US Core Implementation Guide
6.0.0-ballot - STU6 Ballot US

This page is part of the US Core (v6.0.0-ballot: STU6 Ballot 1) based on FHIR R4. The current version which supercedes this version is 5.0.1. For a full list of available versions, see the Directory of published versions

Resource Profile: US Core MedicationRequest Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest Version: 6.0.0-ballot
Active as of 2020-06-26 Computable Name: USCoreMedicationRequestProfile

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

The US Core Medication Request Profile is based upon the core FHIR MedicationRequest Resource and meets the U.S. Core Data for Interoperability (USCDI) v2 Medications requirements. The MedicationRequest resource can be used to record a patient’s medication prescription or order. This profile sets minimum expectations for the MedicationRequest resource to record, search, and fetch a patient’s medication to promote interoperability and adoption through common implementation. It identifies which core elements, extensions, vocabularies, and value sets SHALL be present in the resource when using this profile. It provides the floor for standards development for specific use cases.

Example Usage Scenarios:

The following are example usage scenarios for the US Core-MedicationRequest profile. See the Medication List section for guidance on accessing a patient medications:

  • Fetching all medications that have been prescribed to a particular patient
  • Fetching all active medications that have been prescribed to particular patient
  • Fetching all medications that have been prescribed to particular patient during a particular encounter
  • Record or update medications that have been prescribed for a particular patient

Mandatory and Must Support Data Elements

The following data-elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each MedicationRequest must have:

  1. a status
  2. an intent code
  3. a medication*
  4. a patient
  5. a prescriber

* see guidance below

Each MedicationRequest must support:

  1. the category (e.g. Discharge Medication)
  2. the reported flag or reference signaling that information is from a secondary source such as a patient
  3. the encounters
  4. a date for when written
  5. the prescription Sig
  6. the amount dispensed and number of refills
  7. the dose and rate

Additional USCDI Requirements

For ONC’s USCDI requirements, each MedicationRequest must support the following additional elements. These elements are included in the formal definition of the profile, and they are represented in the examples.

  1. the reason or indication for the prescription*

*see guidance below

Profile specific implementation guidance:

  • See the Medication List section for guidance on accessing a patient medications including over the counter (OTC) medication and other substances taken for medical and recreational use.
  • *This Profile can represent a medication using a code or reference a Medication resource.
    • When using a code, RXNorm concepts are used. They are defined as an extensible binding to .medicationCodeableConcept. USCDI V3+ recommends the National Drug Codes (NDC) as an optional terminology. They can be supplied as an additional coding element.
    • When referencing a Medication resource in .medicationReference, the resource may be contained or an external resource.
    • The server systems are not required to support both a code and a reference, but SHALL support at least one of these methods.
    • If an external reference to a Medication resource is used, the server SHALL support the _include parameter for searching this element.
    • The client application SHALL support all methods.
  • The MedicationRequest resource can represent that information is from a secondary source using either a boolean flag or a reference using MedicationRequest.reportedReference.
    • Although both are marked as must support, the server system is not required to support both, but SHALL support at least one of these elements.
    • The client application SHALL support both elements.
  • *The MedicationRequest resource can communicate the reason or indication for referral or consultation using either a code in MedicationRequest.reasonCodeableConcept or a reference using MedicationRequest.reasonReference.
  • Source EHR identifiers SHOULD be included to support deduplication across MedicationRequest resources. Exposing the EHR identifiers helps client applications identify duplicates.
  • Servers SHALL follow the guidance in the Medication List page and return all active Medications as MedicationRequest. It is always best practice to confirm this list with the Patient or Caregiver.

Usage:

  • Refer to this Resource Profile:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from MedicationRequest

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest 0..*MedicationRequestOrdering of medication for patient or group
... status S1..1codeactive | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.

... intent S1..1codeproposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
Binding: medicationRequest Intent (required): The kind of medication order.

... Slices for category S0..*CodeableConceptType of medication usage
Slice: Unordered, Open by pattern:$this
.... category:us-core S0..*CodeableConceptType of medication usage
Binding: medicationRequest Category Codes (required): The type of medication order.

... reported[x] S0..1Reported rather than primary record
.... reportedBooleanboolean S
.... reportedReferenceReference S(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile)
... medication[x] S1..1Medication to be taken
Binding: Medication Clinical Drug (extensible)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject S1..1Reference(US Core Patient Profile)Who or group medication request is for
... encounter S0..1Reference(US Core Encounter Profile)Encounter created as part of encounter/admission/stay
... authoredOn S0..1dateTimeWhen request was initially authored
... requester S1..1Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device)Who/What requested the Request
... reasonCode 0..*CodeableConceptReason or indication for ordering or not ordering the medication
Binding: US Core Condition Codes (extensible)
... reasonReference 0..*Reference(US Core Condition Encounter Diagnosis Profile | US Core Condition Problems and Health Concerns Profile | US Core Laboratory Result Observation Profile | US Core Observation Pregnancy Status Profile | US Core Observation Pregnancy Intent Profile | US Core Observation Occupation Profile | US Core Respiratory Rate Profile | US Core Simple Observation Profile | US Core Heart Rate Profile | US Core Smoking Status Observation Profile | US Core Observation Screening Assessment Profile | US Core Observation Clinical Result Profile | US Core Vital Signs Profile)Condition or observation that supports why the prescription is being written
... dosageInstruction S0..*DosageHow the medication should be taken
.... text S0..1stringFree text dosage instructions e.g. SIG
.... timing S0..1TimingWhen medication should be administered
.... doseAndRate S0..*ElementAmount of medication administered
..... dose[x] S0..1Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
...... doseQuantityQuantity S
...... doseRangeRange
... dispenseRequest S0..1BackboneElementMedication supply authorization
.... numberOfRepeatsAllowed S0..1unsignedIntNumber of refills authorized
.... quantity S0..1SimpleQuantityAmount of medication to supply per dispense

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
MedicationRequest.statusrequiredmedicationrequest Status
MedicationRequest.intentrequiredmedicationRequest Intent
MedicationRequest.category:us-corerequiredmedicationRequest Category Codes
MedicationRequest.medication[x]extensibleMedication Clinical Drug
MedicationRequest.reasonCodeextensibleUSCoreConditionCodes
MedicationRequest.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest 0..*MedicationRequestOrdering of medication for patient or group
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... status ?!SΣ1..1codeactive | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.

... intent ?!SΣ1..1codeproposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
Binding: medicationRequest Intent (required): The kind of medication order.

... Slices for category S0..*CodeableConceptType of medication usage
Slice: Unordered, Open by pattern:$this
Binding: medicationRequest Category Codes (example): A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.


.... category:us-core S0..*CodeableConceptType of medication usage
Binding: medicationRequest Category Codes (required): The type of medication order.


... doNotPerform ?!Σ0..1booleanTrue if request is prohibiting action
... reported[x] SΣ0..1Reported rather than primary record
.... reportedBooleanboolean
.... reportedReferenceReference(US Core Practitioner Profile)
... medication[x] SΣ1..1Medication to be taken
Binding: Medication Clinical Drug (extensible)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject SΣ1..1Reference(US Core Patient Profile)Who or group medication request is for
... encounter S0..1Reference(US Core Encounter Profile)Encounter created as part of encounter/admission/stay
... authoredOn SΣ0..1dateTimeWhen request was initially authored
... requester SΣ1..1Reference(US Core Practitioner Profile)Who/What requested the Request
... reasonCode 0..*CodeableConceptReason or indication for ordering or not ordering the medication
Binding: US Core Condition Codes (extensible)
... reasonReference 0..*Reference(US Core Condition Encounter Diagnosis Profile | US Core Condition Problems and Health Concerns Profile | US Core Laboratory Result Observation Profile | US Core Observation Pregnancy Status Profile | US Core Observation Pregnancy Intent Profile | US Core Observation Occupation Profile | US Core Respiratory Rate Profile | US Core Simple Observation Profile | US Core Heart Rate Profile | US Core Smoking Status Observation Profile | US Core Observation Screening Assessment Profile | US Core Observation Clinical Result Profile | US Core Vital Signs Profile)Condition or observation that supports why the prescription is being written
... dosageInstruction S0..*DosageHow the medication should be taken
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... text SΣ0..1stringFree text dosage instructions e.g. SIG
.... timing SΣ0..1TimingWhen medication should be administered
.... doseAndRate SΣ0..*ElementAmount of medication administered
..... dose[x] SΣ0..1Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
...... doseQuantityQuantity
... dispenseRequest S0..1BackboneElementMedication supply authorization
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... numberOfRepeatsAllowed S0..1unsignedIntNumber of refills authorized
.... quantity S0..1SimpleQuantityAmount of medication to supply per dispense

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
MedicationRequest.statusrequiredmedicationrequest Status
MedicationRequest.intentrequiredmedicationRequest Intent
MedicationRequest.categoryexamplemedicationRequest Category Codes
MedicationRequest.category:us-corerequiredmedicationRequest Category Codes
MedicationRequest.medication[x]extensibleMedication Clinical Drug
MedicationRequest.reasonCodeextensibleUSCoreConditionCodes
MedicationRequest.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest 0..*MedicationRequestOrdering of medication for patient or group
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierExternal ids for this request
... status ?!SΣ1..1codeactive | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.

... statusReason 0..1CodeableConceptReason for current status
Binding: medicationRequest Status Reason Codes (example): Identifies the reasons for a given status.

... intent ?!SΣ1..1codeproposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
Binding: medicationRequest Intent (required): The kind of medication order.

... Slices for category S0..*CodeableConceptType of medication usage
Slice: Unordered, Open by pattern:$this
Binding: medicationRequest Category Codes (example): A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.


.... category:us-core S0..*CodeableConceptType of medication usage
Binding: medicationRequest Category Codes (required): The type of medication order.


... priority Σ0..1coderoutine | urgent | asap | stat
Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.

... doNotPerform ?!Σ0..1booleanTrue if request is prohibiting action
... reported[x] SΣ0..1Reported rather than primary record
.... reportedBooleanboolean S
.... reportedReferenceReference S(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile)
... medication[x] SΣ1..1Medication to be taken
Binding: Medication Clinical Drug (extensible)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject SΣ1..1Reference(US Core Patient Profile)Who or group medication request is for
... encounter S0..1Reference(US Core Encounter Profile)Encounter created as part of encounter/admission/stay
... supportingInformation 0..*Reference(Resource)Information to support ordering of the medication
... authoredOn SΣ0..1dateTimeWhen request was initially authored
... requester SΣ1..1Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device)Who/What requested the Request
... performer 0..1Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam)Intended performer of administration
... performerType Σ0..1CodeableConceptDesired kind of performer of the medication administration
Binding: ProcedurePerformerRoleCodes (example): Identifies the type of individual that is desired to administer the medication.

... recorder 0..1Reference(Practitioner | PractitionerRole)Person who entered the request
... reasonCode 0..*CodeableConceptReason or indication for ordering or not ordering the medication
Binding: US Core Condition Codes (extensible)
... reasonReference 0..*Reference(US Core Condition Encounter Diagnosis Profile | US Core Condition Problems and Health Concerns Profile | US Core Laboratory Result Observation Profile | US Core Observation Pregnancy Status Profile | US Core Observation Pregnancy Intent Profile | US Core Observation Occupation Profile | US Core Respiratory Rate Profile | US Core Simple Observation Profile | US Core Heart Rate Profile | US Core Smoking Status Observation Profile | US Core Observation Screening Assessment Profile | US Core Observation Clinical Result Profile | US Core Vital Signs Profile)Condition or observation that supports why the prescription is being written
... instantiatesCanonical Σ0..*canonical()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
Binding: medicationRequest Course of Therapy Codes (example): Identifies the overall pattern of medication administratio.

... insurance 0..*Reference(Coverage | ClaimResponse)Associated insurance coverage
... note 0..*AnnotationInformation about the prescription
... dosageInstruction S0..*DosageHow the medication should be taken
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence Σ0..1integerThe order of the dosage instructions
.... text SΣ0..1stringFree text dosage instructions e.g. SIG
.... additionalInstruction Σ0..*CodeableConceptSupplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".


.... patientInstruction Σ0..1stringPatient or consumer oriented instructions
.... timing SΣ0..1TimingWhen medication should be administered
.... asNeeded[x] Σ0..1Take "as needed" (for x)
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.

..... asNeededBooleanboolean
..... asNeededCodeableConceptCodeableConcept
.... site Σ0..1CodeableConceptBody site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.

.... route Σ0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

.... method Σ0..1CodeableConceptTechnique for administering medication
Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.

.... doseAndRate SΣ0..*ElementAmount of medication administered
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... type Σ0..1CodeableConceptThe kind of dose or rate specified
Binding: DoseAndRateType (example): The kind of dose or rate specified.

..... dose[x] SΣ0..1Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
...... doseQuantityQuantity S
...... doseRangeRange
..... rate[x] Σ0..1Amount of medication per unit of time
...... rateRatioRatio
...... rateRangeRange
...... rateQuantityQuantity(SimpleQuantity)
.... maxDosePerPeriod Σ0..1RatioUpper limit on medication per unit of time
.... maxDosePerAdministration Σ0..1SimpleQuantityUpper limit on medication per administration
.... maxDosePerLifetime Σ0..1SimpleQuantityUpper limit on medication per lifetime of the patient
... dispenseRequest S0..1BackboneElementMedication supply authorization
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... initialFill 0..1BackboneElementFirst fill details
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... 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 S0..1unsignedIntNumber of refills authorized
.... quantity S0..1SimpleQuantityAmount of medication to supply per dispense
.... expectedSupplyDuration 0..1DurationNumber of days supply per dispense
.... performer 0..1Reference(Organization)Intended dispenser
... substitution 0..1BackboneElementAny restrictions on medication substitution
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... allowed[x] 1..1Whether substitution is allowed or not
Binding: ActSubstanceAdminSubstitutionCode (example): Identifies the type of substitution allowed.

..... allowedBooleanboolean
..... allowedCodeableConceptCodeableConcept
.... reason 0..1CodeableConceptWhy should (not) substitution be made
Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.

... 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

Terminology Bindings

PathConformanceValueSet
MedicationRequest.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
MedicationRequest.statusrequiredmedicationrequest Status
MedicationRequest.statusReasonexamplemedicationRequest Status Reason Codes
MedicationRequest.intentrequiredmedicationRequest Intent
MedicationRequest.categoryexamplemedicationRequest Category Codes
MedicationRequest.category:us-corerequiredmedicationRequest Category Codes
MedicationRequest.priorityrequiredRequestPriority
MedicationRequest.medication[x]extensibleMedication Clinical Drug
MedicationRequest.performerTypeexampleProcedurePerformerRoleCodes
MedicationRequest.reasonCodeextensibleUSCoreConditionCodes
MedicationRequest.courseOfTherapyTypeexamplemedicationRequest Course of Therapy Codes
MedicationRequest.dosageInstruction.additionalInstructionexampleSNOMEDCTAdditionalDosageInstructions
MedicationRequest.dosageInstruction.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
MedicationRequest.dosageInstruction.siteexampleSNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationRequest.dosageInstruction.routeexampleSNOMEDCTRouteCodes
MedicationRequest.dosageInstruction.methodexampleSNOMEDCTAdministrationMethodCodes
MedicationRequest.dosageInstruction.doseAndRate.typeexampleDoseAndRateType
MedicationRequest.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
MedicationRequest.substitution.allowed[x]exampleActSubstanceAdminSubstitutionCode
MedicationRequest.substitution.reasonexampleSubstanceAdminSubstitutionReason

This structure is derived from MedicationRequest

Summary

Mandatory: 1 element
Must-Support: 18 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element MedicationRequest.category is sliced based on the value of pattern:$this

Differential View

This structure is derived from MedicationRequest

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest 0..*MedicationRequestOrdering of medication for patient or group
... status S1..1codeactive | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.

... intent S1..1codeproposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
Binding: medicationRequest Intent (required): The kind of medication order.

... Slices for category S0..*CodeableConceptType of medication usage
Slice: Unordered, Open by pattern:$this
.... category:us-core S0..*CodeableConceptType of medication usage
Binding: medicationRequest Category Codes (required): The type of medication order.

... reported[x] S0..1Reported rather than primary record
.... reportedBooleanboolean S
.... reportedReferenceReference S(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile)
... medication[x] S1..1Medication to be taken
Binding: Medication Clinical Drug (extensible)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject S1..1Reference(US Core Patient Profile)Who or group medication request is for
... encounter S0..1Reference(US Core Encounter Profile)Encounter created as part of encounter/admission/stay
... authoredOn S0..1dateTimeWhen request was initially authored
... requester S1..1Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device)Who/What requested the Request
... reasonCode 0..*CodeableConceptReason or indication for ordering or not ordering the medication
Binding: US Core Condition Codes (extensible)
... reasonReference 0..*Reference(US Core Condition Encounter Diagnosis Profile | US Core Condition Problems and Health Concerns Profile | US Core Laboratory Result Observation Profile | US Core Observation Pregnancy Status Profile | US Core Observation Pregnancy Intent Profile | US Core Observation Occupation Profile | US Core Respiratory Rate Profile | US Core Simple Observation Profile | US Core Heart Rate Profile | US Core Smoking Status Observation Profile | US Core Observation Screening Assessment Profile | US Core Observation Clinical Result Profile | US Core Vital Signs Profile)Condition or observation that supports why the prescription is being written
... dosageInstruction S0..*DosageHow the medication should be taken
.... text S0..1stringFree text dosage instructions e.g. SIG
.... timing S0..1TimingWhen medication should be administered
.... doseAndRate S0..*ElementAmount of medication administered
..... dose[x] S0..1Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
...... doseQuantityQuantity S
...... doseRangeRange
... dispenseRequest S0..1BackboneElementMedication supply authorization
.... numberOfRepeatsAllowed S0..1unsignedIntNumber of refills authorized
.... quantity S0..1SimpleQuantityAmount of medication to supply per dispense

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
MedicationRequest.statusrequiredmedicationrequest Status
MedicationRequest.intentrequiredmedicationRequest Intent
MedicationRequest.category:us-corerequiredmedicationRequest Category Codes
MedicationRequest.medication[x]extensibleMedication Clinical Drug
MedicationRequest.reasonCodeextensibleUSCoreConditionCodes
MedicationRequest.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest 0..*MedicationRequestOrdering of medication for patient or group
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... status ?!SΣ1..1codeactive | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.

... intent ?!SΣ1..1codeproposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
Binding: medicationRequest Intent (required): The kind of medication order.

... Slices for category S0..*CodeableConceptType of medication usage
Slice: Unordered, Open by pattern:$this
Binding: medicationRequest Category Codes (example): A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.


.... category:us-core S0..*CodeableConceptType of medication usage
Binding: medicationRequest Category Codes (required): The type of medication order.


... doNotPerform ?!Σ0..1booleanTrue if request is prohibiting action
... reported[x] SΣ0..1Reported rather than primary record
.... reportedBooleanboolean
.... reportedReferenceReference(US Core Practitioner Profile)
... medication[x] SΣ1..1Medication to be taken
Binding: Medication Clinical Drug (extensible)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject SΣ1..1Reference(US Core Patient Profile)Who or group medication request is for
... encounter S0..1Reference(US Core Encounter Profile)Encounter created as part of encounter/admission/stay
... authoredOn SΣ0..1dateTimeWhen request was initially authored
... requester SΣ1..1Reference(US Core Practitioner Profile)Who/What requested the Request
... reasonCode 0..*CodeableConceptReason or indication for ordering or not ordering the medication
Binding: US Core Condition Codes (extensible)
... reasonReference 0..*Reference(US Core Condition Encounter Diagnosis Profile | US Core Condition Problems and Health Concerns Profile | US Core Laboratory Result Observation Profile | US Core Observation Pregnancy Status Profile | US Core Observation Pregnancy Intent Profile | US Core Observation Occupation Profile | US Core Respiratory Rate Profile | US Core Simple Observation Profile | US Core Heart Rate Profile | US Core Smoking Status Observation Profile | US Core Observation Screening Assessment Profile | US Core Observation Clinical Result Profile | US Core Vital Signs Profile)Condition or observation that supports why the prescription is being written
... dosageInstruction S0..*DosageHow the medication should be taken
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... text SΣ0..1stringFree text dosage instructions e.g. SIG
.... timing SΣ0..1TimingWhen medication should be administered
.... doseAndRate SΣ0..*ElementAmount of medication administered
..... dose[x] SΣ0..1Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
...... doseQuantityQuantity
... dispenseRequest S0..1BackboneElementMedication supply authorization
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... numberOfRepeatsAllowed S0..1unsignedIntNumber of refills authorized
.... quantity S0..1SimpleQuantityAmount of medication to supply per dispense

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
MedicationRequest.statusrequiredmedicationrequest Status
MedicationRequest.intentrequiredmedicationRequest Intent
MedicationRequest.categoryexamplemedicationRequest Category Codes
MedicationRequest.category:us-corerequiredmedicationRequest Category Codes
MedicationRequest.medication[x]extensibleMedication Clinical Drug
MedicationRequest.reasonCodeextensibleUSCoreConditionCodes
MedicationRequest.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest 0..*MedicationRequestOrdering of medication for patient or group
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierExternal ids for this request
... status ?!SΣ1..1codeactive | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.

... statusReason 0..1CodeableConceptReason for current status
Binding: medicationRequest Status Reason Codes (example): Identifies the reasons for a given status.

... intent ?!SΣ1..1codeproposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
Binding: medicationRequest Intent (required): The kind of medication order.

... Slices for category S0..*CodeableConceptType of medication usage
Slice: Unordered, Open by pattern:$this
Binding: medicationRequest Category Codes (example): A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.


.... category:us-core S0..*CodeableConceptType of medication usage
Binding: medicationRequest Category Codes (required): The type of medication order.


... priority Σ0..1coderoutine | urgent | asap | stat
Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.

... doNotPerform ?!Σ0..1booleanTrue if request is prohibiting action
... reported[x] SΣ0..1Reported rather than primary record
.... reportedBooleanboolean S
.... reportedReferenceReference S(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile)
... medication[x] SΣ1..1Medication to be taken
Binding: Medication Clinical Drug (extensible)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject SΣ1..1Reference(US Core Patient Profile)Who or group medication request is for
... encounter S0..1Reference(US Core Encounter Profile)Encounter created as part of encounter/admission/stay
... supportingInformation 0..*Reference(Resource)Information to support ordering of the medication
... authoredOn SΣ0..1dateTimeWhen request was initially authored
... requester SΣ1..1Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device)Who/What requested the Request
... performer 0..1Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam)Intended performer of administration
... performerType Σ0..1CodeableConceptDesired kind of performer of the medication administration
Binding: ProcedurePerformerRoleCodes (example): Identifies the type of individual that is desired to administer the medication.

... recorder 0..1Reference(Practitioner | PractitionerRole)Person who entered the request
... reasonCode 0..*CodeableConceptReason or indication for ordering or not ordering the medication
Binding: US Core Condition Codes (extensible)
... reasonReference 0..*Reference(US Core Condition Encounter Diagnosis Profile | US Core Condition Problems and Health Concerns Profile | US Core Laboratory Result Observation Profile | US Core Observation Pregnancy Status Profile | US Core Observation Pregnancy Intent Profile | US Core Observation Occupation Profile | US Core Respiratory Rate Profile | US Core Simple Observation Profile | US Core Heart Rate Profile | US Core Smoking Status Observation Profile | US Core Observation Screening Assessment Profile | US Core Observation Clinical Result Profile | US Core Vital Signs Profile)Condition or observation that supports why the prescription is being written
... instantiatesCanonical Σ0..*canonical()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
Binding: medicationRequest Course of Therapy Codes (example): Identifies the overall pattern of medication administratio.

... insurance 0..*Reference(Coverage | ClaimResponse)Associated insurance coverage
... note 0..*AnnotationInformation about the prescription
... dosageInstruction S0..*DosageHow the medication should be taken
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence Σ0..1integerThe order of the dosage instructions
.... text SΣ0..1stringFree text dosage instructions e.g. SIG
.... additionalInstruction Σ0..*CodeableConceptSupplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".


.... patientInstruction Σ0..1stringPatient or consumer oriented instructions
.... timing SΣ0..1TimingWhen medication should be administered
.... asNeeded[x] Σ0..1Take "as needed" (for x)
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.

..... asNeededBooleanboolean
..... asNeededCodeableConceptCodeableConcept
.... site Σ0..1CodeableConceptBody site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.

.... route Σ0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

.... method Σ0..1CodeableConceptTechnique for administering medication
Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.

.... doseAndRate SΣ0..*ElementAmount of medication administered
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... type Σ0..1CodeableConceptThe kind of dose or rate specified
Binding: DoseAndRateType (example): The kind of dose or rate specified.

..... dose[x] SΣ0..1Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
...... doseQuantityQuantity S
...... doseRangeRange
..... rate[x] Σ0..1Amount of medication per unit of time
...... rateRatioRatio
...... rateRangeRange
...... rateQuantityQuantity(SimpleQuantity)
.... maxDosePerPeriod Σ0..1RatioUpper limit on medication per unit of time
.... maxDosePerAdministration Σ0..1SimpleQuantityUpper limit on medication per administration
.... maxDosePerLifetime Σ0..1SimpleQuantityUpper limit on medication per lifetime of the patient
... dispenseRequest S0..1BackboneElementMedication supply authorization
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... initialFill 0..1BackboneElementFirst fill details
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... 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 S0..1unsignedIntNumber of refills authorized
.... quantity S0..1SimpleQuantityAmount of medication to supply per dispense
.... expectedSupplyDuration 0..1DurationNumber of days supply per dispense
.... performer 0..1Reference(Organization)Intended dispenser
... substitution 0..1BackboneElementAny restrictions on medication substitution
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... allowed[x] 1..1Whether substitution is allowed or not
Binding: ActSubstanceAdminSubstitutionCode (example): Identifies the type of substitution allowed.

..... allowedBooleanboolean
..... allowedCodeableConceptCodeableConcept
.... reason 0..1CodeableConceptWhy should (not) substitution be made
Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.

... 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

Terminology Bindings

PathConformanceValueSet
MedicationRequest.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
MedicationRequest.statusrequiredmedicationrequest Status
MedicationRequest.statusReasonexamplemedicationRequest Status Reason Codes
MedicationRequest.intentrequiredmedicationRequest Intent
MedicationRequest.categoryexamplemedicationRequest Category Codes
MedicationRequest.category:us-corerequiredmedicationRequest Category Codes
MedicationRequest.priorityrequiredRequestPriority
MedicationRequest.medication[x]extensibleMedication Clinical Drug
MedicationRequest.performerTypeexampleProcedurePerformerRoleCodes
MedicationRequest.reasonCodeextensibleUSCoreConditionCodes
MedicationRequest.courseOfTherapyTypeexamplemedicationRequest Course of Therapy Codes
MedicationRequest.dosageInstruction.additionalInstructionexampleSNOMEDCTAdditionalDosageInstructions
MedicationRequest.dosageInstruction.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
MedicationRequest.dosageInstruction.siteexampleSNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationRequest.dosageInstruction.routeexampleSNOMEDCTRouteCodes
MedicationRequest.dosageInstruction.methodexampleSNOMEDCTAdministrationMethodCodes
MedicationRequest.dosageInstruction.doseAndRate.typeexampleDoseAndRateType
MedicationRequest.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
MedicationRequest.substitution.allowed[x]exampleActSubstanceAdminSubstitutionCode
MedicationRequest.substitution.reasonexampleSubstanceAdminSubstitutionReason

This structure is derived from MedicationRequest

Summary

Mandatory: 1 element
Must-Support: 18 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element MedicationRequest.category is sliced based on the value of pattern:$this

 

Other representations of profile: CSV, Excel, Schematron

Notes:

Quick Start

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile’s information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

  • The syntax used to describe the interactions is described here.
  • See the General Requirements section for additional rules and expectations when a server requires status parameters.
  • See the General Guidance section for additional guidance on searching for multiple patients.
  1. SHALL support searching using the combination of the patient and intent search parameters:
    • including optional support for these _include parameters: MedicationRequest:medication
    • including support for OR search on intent (e.g.intent={system|}[code],{system|}[code],...)

    GET [base]/MedicationRequest?patient={Type/}[id]&intent=order,plan

    Example:

    1. GET [base]/MedicationRequest?patient=14676&intent=order,plan
    2. GET [base]/MedicationRequest?patient=14676&intent=order,plan&_include=MedicationRequest:medication

    Implementation Notes: Fetches a bundle of all MedicationRequest resources for the specified patient and intent code = order,plan (how to search by reference and how to search by token)

  2. SHALL support searching using the combination of the patient and intent and status search parameters:
    • including optional support for these _include parameters: MedicationRequest:medication
    • including support for OR search on intent (e.g.intent={system|}[code],{system|}[code],...)
    • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)

    GET [base]/MedicationRequest?patient={Type/}[id]&intent=order,plan&status={system|}[code]{,{system|}[code],...}

    Example:

    1. GET [base]/MedicationRequest?patient=1137192&intent=order,plan&status=active
    2. GET [base]/MedicationRequest?patient=1137192&intent=order,plan&status=active&_include=MedicationRequest:medication

    Implementation Notes: Fetches a bundle of all MedicationRequest resources for the specified patient and intent code = order,plan and status (how to search by reference and how to search by token)

Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

  1. SHOULD support searching using the combination of the patient and intent and encounter search parameters:
    • including optional support for these _include parameters: MedicationRequest:medication
    • including support for OR search on intent (e.g.intent={system|}[code],{system|}[code],...)

    GET [base]/MedicationRequest?patient={Type/}[id]&intent=order,plan&encounter={Type/}[id]

    Example:

    1. GET [base]/MedicationRequest?patient=1137192&intent=order,plan&status=active&encounter=Encounter/123
    2. GET [base]/MedicationRequest?patient=1137192&intent=order,plan&status=active&&encounter=Encounter/123&_include=MedicationRequest:medication

    Implementation Notes: Fetches a bundle of all MedicationRequest resources for the specified patient and intent code = order,plan and encounter (how to search by reference and how to search by token)

  2. SHOULD support searching using the combination of the patient and intent and authoredon search parameters:
    • including optional support for these _include parameters: MedicationRequest:medication
    • including support for OR search on intent (e.g.intent={system|}[code],{system|}[code],...)
    • including support for these authoredon comparators: gt,lt,ge,le
    • including optional support for AND search on authoredon (e.g.authoredon=[date]&authoredon=[date]]&...)

    GET [base]/MedicationRequest?patient={Type/}[id]&intent=order,plan&authoredon={gt|lt|ge|le}[date]{&authoredon={gt|lt|ge|le}[date]&...}

    Example:

    1. GET [base]/MedicationRequest?patient=1137192&intent=order,plan&authoredon=ge2019-01-01T00:00:00Z
    2. GET [base]/MedicationRequest?patient=1137192&intent=order,plan&authoredon=ge2019-01-01T00:00:00Z&_include=MedicationRequest:medication

    Implementation Notes: Fetches a bundle of all MedicationRequest resources for the specified patient and intent code = order,plan and authoredon date (how to search by reference and how to search by token and how to search by date)