FHIR Release 3 (STU)

This page is part of the FHIR Specification (v3.0.2: STU 3). 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

Pharmacy Work GroupMaturity Level: 3 Trial UseCompartments: Encounter, Patient, Practitioner

Detailed Descriptions for the elements in the MedicationRequest resource.

MedicationRequest
Definition

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.

Control1..1
Alternate NamesPrescription; Order
MedicationRequest.identifier
Definition

This records 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. For example a re-imbursement system might issue its own id for each prescription that is created. This is particularly important where FHIR only provides part of an entire workflow process where records must be tracked through an entire system.

NoteThis is a business identifer, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
MedicationRequest.definition
Definition

Protocol or definition followed by this request.

Control0..*
TypeReference(ActivityDefinition | PlanDefinition)
Summarytrue
MedicationRequest.basedOn
Definition

A plan or request that is fulfilled in whole or in part by this medication request.

Control0..*
TypeReference(CarePlan | MedicationRequest | ProcedureRequest | ReferralRequest)
Summarytrue
MedicationRequest.groupIdentifier
Definition

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 prescription.

Control0..1
TypeIdentifier
Requirements

Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.

Summarytrue
MedicationRequest.status
Definition

A code specifying the current state of the order. Generally this will be active or completed state.

Control0..1
Terminology BindingMedicationRequestStatus (Required)
Typecode
Is Modifiertrue
Summarytrue
Comments

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

MedicationRequest.intent
Definition

Whether the request is a proposal, plan, or an original order.

Control1..1
Terminology BindingMedicationRequestIntent (Required)
Typecode
Is Modifiertrue
Summarytrue
Comments

It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only.

An instance-order is an instantiation of a request or order and may be used to populate Medication Administration Record.

This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.

MedicationRequest.category
Definition

Indicates the type of medication order and where the medication is expected to be consumed or administered.

Control0..1
Terminology BindingMedicationRequestCategory (Preferred)
TypeCodeableConcept
MedicationRequest.priority
Definition

Indicates how quickly the Medication Request should be addressed with respect to other requests.

Control0..1
Terminology BindingMedicationRequestPriority (Required)
Typecode
Summarytrue
MedicationRequest.medication[x]
Definition

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 medications.

Control1..1
Terminology BindingSNOMED CT Medication Codes (Example)
TypeCodeableConcept|Reference(Medication)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
Comments

If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended.  For example, if you require form or lot number or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource. .

MedicationRequest.subject
Definition

A link to a resource representing the person or set of individuals to whom the medication will be given.

Control1..1
TypeReference(Patient | Group)
Summarytrue
Comments

The subject on a medication request is mandatory. For the secondary use case where the actual subject is not provided, there still must be an anonymized subject specified.

MedicationRequest.context
Definition

A link to an encounter, or episode of care, that identifies the particular occurrence or set occurrences of contact between patient and health care provider.

Control0..1
TypeReference(Encounter | EpisodeOfCare)
Comments

SubstanceAdministration->component->EncounterEvent.

MedicationRequest.supportingInformation
Definition

Include additional information (for example, patient height and weight) that supports the ordering of the medication.

Control0..*
TypeReference(Any)
MedicationRequest.authoredOn
Definition

The date (and perhaps time) when the prescription was initially written or authored on.

Control0..1
TypedateTime
Summarytrue
MedicationRequest.requester
Definition

The individual, organization or device that initiated the request and has responsibility for its activation.

Control0..1
Summarytrue
InvariantsDefined on this element
mps-1: onBehalfOf can only be specified if agent is practitioner or device (expression : (agent.resolve().empty()) or (agent.resolve() is Device) or (agent.resolve() is Practitioner) or onBehalfOf.exists().not(), xpath: contains(f:agent/f:reference/@value, '/Practitioner/') or contains(f:agent/f:reference/@value, '/Device/') or not(exists(f:onBehalfOf)))
MedicationRequest.requester.agent
Definition

The healthcare professional responsible for authorizing the initial prescription.

Control1..1
TypeReference(Practitioner | Organization | Patient | RelatedPerson | Device)
Summarytrue
Comments

It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only.

MedicationRequest.requester.onBehalfOf
Definition

The organization the device or practitioner was acting on behalf of.

Control0..1
TypeReference(Organization)
Requirements

Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when authoring the request.

Summarytrue
InvariantsAffect this element
mps-1: onBehalfOf can only be specified if agent is practitioner or device (expression : (agent.resolve().empty()) or (agent.resolve() is Device) or (agent.resolve() is Practitioner) or onBehalfOf.exists().not(), xpath: contains(f:agent/f:reference/@value, '/Practitioner/') or contains(f:agent/f:reference/@value, '/Device/') or not(exists(f:onBehalfOf)))
MedicationRequest.recorder
Definition

The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order.

Control0..1
TypeReference(Practitioner)
MedicationRequest.reasonCode
Definition

The reason or the indication for ordering the medication.

Control0..*
Terminology BindingCondition/Problem/Diagnosis Codes (Example)
TypeCodeableConcept
Comments

This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference.

MedicationRequest.reasonReference
Definition

Condition or observation that supports why the medication was ordered.

Control0..*
TypeReference(Condition | Observation)
Comments

This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode.

MedicationRequest.note
Definition

Extra information about the prescription that could not be conveyed by the other attributes.

Control0..*
TypeAnnotation
MedicationRequest.dosageInstruction
Definition

Indicates how the medication is to be used by the patient.

Control0..*
TypeDosage
Comments

There are examples where a medication request may include the option of an oral dose or an Intravenous or Intramuscular dose. For example, "Ondansetron 8mg orally or IV twice a day as needed for nausea" or "Compazine® (prochlorperazine) 5-10mg PO or 25mg PR bid prn nausea or vomiting". In these cases, two medication requests would be created that could be grouped together. The decision on which dose and route of administration to use is based on the patient's condition at the time the dose is needed.

MedicationRequest.dispenseRequest
Definition

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 department.

Control0..1
MedicationRequest.dispenseRequest.validityPeriod
Definition

This indicates the validity period of a prescription (stale dating the Prescription).

Control0..1
TypePeriod
Requirements

Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.

Comments

It reflects the prescribers' perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations.

MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
Definition

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.

Control0..1
TypepositiveInt
Comments

If displaying "number of authorized fills", add 1 to this number.

MedicationRequest.dispenseRequest.quantity
Definition

The amount that is to be dispensed for one fill.

Control0..1
TypeSimpleQuantity
MedicationRequest.dispenseRequest.expectedSupplyDuration
Definition

Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last.

Control0..1
TypeDuration
Comments

In some situations, this attribute may be used instead of quantity to identify the amount supplied by how long it is expected to last, rather than the physical quantity issued, e.g. 90 days supply of medication (based on an ordered dosage) When possible, it is always better to specify quantity, as this tends to be more precise. expectedSupplyDuration will always be an estimate that can be influenced by external factors.

MedicationRequest.dispenseRequest.performer
Definition

Indicates the intended dispensing Organization specified by the prescriber.

Control0..1
TypeReference(Organization)
MedicationRequest.substitution
Definition

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 done.

Control0..1
MedicationRequest.substitution.allowed
Definition

True if the prescriber allows a different drug to be dispensed from what was prescribed.

Control1..1
Typeboolean
Is Modifiertrue
Comments

This element is labeled as a modifer because whether substitution is allow or not cannot be ignored.

MedicationRequest.substitution.reason
Definition

Indicates the reason for the substitution, or why substitution must or must not be performed.

Control0..1
Terminology BindingSubstanceAdminSubstitutionReason (Example)
TypeCodeableConcept
MedicationRequest.priorPrescription
Definition

A link to a resource representing an earlier order related order or prescription.

Control0..1
TypeReference(MedicationRequest)
MedicationRequest.detectedIssue
Definition

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 etc.

Control0..*
TypeReference(DetectedIssue)
Alternate NamesContraindication; Drug Utilization Review (DUR); Alert
MedicationRequest.eventHistory
Definition

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 resource.

Control0..*
TypeReference(Provenance)
Comments

This may not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).