STU 2 Ballot

This page is part of the Data Access Framework (v1.6.0: STU 2 Ballot 1) based on FHIR v1.6.0. . For a full list of available versions, see the Directory of published versions

D.4.1 StructureDefinition: DAF-core-medicationorder

Both the MedicationOrder 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 domains’s boundaries section. This profile sets minimum expectations for the MedicationOrder 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 DAF-MedicationOrder profile:

  • Query for medications that have been prescribed to a particular patient
  • Query for all patients who have been prescribed a particular medication
  • Query for all patients who were prescribed a particular medication within a particular time period
Mandatory Data Elements and Terminology

The following data-elements are mandatory (i.e data MUST be present). These are presented below in a simple human-readable explanation. Profile specific guidance and an example are provided as well. The Formal Profile Definition below provides the formal summary, definitions, and terminology requirements.

Each MedicationOrder must have:

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

Profile specific implementation guidance:

  • The MedicationStatement and MedicationOrder resources can represent a medication, using either a code or reference to a Medication resource. The server application can choose one way or both methods, but the client application must support both methods. More specific guidance is provided in the conformance resource for this profile
Example: MedicationOrder Example: example

D.4.1.1 Formal Views of Profile Content

The official URL for this profile is: 

http://hl7.org/fhir/us/daf/StructureDefinition/daf-core-medicationorder

This profile was published on Mon Aug 01 00:00:00 AEST 2016 as a draft by Health Level Seven International (FHIR-Infrastructure).

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

This structure is derived from MedicationOrder

Complete Summary of the Mandatory Requirements

  1. One status in MedicationOrder.status which has an required binding to:
  2. One medication via MedicationOrder.medicationCodeableConcept or MedicationOrder.medicationReference
  3. One patient reference in MedicationOrder.patient
  4. One date in MedicationOrder.dateWritten
  5. One practitioner in MedicationOrder.prescriber
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationOrder I0..*Prescription of medication to for patient
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
... id ∑0..1idLogical id of this artifact
... meta ∑0..1MetaMetadata about the resource
... implicitRules ?!∑0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (extensible)
... text I0..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 identifier
... status ?!S1..1codeactive | on-hold | completed | entered-in-error | stopped | draft
Binding: MedicationOrderStatus (required)
... medication[x] S1..1CodeableConcept, Reference(Profile daf-core-medication)Medication to be taken
Binding: Medication Clinical Drug (RxNorm) (extensible)
... patient S1..1Reference(Profile daf-core-patient)Who prescription is for
... encounter 0..1Reference(Encounter)Created during encounter/admission/stay
... dateWritten S1..1dateTimeWhen prescription was initially authorized
... prescriber S1..1Reference(Profile daf-core-pract)Who ordered the initial medication(s)
... reasonCode 0..*CodeableConceptReason or indication for writing the prescription
Binding: Condition/Problem/Diagnosis Codes (example)
... reasonReference 0..*Reference(Condition)Condition that supports why the prescription is being written
... note 0..*AnnotationInformation about the prescription
... category 0..1codeType of medication usage
Binding: MedicationOrderCategory (example)
... dosageInstruction 0..*BackboneElementHow medication should be taken
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... text 0..1stringFree text dosage instructions e.g. SIG
.... additionalInstructions 0..*CodeableConceptSupplemental instructions - e.g. "with meals"
Binding: SNOMED CT Additional Dosage Instructions (example)
.... timing 0..1TimingWhen medication should be administered
.... asNeeded[x] 0..1boolean, CodeableConceptTake "as needed" (for x)
Binding: SNOMED CT Medication As Needed Reason Codes (example)
.... site[x] 0..1CodeableConcept, Reference(BodySite)Body site to administer to
Binding: SNOMED CT Anatomical Structure for Administration Site Codes (example)
.... route 0..1CodeableConceptHow drug should enter body
Binding: SNOMED CT Route Codes (example)
.... method 0..1CodeableConceptTechnique for administering medication
Binding: SNOMED CT Administration Method Codes (example)
.... dose[x] 0..1Range, SimpleQuantityAmount of medication per dose
.... maxDosePerPeriod 0..1RatioUpper limit on medication per unit of time
.... maxDosePerAdministration 0..1SimpleQuantityUpper limit on medication per administration
.... maxDosePerLifetime 0..1SimpleQuantityUpper limit on medication per lifetime of the patient
.... rate[x] 0..1Ratio, Range, SimpleQuantityAmount of medication per unit of time
... dispenseRequest 0..1BackboneElementMedication supply authorization
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... validityPeriod 0..1PeriodTime period supply is authorized for
.... numberOfRepeatsAllowed 0..1positiveIntNumber of refills authorized
.... quantity 0..1SimpleQuantityAmount of medication to supply per dispense
.... expectedSupplyDuration 0..1DurationNumber of days supply per dispense
... substitution 0..1BackboneElementAny restrictions on medication substitution
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... allowed 1..1booleanWhether substitution is allowed or not
.... reason 0..1CodeableConceptWhy should (not) substitution be made
Binding: SubstanceAdminSubstitutionReason (example)
... priorPrescription 0..1Reference(MedicationOrder)An order/prescription that this supersedes
... eventHistory 0..*BackboneElementA list of events of interest in the lifecycle
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... status 1..1codeactive | on-hold | completed | entered-in-error | stopped | draft
Binding: MedicationOrderStatus (required)
.... action 0..1CodeableConceptAction taken (e.g. verify, discontinue)
Binding: (unbound) (example)
.... dateTime 1..1dateTimeThe date at which the event happened
.... actor 0..1Reference(Practitioner)Who took the action
.... reason 0..1CodeableConceptReason the action was taken
Binding: (unbound) (example)

doco Documentation for this format

yet to be done: Xml template

yet to be done: Json template

This structure is derived from MedicationOrder

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationOrder I0..*Prescription of medication to for patient
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
... id ∑0..1idLogical id of this artifact
... meta ∑0..1MetaMetadata about the resource
... implicitRules ?!∑0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (extensible)
... text I0..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 identifier
... status ?!S1..1codeactive | on-hold | completed | entered-in-error | stopped | draft
Binding: MedicationOrderStatus (required)
... medication[x] S1..1CodeableConcept, Reference(Profile daf-core-medication)Medication to be taken
Binding: Medication Clinical Drug (RxNorm) (extensible)
... patient S1..1Reference(Profile daf-core-patient)Who prescription is for
... encounter 0..1Reference(Encounter)Created during encounter/admission/stay
... dateWritten S1..1dateTimeWhen prescription was initially authorized
... prescriber S1..1Reference(Profile daf-core-pract)Who ordered the initial medication(s)
... reasonCode 0..*CodeableConceptReason or indication for writing the prescription
Binding: Condition/Problem/Diagnosis Codes (example)
... reasonReference 0..*Reference(Condition)Condition that supports why the prescription is being written
... note 0..*AnnotationInformation about the prescription
... category 0..1codeType of medication usage
Binding: MedicationOrderCategory (example)
... dosageInstruction 0..*BackboneElementHow medication should be taken
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... text 0..1stringFree text dosage instructions e.g. SIG
.... additionalInstructions 0..*CodeableConceptSupplemental instructions - e.g. "with meals"
Binding: SNOMED CT Additional Dosage Instructions (example)
.... timing 0..1TimingWhen medication should be administered
.... asNeeded[x] 0..1boolean, CodeableConceptTake "as needed" (for x)
Binding: SNOMED CT Medication As Needed Reason Codes (example)
.... site[x] 0..1CodeableConcept, Reference(BodySite)Body site to administer to
Binding: SNOMED CT Anatomical Structure for Administration Site Codes (example)
.... route 0..1CodeableConceptHow drug should enter body
Binding: SNOMED CT Route Codes (example)
.... method 0..1CodeableConceptTechnique for administering medication
Binding: SNOMED CT Administration Method Codes (example)
.... dose[x] 0..1Range, SimpleQuantityAmount of medication per dose
.... maxDosePerPeriod 0..1RatioUpper limit on medication per unit of time
.... maxDosePerAdministration 0..1SimpleQuantityUpper limit on medication per administration
.... maxDosePerLifetime 0..1SimpleQuantityUpper limit on medication per lifetime of the patient
.... rate[x] 0..1Ratio, Range, SimpleQuantityAmount of medication per unit of time
... dispenseRequest 0..1BackboneElementMedication supply authorization
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... validityPeriod 0..1PeriodTime period supply is authorized for
.... numberOfRepeatsAllowed 0..1positiveIntNumber of refills authorized
.... quantity 0..1SimpleQuantityAmount of medication to supply per dispense
.... expectedSupplyDuration 0..1DurationNumber of days supply per dispense
... substitution 0..1BackboneElementAny restrictions on medication substitution
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... allowed 1..1booleanWhether substitution is allowed or not
.... reason 0..1CodeableConceptWhy should (not) substitution be made
Binding: SubstanceAdminSubstitutionReason (example)
... priorPrescription 0..1Reference(MedicationOrder)An order/prescription that this supersedes
... eventHistory 0..*BackboneElementA list of events of interest in the lifecycle
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... status 1..1codeactive | on-hold | completed | entered-in-error | stopped | draft
Binding: MedicationOrderStatus (required)
.... action 0..1CodeableConceptAction taken (e.g. verify, discontinue)
Binding: (unbound) (example)
.... dateTime 1..1dateTimeThe date at which the event happened
.... actor 0..1Reference(Practitioner)Who took the action
.... reason 0..1CodeableConceptReason the action was taken
Binding: (unbound) (example)

doco Documentation for this format

XML Template

yet to be done: Xml template

JSON Template

yet to be done: Json template

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

 

D.4.1.2 Terminology Bindings

Terminology Bindings

PathNameConformanceValueSet
MedicationOrder.languageCommon LanguagesextensibleCommon Languages
MedicationOrder.statusMedicationOrderStatusrequiredMedicationOrderStatus
MedicationOrder.medication[x]Medication Clinical Drug (RxNorm)extensibleMedication Clinical Drug (RxNorm)
MedicationOrder.reasonCodeCondition/Problem/Diagnosis CodesexampleCondition/Problem/Diagnosis Codes
MedicationOrder.categoryMedicationOrderCategoryexampleMedicationOrderCategory
MedicationOrder.dosageInstruction.additionalInstructionsSNOMED CT Additional Dosage InstructionsexampleSNOMED CT Additional Dosage Instructions
MedicationOrder.dosageInstruction.asNeeded[x]SNOMED CT Medication As Needed Reason CodesexampleSNOMED CT Medication As Needed Reason Codes
MedicationOrder.dosageInstruction.site[x]SNOMED CT Anatomical Structure for Administration Site CodesexampleSNOMED CT Anatomical Structure for Administration Site Codes
MedicationOrder.dosageInstruction.routeSNOMED CT Route CodesexampleSNOMED CT Route Codes
MedicationOrder.dosageInstruction.methodSNOMED CT Administration Method CodesexampleSNOMED CT Administration Method Codes
MedicationOrder.substitution.reasonSubstanceAdminSubstitutionReasonexampleSubstanceAdminSubstitutionReason
MedicationOrder.eventHistory.statusMedicationOrderStatusrequiredMedicationOrderStatus
MedicationOrder.eventHistory.action?extexample
MedicationOrder.eventHistory.reason?extexample

D.4.1.3 Constraints

Constraints

IdPathDetailsRequirements
dom-2MedicationOrderIf the resource is contained in another resource, it SHALL NOT contain nested Resources
XPath: not(parent::f:contained and f:contained)
dom-1MedicationOrderIf the resource is contained in another resource, it SHALL NOT contain any narrative
XPath: not(parent::f:contained and f:text)
dom-4MedicationOrderIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
XPath: not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
dom-3MedicationOrderIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
XPath: not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))
.