R6 Ballot (1st Draft)

This page is part of the FHIR Specification v6.0.0-ballot1: Release 6 Ballot (1st Draft) (see Ballot Notes). The current version is 5.0.0. For a full list of available versions, see the Directory of published versions

11.5 Resource Medication - Content

Pharmacy icon Work GroupMaturity Level: 4 Trial UseSecurity Category: Business Compartments: No defined compartments

This resource is primarily used for the identification and definition of a medication, including ingredients, for the purposes of prescribing, dispensing, and administering a medication as well as for making statements about medication use.

11.5.1 Scope and Usage

Representing medications in most healthcare settings is a matter of identifying an item from a list and then conveying a reference for the item selected either into a patient-related resource or to other applications. Additional information about the medication is frequently provided for human verification (e.g., the product name), but a full representation of the details of composition and efficacy of the medicine is conveyed by referring to drug dictionaries by means of the codes they define. There are some occasions where it is necessary to identify slightly more detail, such as when dispensing a package containing a particular medication requires identification both of the medicine and the package at once. There are also some occasions (e.g. custom formulations) where the composition of a medicine must be represented. In these cases, the ingredients of the medicine must be specified together with the amount contained, though the Medication resource does not provide full details.

The Medication resource allows for medications to be characterized by the form of the drug and the ingredient (or ingredients), and how it is packaged. The medication will include the ingredient(s), and their strength(s) and the package can include the amount (for example, number of tablets, volume, etc.) that is contained in a particular container (for example, 100 capsules of Amoxicillin 500mg per bottle).

The Medication resource can be used to describe a compounded (aka extemporaneous or magistral) product that is manufactured by the pharmacy at the time of dispensing. In this case there will be multiple ingredients which are typically base chemicals (for example, hydrocortisone powder) and there may be other ingredients that are manufactured products (for example, Glaxal Base).

When a medication includes a package, further details about the composition can be provided. A package has a container (vacuum packed box, jar, etc.) and a list of the products or other packages that are in the package.

11.5.2 References to this Resource

11.5.3 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Medication TUDomainResourceDefinition of a Medication

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierBusiness identifier for this medication

... code Σ0..1CodeableConceptCodes that identify this medication
Binding: SNOMED CT Medication Codes (Example)
... status ?!Σ0..1codeactive | inactive | entered-in-error
Binding: Medication Status Codes (Required)
... doseForm 0..1CodeableConceptpowder | tablets | capsule +
Binding: SNOMED CT Form Codes (Example)
... totalVolume Σ0..1QuantityWhen the specified product code does not infer a package size, this is the specific amount of drug in the product
... ingredient 0..*BackboneElementActive or inactive ingredient

.... item 1..1CodeableReference(Substance | Medication)The ingredient (substance or medication) that the ingredient.strength relates to
Binding: SNOMED CT Medication Codes (Example)
.... isActive 0..1booleanActive ingredient indicator
.... strength[x] 0..1Quantity of ingredient present
Binding: Medication Ingredient Strength Codes (Preferred)
..... strengthRatioRatio
..... strengthCodeableConceptCodeableConcept
..... strengthQuantityQuantity
... batch 0..1BackboneElementDetails about packaged medications
.... lotNumber 0..1stringIdentifier assigned to batch
.... expirationDate 0..1dateTimeWhen batch will expire
... definition 0..1Reference(MedicationKnowledge)Knowledge about this medication

doco Documentation for this format icon

See the Extensions for this resource

UML Diagram (Legend)

Medication (DomainResource)Business identifier for this medicationidentifier : Identifier [0..*]A code (or set of codes) that specify this medication, or a textual description if no code is available. Usage note: This could be a standard medication code such as a code from RxNorm, SNOMED CT, IDMP etc. It could also be a national or local formulary code, optionally with translations to other code systemscode : CodeableConcept [0..1] « null (Strength=Example)SNOMEDCTMedicationCodes?? »A code to indicate if the medication is in active use (this element modifies the meaning of other elements)status : code [0..1] « null (Strength=Required)MedicationStatusCodes! »The company or other legal entity that has authorization, from the appropriate drug regulatory authority, to market a medicine in one or more jurisdictions. Typically abbreviated MAH.Note: The MAH may manufacture the product and may also contract the manufacturing of the product to one or more companies (organizations)marketingAuthorizationHolder : Reference [0..1] « Organization »Describes the form of the item. Powder; tablets; capsuledoseForm : CodeableConcept [0..1] « null (Strength=Example)SNOMEDCTFormCodes?? »When the specified product code does not infer a package size, this is the specific amount of drug in the product. For example, when specifying a product that has the same strength (For example, Insulin glargine 100 unit per mL solution for injection), this attribute provides additional clarification of the package amount (For example, 3 mL, 10mL, etc.)totalVolume : Quantity [0..1]A reference to a knowledge resource that provides more information about this medicationdefinition : Reference [0..1] « MedicationKnowledge »IngredientThe ingredient (substance or medication) that the ingredient.strength relates to. This is represented as a concept from a code system or described in another resource (Substance or Medication)item : CodeableReference [1..1] « Substance|Medication; null (Strength=Example) SNOMEDCTMedicationCodes?? »Indication of whether this ingredient affects the therapeutic action of the drugisActive : boolean [0..1]Specifies how many (or how much) of the items there are in this Medication. For example, 250 mg per tablet. This is expressed as a ratio where the numerator is 250mg and the denominator is 1 tablet but can also be expressed a quantity when the denominator is assumed to be 1 tabletstrength[x] : DataType [0..1] « Ratio|CodeableConcept|Quantity; null (Strength=Preferred) MedicationIngredientStrengthC...? »BatchThe assigned lot number of a batch of the specified productlotNumber : string [0..1]When this specific batch of product will expireexpirationDate : dateTime [0..1]Identifies a particular constituent of interest in the productingredient[0..*]Information that only applies to packages (not products)batch[0..1]

XML Template

<Medication xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business identifier for this medication --></identifier>
 <code><!-- 0..1 CodeableConcept Codes that identify this medication --></code>
 <status value="[code]"/><!-- 0..1 active | inactive | entered-in-error -->
 <marketingAuthorizationHolder><!-- 0..1 Reference(Organization) Organization that has authorization to market medication --></marketingAuthorizationHolder>
 <doseForm><!-- 0..1 CodeableConcept powder | tablets | capsule + --></doseForm>
 <totalVolume><!-- 0..1 Quantity When the specified product code does not infer a package size, this is the specific amount of drug in the product --></totalVolume>
 <ingredient>  <!-- 0..* Active or inactive ingredient -->
  <item><!-- 1..1 CodeableReference(Medication|Substance) The ingredient (substance or medication) that the ingredient.strength relates to --></item>
  <isActive value="[boolean]"/><!-- 0..1 Active ingredient indicator -->
  <strength[x]><!-- 0..1 Ratio|CodeableConcept|Quantity Quantity of ingredient present --></strength[x]>
 </ingredient>
 <batch>  <!-- 0..1 Details about packaged medications -->
  <lotNumber value="[string]"/><!-- 0..1 Identifier assigned to batch -->
  <expirationDate value="[dateTime]"/><!-- 0..1 When batch will expire -->
 </batch>
 <definition><!-- 0..1 Reference(MedicationKnowledge) Knowledge about this medication --></definition>
</Medication>

Turtle Template

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


[ a fhir:Medication;
  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:identifier  ( [ Identifier ] ... ) ; # 0..* Business identifier for this medication
  fhir:code [ CodeableConcept ] ; # 0..1 Codes that identify this medication
  fhir:status [ code ] ; # 0..1 active | inactive | entered-in-error
  fhir:marketingAuthorizationHolder [ Reference(Organization) ] ; # 0..1 Organization that has authorization to market medication
  fhir:doseForm [ CodeableConcept ] ; # 0..1 powder | tablets | capsule +
  fhir:totalVolume [ Quantity ] ; # 0..1 When the specified product code does not infer a package size, this is the specific amount of drug in the product
  fhir:ingredient ( [ # 0..* Active or inactive ingredient
    fhir:item [ CodeableReference(Medication|Substance) ] ; # 1..1 The ingredient (substance or medication) that the ingredient.strength relates to
    fhir:isActive [ boolean ] ; # 0..1 Active ingredient indicator
    # strength[x] : 0..1 Quantity of ingredient present. One of these 3
      fhir:strength [  a fhir:Ratio ; Ratio ]
      fhir:strength [  a fhir:CodeableConcept ; CodeableConcept ]
      fhir:strength [  a fhir:Quantity ; Quantity ]
  ] ... ) ;
  fhir:batch [ # 0..1 Details about packaged medications
    fhir:lotNumber [ string ] ; # 0..1 Identifier assigned to batch
    fhir:expirationDate [ dateTime ] ; # 0..1 When batch will expire
  ] ;
  fhir:definition [ Reference(MedicationKnowledge) ] ; # 0..1 Knowledge about this medication
]

Changes from both R4 and R4B

Medication
Medication.marketingAuthorizationHolder
  • Added Element
Medication.doseForm
  • Added Element
Medication.totalVolume
  • Added Element
Medication.ingredient.item
  • Renamed from item[x] to item
  • Add Type CodeableReference
  • Remove Types CodeableConcept, Reference(Substance | Medication)
Medication.ingredient.strength[x]
  • Renamed from strength to strength[x]
  • Add Types CodeableConcept, Quantity
Medication.definition
  • Added Element
Medication.manufacturer
  • Deleted
Medication.form
  • Deleted
Medication.amount
  • Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

See R4 <--> R5 Conversion Maps (status = See Conversions Summary.)

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Medication TUDomainResourceDefinition of a Medication

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierBusiness identifier for this medication

... code Σ0..1CodeableConceptCodes that identify this medication
Binding: SNOMED CT Medication Codes (Example)
... status ?!Σ0..1codeactive | inactive | entered-in-error
Binding: Medication Status Codes (Required)
... doseForm 0..1CodeableConceptpowder | tablets | capsule +
Binding: SNOMED CT Form Codes (Example)
... totalVolume Σ0..1QuantityWhen the specified product code does not infer a package size, this is the specific amount of drug in the product
... ingredient 0..*BackboneElementActive or inactive ingredient

.... item 1..1CodeableReference(Substance | Medication)The ingredient (substance or medication) that the ingredient.strength relates to
Binding: SNOMED CT Medication Codes (Example)
.... isActive 0..1booleanActive ingredient indicator
.... strength[x] 0..1Quantity of ingredient present
Binding: Medication Ingredient Strength Codes (Preferred)
..... strengthRatioRatio
..... strengthCodeableConceptCodeableConcept
..... strengthQuantityQuantity
... batch 0..1BackboneElementDetails about packaged medications
.... lotNumber 0..1stringIdentifier assigned to batch
.... expirationDate 0..1dateTimeWhen batch will expire
... definition 0..1Reference(MedicationKnowledge)Knowledge about this medication

doco Documentation for this format icon

See the Extensions for this resource

UML Diagram (Legend)

Medication (DomainResource)Business identifier for this medicationidentifier : Identifier [0..*]A code (or set of codes) that specify this medication, or a textual description if no code is available. Usage note: This could be a standard medication code such as a code from RxNorm, SNOMED CT, IDMP etc. It could also be a national or local formulary code, optionally with translations to other code systemscode : CodeableConcept [0..1] « null (Strength=Example)SNOMEDCTMedicationCodes?? »A code to indicate if the medication is in active use (this element modifies the meaning of other elements)status : code [0..1] « null (Strength=Required)MedicationStatusCodes! »The company or other legal entity that has authorization, from the appropriate drug regulatory authority, to market a medicine in one or more jurisdictions. Typically abbreviated MAH.Note: The MAH may manufacture the product and may also contract the manufacturing of the product to one or more companies (organizations)marketingAuthorizationHolder : Reference [0..1] « Organization »Describes the form of the item. Powder; tablets; capsuledoseForm : CodeableConcept [0..1] « null (Strength=Example)SNOMEDCTFormCodes?? »When the specified product code does not infer a package size, this is the specific amount of drug in the product. For example, when specifying a product that has the same strength (For example, Insulin glargine 100 unit per mL solution for injection), this attribute provides additional clarification of the package amount (For example, 3 mL, 10mL, etc.)totalVolume : Quantity [0..1]A reference to a knowledge resource that provides more information about this medicationdefinition : Reference [0..1] « MedicationKnowledge »IngredientThe ingredient (substance or medication) that the ingredient.strength relates to. This is represented as a concept from a code system or described in another resource (Substance or Medication)item : CodeableReference [1..1] « Substance|Medication; null (Strength=Example) SNOMEDCTMedicationCodes?? »Indication of whether this ingredient affects the therapeutic action of the drugisActive : boolean [0..1]Specifies how many (or how much) of the items there are in this Medication. For example, 250 mg per tablet. This is expressed as a ratio where the numerator is 250mg and the denominator is 1 tablet but can also be expressed a quantity when the denominator is assumed to be 1 tabletstrength[x] : DataType [0..1] « Ratio|CodeableConcept|Quantity; null (Strength=Preferred) MedicationIngredientStrengthC...? »BatchThe assigned lot number of a batch of the specified productlotNumber : string [0..1]When this specific batch of product will expireexpirationDate : dateTime [0..1]Identifies a particular constituent of interest in the productingredient[0..*]Information that only applies to packages (not products)batch[0..1]

XML Template

<Medication xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business identifier for this medication --></identifier>
 <code><!-- 0..1 CodeableConcept Codes that identify this medication --></code>
 <status value="[code]"/><!-- 0..1 active | inactive | entered-in-error -->
 <marketingAuthorizationHolder><!-- 0..1 Reference(Organization) Organization that has authorization to market medication --></marketingAuthorizationHolder>
 <doseForm><!-- 0..1 CodeableConcept powder | tablets | capsule + --></doseForm>
 <totalVolume><!-- 0..1 Quantity When the specified product code does not infer a package size, this is the specific amount of drug in the product --></totalVolume>
 <ingredient>  <!-- 0..* Active or inactive ingredient -->
  <item><!-- 1..1 CodeableReference(Medication|Substance) The ingredient (substance or medication) that the ingredient.strength relates to --></item>
  <isActive value="[boolean]"/><!-- 0..1 Active ingredient indicator -->
  <strength[x]><!-- 0..1 Ratio|CodeableConcept|Quantity Quantity of ingredient present --></strength[x]>
 </ingredient>
 <batch>  <!-- 0..1 Details about packaged medications -->
  <lotNumber value="[string]"/><!-- 0..1 Identifier assigned to batch -->
  <expirationDate value="[dateTime]"/><!-- 0..1 When batch will expire -->
 </batch>
 <definition><!-- 0..1 Reference(MedicationKnowledge) Knowledge about this medication --></definition>
</Medication>

Turtle Template

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


[ a fhir:Medication;
  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:identifier  ( [ Identifier ] ... ) ; # 0..* Business identifier for this medication
  fhir:code [ CodeableConcept ] ; # 0..1 Codes that identify this medication
  fhir:status [ code ] ; # 0..1 active | inactive | entered-in-error
  fhir:marketingAuthorizationHolder [ Reference(Organization) ] ; # 0..1 Organization that has authorization to market medication
  fhir:doseForm [ CodeableConcept ] ; # 0..1 powder | tablets | capsule +
  fhir:totalVolume [ Quantity ] ; # 0..1 When the specified product code does not infer a package size, this is the specific amount of drug in the product
  fhir:ingredient ( [ # 0..* Active or inactive ingredient
    fhir:item [ CodeableReference(Medication|Substance) ] ; # 1..1 The ingredient (substance or medication) that the ingredient.strength relates to
    fhir:isActive [ boolean ] ; # 0..1 Active ingredient indicator
    # strength[x] : 0..1 Quantity of ingredient present. One of these 3
      fhir:strength [  a fhir:Ratio ; Ratio ]
      fhir:strength [  a fhir:CodeableConcept ; CodeableConcept ]
      fhir:strength [  a fhir:Quantity ; Quantity ]
  ] ... ) ;
  fhir:batch [ # 0..1 Details about packaged medications
    fhir:lotNumber [ string ] ; # 0..1 Identifier assigned to batch
    fhir:expirationDate [ dateTime ] ; # 0..1 When batch will expire
  ] ;
  fhir:definition [ Reference(MedicationKnowledge) ] ; # 0..1 Knowledge about this medication
]

Changes from both R4 and R4B

Medication
Medication.marketingAuthorizationHolder
  • Added Element
Medication.doseForm
  • Added Element
Medication.totalVolume
  • Added Element
Medication.ingredient.item
  • Renamed from item[x] to item
  • Add Type CodeableReference
  • Remove Types CodeableConcept, Reference(Substance | Medication)
Medication.ingredient.strength[x]
  • Renamed from strength to strength[x]
  • Add Types CodeableConcept, Quantity
Medication.definition
  • Added Element
Medication.manufacturer
  • Deleted
Medication.form
  • Deleted
Medication.amount
  • Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

See R4 <--> R5 Conversion Maps (status = See Conversions Summary.)

 

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

11.5.3.1 Terminology Bindings

PathValueSetTypeDocumentation
Medication.code SNOMEDCTMedicationCodes Example

This value set includes all drug or medicament substance codes and all pharmaceutical/biologic products from SNOMED CT - provided as an exemplar value set.
Medication.status MedicationStatusCodes Required

Medication Status Codes
Medication.doseForm SNOMEDCTFormCodes Example

This value set includes all dose form codes from SNOMED CT - provided as an exemplar.
Medication.ingredient.item SNOMEDCTMedicationCodes Example

This value set includes all drug or medicament substance codes and all pharmaceutical/biologic products from SNOMED CT - provided as an exemplar value set.
Medication.ingredient.strength[x] MedicationIngredientStrengthCodes Preferred

Medication Ingredient Strength Codes

11.5.4 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionExpressionIn Common
codetokenReturns medications for a specific codeMedication.code22 Resources
expiration-datedateReturns medications in a batch with this expiration dateMedication.batch.expirationDate
formtokenReturns medications for a specific dose form
identifiertokenReturns medications with this external identifierMedication.identifier65 Resources
ingredientreferenceReturns medications for this ingredient referenceMedication.ingredient.item.reference
ingredient-codetokenReturns medications for this ingredient codeMedication.ingredient.item.concept
lot-numbertokenReturns medications in a batch with this lot numberMedication.batch.lotNumber
marketingauthorizationholderreferenceReturns medications made or sold for this marketing authorization holderMedication.marketingAuthorizationHolder
(Organization)
serial-numbertokenReturns medications in a batch with this lot numberMedication.identifier
statustokenReturns medications for this statusMedication.status