }], // Instantiates FHIR protocol or definition
  "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
  "basedOn" : [{ Reference(CarePlan|ImmunizationRecommendation|
   MedicationRequest|ServiceRequest) }], // What request fulfills
  "groupIdentifier" : { Identifier }, // Composite request this is part of
  "courseOfTherapyType" : { CodeableConcept }, // Overall pattern of medication administration
  "insurance" : [{ Reference(ClaimResponse|Coverage) }], // Associated insurance coverage
  "note" : [{ Annotation }], // Information about the prescription
  "renderedDosageInstruction" : "<string>", // Full representation of the dosage instructions
  "dosageInstruction" : [{ Dosage }], // How the medication should be taken
  "dispenseRequest" : { // Medication supply authorization
    "initialFill" : { // First fill details
      "quantity" : { Quantity(SimpleQuantity) }, // First fill quantity
      "duration" : { Duration } // First fill duration
    },
    "dispenseInterval" : { Duration }, // Minimum period of time between dispenses
    "validityPeriod" : { Period }, // Time period supply is authorized for
    "numberOfRepeatsAllowed" : "<unsignedInt>", // Number of refills authorized
    "quantity" : { Quantity(SimpleQuantity) }, // Amount of medication to supply per dispense
    "expectedSupplyDuration" : { Duration }, // Number of days supply per dispense
    "dispenser" : { Reference(Organization) }, // Intended performer of dispense
    "dispenserInstruction" : [{ Annotation }], // Additional information for the dispenser
    "doseAdministrationAid" : { CodeableConcept } // Type of adherence packaging to use for the dispense
  },
  "substitution" : { // Any restrictions on medication substitution
    // allowed[x]: Whether substitution is allowed or not. One of these 2:
    "allowedBoolean" : <boolean>,
    "allowedCodeableConcept" : { CodeableConcept },
    "reason" : { CodeableConcept } // Why should (not) substitution be made 
  },
  "priorPrescription" : { Reference(MedicationRequest) }, // An order/prescription that is being replaced
  "detectedIssue" : [{ Reference(DetectedIssue) }], // Clinical Issue with action
  "eventHistory" : [{ Reference(Provenance) }] // A list of events of interest in the lifecycle
}

Turtle Template

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


[ a fhir:MedicationRequest;
  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:MedicationRequest.identifier [ Identifier ], ... ; # 0..* External ids for this request
  fhir:MedicationRequest.status [ code ]; # 1..1 active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
  fhir:MedicationRequest.statusReason [ CodeableConcept ]; # 0..1 Reason for current status
  fhir:MedicationRequest.intent [ code ]; # 1..1 proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
  fhir:MedicationRequest.category [ CodeableConcept ], ... ; # 0..* Grouping or category of medication request
  fhir:MedicationRequest.priority [ code ]; # 0..1 routine | urgent | asap | stat
  fhir:MedicationRequest.doNotPerform [ boolean ]; # 0..1 True if patient is to stop taking or not to start taking the medication
  fhir:MedicationRequest.reported [ boolean ]; # 0..1 Reported rather than primary record
  fhir:MedicationRequest.informationSource [ Reference(Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 0..1 The person or organization who provided the information about this request, if the source is someone other than the requestor
  fhir:MedicationRequest.medication [ CodeableReference(Medication) ]; # 1..1 Medication to be taken
  fhir:MedicationRequest.subject [ Reference(Group|Patient) ]; # 1..1 Who or group medication request is for
  fhir:MedicationRequest.encounter [ Reference(Encounter) ]; # 0..1 Encounter created as part of encounter/admission/stay
  fhir:MedicationRequest.supportingInformation [ Reference(Any) ], ... ; # 0..* Information to support ordering of the medication
  fhir:MedicationRequest.authoredOn [ dateTime ]; # 0..1 When request was initially authored
  fhir:MedicationRequest.requester [ Reference(Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 0..1 Who/What requested the Request
  fhir:MedicationRequest.performer [ Reference(CareTeam|Device|HealthcareService|Organization|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ]; # 0..1 Intended performer of administration
  fhir:MedicationRequest.performerType [ CodeableConcept ]; # 0..1 Desired kind of performer of the medication administration
  fhir:MedicationRequest.recorder [ Reference(Practitioner|PractitionerRole) ]; # 0..1 Person who entered the request
  fhir:MedicationRequest.reason [ CodeableReference(Condition|Observation) ], ... ; # 0..* Reason or indication for ordering or not ordering the medication
  fhir:MedicationRequest.instantiatesCanonical [ canonical(ActivityDefinition|PlanDefinition) ], ... ; # 0..* Instantiates FHIR protocol or definition
  fhir:MedicationRequest.instantiatesUri [ uri ], ... ; # 0..* Instantiates external protocol or definition
  fhir:MedicationRequest.basedOn [ Reference(CarePlan|ImmunizationRecommendation|MedicationRequest|ServiceRequest) ], ... ; # 0..* What request fulfills
  fhir:MedicationRequest.groupIdentifier [ Identifier ]; # 0..1 Composite request this is part of
  fhir:MedicationRequest.courseOfTherapyType [ CodeableConcept ]; # 0..1 Overall pattern of medication administration
  fhir:MedicationRequest.insurance [ Reference(ClaimResponse|Coverage) ], ... ; # 0..* Associated insurance coverage
  fhir:MedicationRequest.note [ Annotation ], ... ; # 0..* Information about the prescription
  fhir:MedicationRequest.renderedDosageInstruction [ string ]; # 0..1 Full representation of the dosage instructions
  fhir:MedicationRequest.dosageInstruction [ Dosage ], ... ; # 0..* How the medication should be taken
  fhir:MedicationRequest.dispenseRequest [ # 0..1 Medication supply authorization
    fhir:MedicationRequest.dispenseRequest.initialFill [ # 0..1 First fill details
      fhir:MedicationRequest.dispenseRequest.initialFill.quantity [ Quantity(SimpleQuantity) ]; # 0..1 First fill quantity
      fhir:MedicationRequest.dispenseRequest.initialFill.duration [ Duration ]; # 0..1 First fill duration
    ];
    fhir:MedicationRequest.dispenseRequest.dispenseInterval [ Duration ]; # 0..1 Minimum period of time between dispenses
    fhir:MedicationRequest.dispenseRequest.validityPeriod [ Period ]; # 0..1 Time period supply is authorized for
    fhir:MedicationRequest.dispenseRequest.numberOfRepeatsAllowed [ unsignedInt ]; # 0..1 Number of refills authorized
    fhir:MedicationRequest.dispenseRequest.quantity [ Quantity(SimpleQuantity) ]; # 0..1 Amount of medication to supply per dispense
    fhir:MedicationRequest.dispenseRequest.expectedSupplyDuration [ Duration ]; # 0..1 Number of days supply per dispense
    fhir:MedicationRequest.dispenseRequest.dispenser [ Reference(Organization) ]; # 0..1 Intended performer of dispense
    fhir:MedicationRequest.dispenseRequest.dispenserInstruction [ Annotation ], ... ; # 0..* Additional information for the dispenser
    fhir:MedicationRequest.dispenseRequest.doseAdministrationAid [ CodeableConcept ]; # 0..1 Type of adherence packaging to use for the dispense
  ];
  fhir:MedicationRequest.substitution [ # 0..1 Any restrictions on medication substitution
    # MedicationRequest.substitution.allowed[x] : 1..1 Whether substitution is allowed or not. One of these 2
      fhir:MedicationRequest.substitution.allowedBoolean [ boolean ]
      fhir:MedicationRequest.substitution.allowedCodeableConcept [ CodeableConcept ]
    fhir:MedicationRequest.substitution.reason [ CodeableConcept ]; # 0..1 Why should (not) substitution be made
  ];
  fhir:MedicationRequest.priorPrescription [ Reference(MedicationRequest) ]; # 0..1 An order/prescription that is being replaced
  fhir:MedicationRequest.detectedIssue [ Reference(DetectedIssue) ], ... ; # 0..* Clinical Issue with action
  fhir:MedicationRequest.eventHistory [ Reference(Provenance) ], ... ; # 0..* A list of events of interest in the lifecycle
]

Changes since Release 3

MedicationRequest
MedicationRequest.status
  • Change value set from http://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.0 to http://hl7.org/fhir/ValueSet/medicationrequest-status|4.6.0
MedicationRequest.intent
  • Change value set from http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.0 to http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.6.0
MedicationRequest.priority
  • Change value set from http://hl7.org/fhir/ValueSet/request-priority|4.0.0 to http://hl7.org/fhir/ValueSet/request-priority|4.6.0
MedicationRequest.reported
  • Added Element
MedicationRequest.informationSource
  • Added Element
MedicationRequest.medication
  • Added Mandatory Element
MedicationRequest.performer
  • Type Reference: Added Target Type HealthcareService
MedicationRequest.reason
  • Added Element
MedicationRequest.instantiatesCanonical
  • Type changed from canonical to canonical(PlanDefinition | ActivityDefinition)
MedicationRequest.renderedDosageInstruction
  • Added Element
MedicationRequest.dispenseRequest.dispenser
  • Added Element
MedicationRequest.dispenseRequest.dispenserInstruction
  • Added Element
MedicationRequest.dispenseRequest.doseAdministrationAid
  • Added Element
MedicationRequest.reported[x]
  • deleted
MedicationRequest.medication[x]
  • deleted
MedicationRequest.reasonCode
  • deleted
MedicationRequest.reasonReference
  • deleted
MedicationRequest.dispenseRequest.performer
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 36 tests that all execute ok. 8 fail round-trip testing and 36 r3 resources are invalid (0 errors).)

 

See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis a

11.1.4.1 Terminology Bindings

PathDefinitionTypeReference
MedicationRequest.status Requiredmedicationrequest Status
MedicationRequest.statusReason ExamplemedicationRequest Status Reason Codes
MedicationRequest.intent RequiredmedicationRequest Intent
MedicationRequest.category ExamplemedicationRequest Administration Location Codes
MedicationRequest.priority RequiredRequestPriority
MedicationRequest.medication ExampleSNOMEDCTMedicationCodes
MedicationRequest.performerType ExampleProcedurePerformerRoleCodes
MedicationRequest.reason ExampleCondition/Problem/DiagnosisCodes
MedicationRequest.courseOfTherapyType ExamplemedicationRequest Course of Therapy Codes
MedicationRequest.dispenseRequest.doseAdministrationAid ExampleMedication Dose Aids
MedicationRequest.substitution.allowed[x] ExampleActSubstanceAdminSubstitutionCode
MedicationRequest.substitution.reason A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.ExampleSubstanceAdminSubstitutionReason

11.1.4.2 Dosage Instructions

Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing.

11.1.4.2.1 Grouping Medication Requests

In general, each prescribed drug will be a separate Medication Request.

When drug orders are grouped together at the time of order entry, but each of the drugs can be manipulated independently e.g. changing the status of one order to "completed" or "cancelled", changing another order status to "on-hold", the method to "group" all of the medication requests together is to use MedicationRequest.groupIdentifier element. All of the orders grouped together in this manner will have the same groupIdentifier, and separately, each order in the group may have a unique identifier.

There are cases that require grouping of Medication orders together when it is necessary to specify optionality e.g. order two drugs at one time, but stating either of these drugs may be used to treat the patient. The use of a RequestGroup should be used as a parent for the Medication orders that require this type of grouping. An example when it may be necessary to group medication orders together is when you specify:

  • timing relationships e.g. order drug "xyz" with dose 123, then taper the same drug to a different dose after some interval of time precedence. For example:
    • give drug "abc" followed by drug "def"
    • give drug 30 minutes before some procedure was performed.
  • more generically this supports - hierarchical groups of actions, where each specific action references the action to be performed (in terms of a Request resource), and each group describes additional behavior, relationships, and applicable conditions between the actions in the overall group.

Note that one should NOT use the List or Composition resource to accomplish the above requirements. You may use List or Composition for other business requirements, but not to address the specific requirements of grouping medication orders.

11.1.5 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
authoredon NdateReturn prescriptions written on this dateMedicationRequest.authoredOn
categorytokenReturns prescriptions with different categoriesMedicationRequest.category
code DtokenReturn prescriptions of this medication codeMedicationRequest.medication.concept
combo-datedateReturns medication request to be administered on a specific date or within a date rangeMedicationRequest.dosageInstruction.timing.event | (MedicationRequest.dosageInstruction.timing.repeat.bounds as Period)
encounterreferenceReturn prescriptions with this encounter identifierMedicationRequest.encounter
(Encounter)
identifiertokenReturn prescriptions with this external identifierMedicationRequest.identifier
intended-dispenserreferenceReturns prescriptions intended to be dispensed by this OrganizationMedicationRequest.dispenseRequest.dispenser
(Organization)
intended-performerreferenceReturns the intended performer of the administration of the medication requestMedicationRequest.performer
(Practitioner, Organization, CareTeam, Device, Patient, HealthcareService, PractitionerRole, RelatedPerson)
intended-performertypetokenReturns requests for a specific type of performerMedicationRequest.performerType
intent NtokenReturns prescriptions with different intentsMedicationRequest.intent
medication DreferenceReturn prescriptions for this medication referenceMedicationRequest.medication.reference
patientreferenceReturns prescriptions for a specific patientMedicationRequest.subject.where(resolve() is Patient)
(Group, Patient)
priority NtokenReturns prescriptions with different prioritiesMedicationRequest.priority
requesterreferenceReturns prescriptions prescribed by this prescriberMedicationRequest.requester
(Practitioner, Organization, Device, Patient, PractitionerRole, RelatedPerson)
status NtokenStatus of the prescriptionMedicationRequest.status
subjectreferenceThe identity of a patient to list orders forMedicationRequest.subject
(Group, Patient)