HL7 FHIR® US Core Implementation Guide STU 3

This page is part of the US Core (v3.0.0: STU3) 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

StructureDefinition-us-core-medicationrequest

Both the MedicationRequest and MedicationStatement resources can be used to record a patient’s medication. For more information about the context for their usages, refer to the medication domain boundaries section. This profile sets minimum expectations for the MedicationRequest resource to record, search and fetch medications associated with a patient. It identifies which core elements, extensions, vocabularies and value sets SHALL be present in the resource when using this profile.

Example Usage Scenarios:

The following are example usage scenarios for the US Core-MedicationRequest profile:

  • Query for medications that have been prescribed to a particular patient
  • Record medications that have been prescribed to a particular patient

Mandatory and Must Support Data Elements

The following data-elements are mandatory (i.e data MUST be present) 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 Profile Definition below provides the formal summary, definitions, and terminology requirements.

Each MedicationRequest must have:

  1. a status
  2. a medication
  3. a patient
  4. a date for when written
  5. a prescriber

Each MedicationRequest must support:

  1. the prescription Sig

Profile specific implementation guidance:

  • The MedicationStatement and MedicationRequest resources can represent a medication using either a code, or reference a Medication resource.
    • When referencing a Medication resource, the resource may be contained or an external resource.
    • The server application MAY choose any combination of these methods, but if an external reference to Medication is used, the server SHALL support the include parameter for searching this element.
    • The client application SHALL support all methods.
    • Additional guidance is provided below in the Search section and in the CapabilityStatement section.
  • Source EHR identifiers SHOULD be included to support deduplication across MedicationStatement and MedicationRequest resources. A patient medication may appear when a prescription is present as a MedicationRequest or MedicationStatement even though the EHR stores as a single instance. Exposing the EHR identifiers helps client applications identify duplicates.

Examples

Formal Views of Profile Content

Description of Profiles, Differentials, and Snapshots.

The official URL for this profile is: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest

Published on Tue May 21 00:00:00 EDT 2019 as active by the HL7 US Realm Steering Committee.

This profile builds on MedicationRequest

MedicationRequest

Summary of the Mandatory Requirements

  1. A code in MedicationRequest.status with a required binding to Medicationrequest status
  2. A CodeableConcept in MedicationRequest.medication[x] with an extensible binding to US Core Medication Codes (RxNorm)
  3. A Patient Reference in MedicationRequest.subject
  4. A dateTime in MedicationRequest.authoredOn
  5. A Requester Reference in MedicationRequest.requester

Summary of the Must Support Requirements

  1. One or more Dosages in MedicationRequest.dosageInstruction
    • which should have a string value in MedicationRequest.dosageInstruction.text
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest I0..*Ordering 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)
Max Binding: AllLanguages
... 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)
... statusReason 0..1CodeableConceptReason for current status
Binding: medicationRequest Status Reason Codes (example)
... intent ?!Σ1..1codeproposal | plan | order | original-order | instance-order | option
Binding: medicationRequest Intent (required)
... category 0..*CodeableConceptType of medication usage
Binding: medicationRequest Category Codes (example)
... priority Σ0..1coderoutine | urgent | asap | stat
Binding: RequestPriority (required)
... doNotPerform ?!Σ0..1booleanTrue if request is prohibiting action
... reported[x] Σ0..1boolean, Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization)Reported rather than primary record
... medication[x] SΣ1..1CodeableConcept, Reference(US Core Medication Profile)Medication to be taken
Binding: US Core Medication Codes (RxNorm) (extensible)
... subject SΣ1..1Reference(US Core Patient Profile)Who or group medication request is for
... encounter 0..1Reference(Encounter)Encounter created as part of encounter/admission/stay
... supportingInformation 0..*Reference(Resource)Information to support ordering of the medication
... authoredOn SΣ1..1dateTimeWhen request was initially authored
... requester SΣ1..1Reference(US Core Practitioner Profile)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)
... recorder 0..1Reference(Practitioner | PractitionerRole)Person who entered the request
... reasonCode 0..*CodeableConceptReason or indication for ordering or not ordering the medication
Binding: Condition/Problem/DiagnosisCodes (example)
... reasonReference 0..*Reference(Condition | Observation)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)
... 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)
.... patientInstruction Σ0..1stringPatient or consumer oriented instructions
.... timing Σ0..1TimingWhen medication should be administered
.... asNeeded[x] Σ0..1boolean, CodeableConceptTake "as needed" (for x)
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example)
.... site Σ0..1CodeableConceptBody site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example)
.... route Σ0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (example)
.... method Σ0..1CodeableConceptTechnique for administering medication
Binding: SNOMEDCTAdministrationMethodCodes (example)
.... doseAndRate ΣI0..*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)
..... dose[x] Σ0..1Range, SimpleQuantityAmount of medication per dose
..... rate[x] Σ0..1Ratio, Range, SimpleQuantityAmount of medication per unit of time
.... 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 I0..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 I0..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 0..1unsignedIntNumber of refills authorized
.... quantity 0..1SimpleQuantityAmount of medication to supply per dispense
.... expectedSupplyDuration 0..1DurationNumber of days supply per dispense
.... performer 0..1Reference(Organization)Intended dispenser
... substitution I0..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..1boolean, CodeableConceptWhether substitution is allowed or not
Binding: V3 Value SetActSubstanceAdminSubstitutionCode (example)
.... reason 0..1CodeableConceptWhy should (not) substitution be made
Binding: V3 Value SetSubstanceAdminSubstitutionReason (example)
... priorPrescription 0..1Reference(MedicationRequest)An order/prescription that is being replaced
... detectedIssue 0..*Reference(DetectedIssue)Clinical Issue with action
... eventHistory 0..*Reference(Provenance)A list of events of interest in the lifecycle

doco Documentation for this format

MedicationRequest

Summary of the Mandatory Requirements

  1. A code in MedicationRequest.status with a required binding to Medicationrequest status
  2. A CodeableConcept in MedicationRequest.medication[x] with an extensible binding to US Core Medication Codes (RxNorm)
  3. A Patient Reference in MedicationRequest.subject
  4. A dateTime in MedicationRequest.authoredOn
  5. A Requester Reference in MedicationRequest.requester

Summary of the Must Support Requirements

  1. One or more Dosages in MedicationRequest.dosageInstruction
    • which should have a string value in MedicationRequest.dosageInstruction.text

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest I0..*Ordering 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)
Max Binding: AllLanguages
... 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)
... statusReason 0..1CodeableConceptReason for current status
Binding: medicationRequest Status Reason Codes (example)
... intent ?!Σ1..1codeproposal | plan | order | original-order | instance-order | option
Binding: medicationRequest Intent (required)
... category 0..*CodeableConceptType of medication usage
Binding: medicationRequest Category Codes (example)
... priority Σ0..1coderoutine | urgent | asap | stat
Binding: RequestPriority (required)
... doNotPerform ?!Σ0..1booleanTrue if request is prohibiting action
... reported[x] Σ0..1boolean, Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization)Reported rather than primary record
... medication[x] SΣ1..1CodeableConcept, Reference(US Core Medication Profile)Medication to be taken
Binding: US Core Medication Codes (RxNorm) (extensible)
... subject SΣ1..1Reference(US Core Patient Profile)Who or group medication request is for
... encounter 0..1Reference(Encounter)Encounter created as part of encounter/admission/stay
... supportingInformation 0..*Reference(Resource)Information to support ordering of the medication
... authoredOn SΣ1..1dateTimeWhen request was initially authored
... requester SΣ1..1Reference(US Core Practitioner Profile)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)
... recorder 0..1Reference(Practitioner | PractitionerRole)Person who entered the request
... reasonCode 0..*CodeableConceptReason or indication for ordering or not ordering the medication
Binding: Condition/Problem/DiagnosisCodes (example)
... reasonReference 0..*Reference(Condition | Observation)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)
... 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)
.... patientInstruction Σ0..1stringPatient or consumer oriented instructions
.... timing Σ0..1TimingWhen medication should be administered
.... asNeeded[x] Σ0..1boolean, CodeableConceptTake "as needed" (for x)
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example)
.... site Σ0..1CodeableConceptBody site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example)
.... route Σ0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (example)
.... method Σ0..1CodeableConceptTechnique for administering medication
Binding: SNOMEDCTAdministrationMethodCodes (example)
.... doseAndRate ΣI0..*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)
..... dose[x] Σ0..1Range, SimpleQuantityAmount of medication per dose
..... rate[x] Σ0..1Ratio, Range, SimpleQuantityAmount of medication per unit of time
.... 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 I0..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 I0..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 0..1unsignedIntNumber of refills authorized
.... quantity 0..1SimpleQuantityAmount of medication to supply per dispense
.... expectedSupplyDuration 0..1DurationNumber of days supply per dispense
.... performer 0..1Reference(Organization)Intended dispenser
... substitution I0..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..1boolean, CodeableConceptWhether substitution is allowed or not
Binding: V3 Value SetActSubstanceAdminSubstitutionCode (example)
.... reason 0..1CodeableConceptWhy should (not) substitution be made
Binding: V3 Value SetSubstanceAdminSubstitutionReason (example)
... priorPrescription 0..1Reference(MedicationRequest)An order/prescription that is being replaced
... detectedIssue 0..*Reference(DetectedIssue)Clinical Issue with action
... eventHistory 0..*Reference(Provenance)A list of events of interest in the lifecycle

doco Documentation for this format

Downloads: StructureDefinition: (XML, JSON), Schema: XML Schematron


Quick Start

Below is an overview of the required set of RESTful FHIR interactions - for example, search and read operations - for this profile. See the Conformance requirements for a complete list of supported RESTful interactions for this IG.

Mandatory Search Parameters:

The following search parameters, search parameter combinations and search parameter modifiers, comparators, chains and composites SHALL be supported. the modifiers, comparators, chains and composites that are listed as optional SHOULD be supported.:

  1. SHALL support searching for all prescriptions for a patient. The server application represents the medication using either an inline code or a contained or external reference to the Medication resource. using the patient search parameter:

    • including optional support for these _include parameters: MedicationRequest:medication

    GET [base]/MedicationRequest?patient=[reference]

    Example:

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

    Implementation Notes: Fetches a bundle of all MedicationRequest resources for the specified patient. Mandatory for client to support the _include parameter. Optional for server to support the _include parameter. (how to search by reference)

  2. SHALL support searching using the combination of the patient and status search parameters:

    • including optional support for these _include parameters: MedicationRequest:medication

    GET [base]/MedicationRequest?patient=[reference]&status={[system]}|[code]

    Example:

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

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

Optional Search Parameters:

The following search parameters, search parameter combinations and search parameter modifiers, comparators, chains and composites SHOULD be supported.

  1. SHOULD support searching using the combination of the patient and authoredon search parameters:
    • including optional support for these _include parameters: MedicationRequest:medication
    • including support for these authoredon comparators: gt,lt,ge,le
    • including optional support for composite AND search on authoredon (e.g.authoredon=[date]&authoredon=[date]]&...)

    GET [base]/MedicationRequest?patient=[reference]&authoredon={gt|lt|ge|le}[date]{&authoredon={gt|lt|ge|le}[date]&...}

    Example:

    1. GET [base]/MedicationRequest?patient=1137192&effective=ge2019
    2. GET [base]/MedicationStatement?patient=1137192&effective=ge2019&_include=MedicationRequest:medication

    Implementation Notes: Fetches a bundle of all MedicationRequest resources for the specified patient and date (how to search by reference and how to search by date)