Release 4B Snapshot #1
This page is part of the FHIR Specification (v4.3.0-snapshot1: Release 4B Snapshot #1). 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
Medicationstatementexample1.xml

Pharmacy Work Group
Maturity Level: N/A
Standards Status: Informative
Compartments: Patient, Practitioner, RelatedPerson
Raw XML (canonical form + also see XML Format Specification)
Jump past Narrative
Patient reports they are taking Tylenol PM and has the bottle (id = "example001")
<?xml version="1.0" encoding="UTF-8"?>

<MedicationStatement xmlns="http://hl7.org/fhir">
  <id value="example001"/> 
  <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><p> <b> Generated Narrative</b> </p> <div> <p> Resource &quot;example001&quot; </p> </div> <p> <b> identifier</b> : id: 12345689 (OFFICIAL)</p> <p> <b> status</b> : active</p> <p> <b> category</b> : Inpatient <span>  (<a> MedicationStatement Category Codes</a> #inpatient)</span> </p> <p> <b> medication</b> : <a>  </a> </p> <blockquote> <div> <p> Resource &quot;med0309&quot; </p> </div> <p> <b> code</b> : Tylenol PM <span>  (<a> National drug codes</a> #50580-506-02)</span> </p> <p> <b> form</b> : Film-coated tablet (qualifier value) <span>  (<a> SNOMED CT</a> #385057009)</span> </p> <blockquote> <p> <b> ingredient</b> </p> <p> <b> item</b> : Acetaminophen 500 MG <span>  (<a> RxNorm</a> #315266)</span> </p> <p> <b> strength</b> : 500 mg<span>  (Details: UCUM code mg = 'mg')</span> /1 Tab<span>  (Details: http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm code Tab = 'Tab')</span> </p> </blockquote> <blockquote> <p> <b> ingredient</b> </p> <p> <b> item</b> : Diphenhydramine Hydrochloride 25 mg <span>  (<a> RxNorm</a> #901813)</span> </p> <p> <b> strength</b> : 25 mg<span>  (Details: UCUM code mg = 'mg')</span> /1 Tab<span>  (Details: http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm code Tab = 'Tab')</span> </p> </blockquote> <h3> Batches</h3> <table> <tr> <td> -</td> <td> <b> LotNumber</b> </td> <td> <b> ExpirationDate</b> </td> </tr> <tr> <td> *</td> <td> 9494788</td> <td> 2017-05-22</td> </tr> </table> </blockquote> <p> <b> subject</b> : <a> Patient/pat1: Donald Duck</a>  &quot;Duck DONALD&quot;</p> <p> <b> effective</b> : 2015-01-23</p> <p> <b> dateAsserted</b> : 2015-02-22</p> <p> <b> informationSource</b> : <a> Patient/pat1: Donald Duck</a>  &quot;Duck DONALD&quot;</p> <p> <b> derivedFrom</b> : <a> MedicationRequest/medrx002</a> </p> <p> <b> reasonCode</b> : Restless Legs <span>  (<a> SNOMED CT</a> #32914008)</span> </p> <p> <b> note</b> : Patient indicates they miss the occasional dose</p> </div> </text> <contained> 
    <Medication> 
      <id value="med0309"/> 
    <code> 
      <coding> 
        <system value="http://hl7.org/fhir/sid/ndc"/> 
        <code value="50580-506-02"/> 
        <display value="Tylenol PM"/> 
      </coding> 
    </code> 
      <form> 
        <coding> 
          <system value="http://snomed.info/sct"/> 
          <code value="385057009"/> 
          <display value="Film-coated tablet (qualifier value)"/> 
        </coding> 
      </form> 
      <ingredient> 
        <itemCodeableConcept> 
          <coding> 
            <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/> 
            <code value="315266"/> 
            <display value="Acetaminophen 500 MG"/> 
          </coding> 
        </itemCodeableConcept> 
        <strength> 
          <numerator> 
            <value value="500"/> 
            <system value="http://unitsofmeasure.org"/> 
            <code value="mg"/> 
          </numerator> 
          <denominator> 
            <value value="1"/> 
            <system value="http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm"/> 
            <code value="Tab"/> 
          </denominator> 
        </strength> 
      </ingredient> 
      <ingredient> 
        <itemCodeableConcept> 
          <coding> 
            <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/> 
            <code value="901813"/> 
            <display value="Diphenhydramine Hydrochloride 25 mg"/> 
          </coding> 
        </itemCodeableConcept> 
        <strength> 
          <numerator> 
            <value value="25"/> 
            <system value="http://unitsofmeasure.org"/> 
            <code value="mg"/> 
          </numerator> 
          <denominator> 
            <value value="1"/> 
            <system value="http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm"/> 
            <code value="Tab"/> 
          </denominator> 
        </strength> 
      </ingredient> 
      <batch> 
        <lotNumber value="9494788"/> 
        <expirationDate value="2017-05-22"/> 
      </batch>  

    </Medication> 
  </contained> 
  <identifier> 
    <use value="official"/> 
    <system value="http://www.bmc.nl/portal/medstatements"/> 
    <value value="12345689"/> 
  </identifier> 
  <status value="active"/> 
  <category> 
    <coding> 
      <system value="http://terminology.hl7.org/CodeSystem/medication-statement-category"/> 
      <code value="inpatient"/> 
      <display value="Inpatient"/> 
    </coding> 
  </category> 
  <medicationReference>  <!--    Linked to a RESOURCE Medication    -->
    <reference value="#med0309"/> 
  </medicationReference>  
  <subject> 
    <reference value="Patient/pat1"/> 
    <display value="Donald Duck"/>  
  </subject>  
  <effectiveDateTime value="2015-01-23"/> 
  <dateAsserted value="2015-02-22"/> 
  <informationSource> 
    <reference value="Patient/pat1"/> 
    <display value="Donald Duck"/>  
  </informationSource> 
  <derivedFrom> 
    <reference value="MedicationRequest/medrx002"/> 
  </derivedFrom> 
  <reasonCode> 
    <coding> 
      <system value="http://snomed.info/sct"/> 
      <code value="32914008"/> 
      <display value="Restless Legs"/> 
    </coding> 
  </reasonCode> 



  <note> 
    <text value="Patient indicates they miss the occasional dose"/> 
  </note> 
  <dosage> 
    <sequence value="1"/> 
    <text value="1-2 tablets once daily at bedtime as needed for restless legs"/> 
    <additionalInstruction> 
      <text value="Taking at bedtime"/> 
    </additionalInstruction> 
    <timing> 
      <repeat> 
          <frequency value="1"/> 
        <period value="1"/> 
        <periodUnit value="d"/> 
      </repeat> 
    </timing> 
      <asNeededCodeableConcept> 
        <coding> 
          <system value="http://snomed.info/sct"/> 
          <code value="32914008"/> 
          <display value="Restless Legs"/> 
        </coding> 
      </asNeededCodeableConcept> 
    <route> 
      <coding> 
      <system value="http://snomed.info/sct"/> 
          <code value="26643006"/> 
          <display value="Oral Route"/> 
      </coding> 
    </route> 
    <doseAndRate> 
      <type> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/dose-rate-type"/> 
          <code value="ordered"/> 
          <display value="Ordered"/> 
        </coding> 
      </type> 
      <doseRange> 
        <low> 
          <value value="1"/> 
          <unit value="TAB"/> 
          <system value="http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm"/> 
          <code value="TAB"/> 
        </low> 
        <high> 
          <value value="2"/> 
          <unit value="TAB"/> 
          <system value="http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm"/> 
          <code value="TAB"/> 
        </high> 
      </doseRange> 
    </doseAndRate> 
    
  </dosage> 
</MedicationStatement>
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.