Example Usage Scenarios:

Queries on Medication resource are expected to be within the context of a MedicationRequest resource query. The following are example usage scenarios for the US Core Medication profile:

• Read Medication resources referenced in MedicationRequest resources.

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 Medication Must Have:

1. A medication code

Profile Specific Implementation Guidance:

• RXNorm concepts are used and are defined as an extensible binding. USCDI V3+ recommends the National Drug Codes (NDC) as an optional terminology. They can be supplied as an additional coding element.
• Since the binding is extensible, when a code is unavailable just text is allowed.
• When the medication is compounded and is a list of ingredients, the code is still present and may contain only the text.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from Medication

Name	Flags	Card.	Type	Description & Constraints
Medication		0..*	Medication	Definition of a Medication
code	S	1..1	CodeableConcept	(USCDI) Codes that identify this medication Binding: Medication Clinical Drug (extensible)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Medication.code	extensible	Medication Clinical Drug

Name	Flags	Card.	Type	Description & Constraints
Medication		0..*	Medication	Definition of a Medication
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
code	SΣ	1..1	CodeableConcept	(USCDI) Codes that identify this medication Binding: Medication Clinical Drug (extensible)
status	?!Σ	0..1	code	active | inactive | entered-in-error Binding: Medication Status Codes (required): A coded concept defining if the medication is in active use.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Medication.code	extensible	Medication Clinical Drug
Medication.status	required	Medication Status Codes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Medication	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Medication	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Medication	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Medication	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Medication	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints
Medication		0..*	Medication	Definition of a Medication
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business identifier for this medication
code	SΣ	1..1	CodeableConcept	(USCDI) Codes that identify this medication Binding: Medication Clinical Drug (extensible)
status	?!Σ	0..1	code	active | inactive | entered-in-error Binding: Medication Status Codes (required): A coded concept defining if the medication is in active use.
manufacturer	Σ	0..1	Reference(Organization)	Manufacturer of the item
form		0..1	CodeableConcept	powder | tablets | capsule + Binding: SNOMEDCTFormCodes (example): A coded concept defining the form of a medication.
amount	Σ	0..1	Ratio	Amount of drug in package
ingredient		0..*	BackboneElement	Active or inactive ingredient
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
item[x]		1..1		The actual ingredient or content
itemCodeableConcept			CodeableConcept
itemReference			Reference(Substance | Medication)
isActive		0..1	boolean	Active ingredient indicator
strength		0..1	Ratio	Quantity of ingredient present
batch		0..1	BackboneElement	Details about packaged medications
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
lotNumber		0..1	string	Identifier assigned to batch
expirationDate		0..1	dateTime	When batch will expire
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Medication.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Medication.code	extensible	Medication Clinical Drug
Medication.status	required	Medication Status Codes
Medication.form	example	SNOMEDCTFormCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from Medication

Name	Flags	Card.	Type	Description & Constraints
Medication		0..*	Medication	Definition of a Medication
code	S	1..1	CodeableConcept	(USCDI) Codes that identify this medication Binding: Medication Clinical Drug (extensible)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Medication.code	extensible	Medication Clinical Drug

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Medication		0..*	Medication	Definition of a Medication
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
code	SΣ	1..1	CodeableConcept	(USCDI) Codes that identify this medication Binding: Medication Clinical Drug (extensible)
status	?!Σ	0..1	code	active | inactive | entered-in-error Binding: Medication Status Codes (required): A coded concept defining if the medication is in active use.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Medication.code	extensible	Medication Clinical Drug
Medication.status	required	Medication Status Codes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Medication	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Medication	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Medication	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Medication	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Medication	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Medication		0..*	Medication	Definition of a Medication
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business identifier for this medication
code	SΣ	1..1	CodeableConcept	(USCDI) Codes that identify this medication Binding: Medication Clinical Drug (extensible)
status	?!Σ	0..1	code	active | inactive | entered-in-error Binding: Medication Status Codes (required): A coded concept defining if the medication is in active use.
manufacturer	Σ	0..1	Reference(Organization)	Manufacturer of the item
form		0..1	CodeableConcept	powder | tablets | capsule + Binding: SNOMEDCTFormCodes (example): A coded concept defining the form of a medication.
amount	Σ	0..1	Ratio	Amount of drug in package
ingredient		0..*	BackboneElement	Active or inactive ingredient
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
item[x]		1..1		The actual ingredient or content
itemCodeableConcept			CodeableConcept
itemReference			Reference(Substance | Medication)
isActive		0..1	boolean	Active ingredient indicator
strength		0..1	Ratio	Quantity of ingredient present
batch		0..1	BackboneElement	Details about packaged medications
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
lotNumber		0..1	string	Identifier assigned to batch
expirationDate		0..1	dateTime	When batch will expire
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Medication.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Medication.code	extensible	Medication Clinical Drug
Medication.status	required	Medication Status Codes
Medication.form	example	SNOMEDCTFormCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from Medication

Summary

Mandatory: 1 element
Must-Support: 1 element

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.

• Servers providing access to data can use US Core SMART Scopes for:
  • resource level scopes (for example, patient/Medication.rs).
• 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.

No required search criteria for us-core-medication profile.