0.3.0 - Second STU ballot

This page is part of a downloaded copy of this specification. This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v0.3.0: STU 1 Ballot 2) based on FHIR R4. . For a full list of available versions, see the Directory of published versions

## StructureDefinition: MedicationRequestSTU3 - Detailed Descriptions

Definitions for the profile-medicationrequest-stu3 Profile.

1. MedicationRequest
Definition | The US Core Medication Request (Order) Profile is based upon the core FHIR MedicationRequest Resource and created to meet the 2015 Edition Common Clinical Data Set 'Medications' requirements.
Control | 0..*
Alternate Names | Prescription, Order
Invariants | Defined on this element dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (: contained.text.empty()) dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (: contained.where(('#'+id in %resource.descendants().reference).not()).empty()) dom-4: 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())
2. MedicationRequest.id
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Control | 0..1
Type | id
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
3. MedicationRequest.meta
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.
Control | 0..1
Type | Meta
4. MedicationRequest.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.
Control | 0..1
Type | uri
Is Modifier | true
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.
5. MedicationRequest.language
Definition | The base language in which the resource is written.
Control | 0..1
Binding | A human language. The codes SHALL be taken from Common Languages; other codes may be used where these codes are not suitable Max Binding: All Languages
Type | code
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
6. MedicationRequest.text
Definition | A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Control | 0..1 This element is affected by the following invariants: dom-1
Type | Narrative
Alternate Names | narrative, html, xhtml, display
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.
7. MedicationRequest.contained
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Control | 0..*
Type | Resource
Alternate Names | inline resources, anonymous resources, contained resources
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.
8. MedicationRequest.extension
Definition | An Extension
Control | 0..*
Type | Extension
9. MedicationRequest.extension:MedicationRequest-insurance
Definition | Indicates coverage relevant to the request.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Extension(insurance) (Extension Type: Reference(CoverageSTU3))
Must Support | true
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
10. MedicationRequest.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Control | 0..*
Type | Extension
Is Modifier | true
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
11. MedicationRequest.identifier
Definition | This records identifiers associated with this medication request that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. For example a re-imbursement system might issue its own id for each prescription that is created. This is particularly important where FHIR only provides part of an entire workflow process where records must be tracked through an entire system.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
Must Support | true
12. MedicationRequest.definition
Definition | Protocol or definition followed by this request.
Control | 0..*
Type | Reference(ActivityDefinition | PlanDefinition)
Comments | potentially relevant for CRD in some situations.
13. MedicationRequest.basedOn
Definition | A plan or request that is fulfilled in whole or in part by this medication request.
Control | 0..*
Type | Reference(MedicationRequestSTU3)
Comments | potentially relevant for CRD in some situations.
14. MedicationRequest.groupIdentifier
Definition | A shared identifier common to all requests that were authorized more or less simultaneously by a single author, representing the identifier of the requisition or prescription.
Control | 0..1
Type | Identifier
Requirements | Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.
Comments | potentially relevant for CRD in some situations.
15. MedicationRequest.status
Definition | A code specifying the current state of the order. Generally this will be active or completed state.
Control | 1..1
Binding | A code specifying the state of the prescribing event. Describes the lifecycle of the prescription. The codes SHALL be taken from MedicationRequestStatus
Type | code
Is Modifier | true
Must Support | true
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Fixed Value | draft
16. MedicationRequest.intent
Definition | Whether the request is a proposal, plan, or an original order.
Control | 1..1
Binding | The kind of medication order The codes SHALL be taken from MedicationRequestIntent
Type | code
Is Modifier | true
Comments | potentially relevant for CRD in some situations.
17. MedicationRequest.category
Definition | Indicates the type of medication order and where the medication is expected to be consumed or administered.
Control | 0..1
Binding | A coded concept identifying where the medication ordered is expected to be consumed or administered The codes SHOULD be taken from MedicationRequestCategory
Type | CodeableConcept
Comments | potentially relevant for CRD in some situations.
18. MedicationRequest.priority
Definition | Indicates how quickly the Medication Request should be addressed with respect to other requests.
Control | 0..1
Binding | Identifies the level of importance to be assigned to actioning the request The codes SHALL be taken from MedicationRequestPriority
Type | code
19. MedicationRequest.medication[x]
Definition | Identifies the medication being requested. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medications.
Control | 1..1
Binding | Prescribable medications The codes SHALL be taken from Medication Clinical Drug (RxNorm); other codes may be used where these codes are not suitable
Type | Choice of: Reference(US Core Medication Profile), CodeableConcept
[x] Note | See Choice of Data Types for further information about how to use [x]
Must Support | true
Comments | If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example, if you require form or lot number or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource. .
20. MedicationRequest.subject
Definition | A link to a resource representing the person or set of individuals to whom the medication will be given.
Control | 1..1
Type | Reference(PatientSTU3)
Must Support | true
Comments | The subject on a medication request is mandatory. For the secondary use case where the actual subject is not provided, there still must be an anonymized subject specified.
21. MedicationRequest.context
Definition | A link to an encounter, or episode of care, that identifies the particular occurrence or set occurrences of contact between patient and health care provider.
Control | 0..1
Type | Reference(EncounterSTU3)
Comments | potentially relevant for CRD in some situations.
22. MedicationRequest.supportingInformation
Definition | Include additional information (for example, patient height and weight) that supports the ordering of the medication.
Control | 0..*
Type | Reference(Resource)
Comments | potentially relevant for CRD in some situations.
23. MedicationRequest.authoredOn
Definition | The date (and perhaps time) when the prescription was initially written or authored on.
Control | 1..1
Type | dateTime
Must Support | true
24. MedicationRequest.requester
Definition | The individual, organization or device that initiated the request and has responsibility for its activation.
Control | 1..1
Type | BackboneElement
Must Support | true
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count())) mps-1: onBehalfOf can only be specified if agent is practitioner or device (: (agent.resolve().empty()) or (agent.resolve() is Device) or (agent.resolve() is Practitioner) or onBehalfOf.exists().not())
25. MedicationRequest.requester.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
26. MedicationRequest.requester.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
27. MedicationRequest.requester.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Control | 0..*
Type | Extension
Is Modifier | true
Alternate Names | extensions, user content, modifiers
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
28. MedicationRequest.requester.agent
Definition | The healthcare professional responsible for authorizing the initial prescription.
Control | 1..1
Type | Reference(PractitionerSTU3)
Must Support | true
Comments | It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only.
29. MedicationRequest.requester.onBehalfOf
Definition | The organization the device or practitioner was acting on behalf of.
Control | 0..1 This element is affected by the following invariants: mps-1
Type | Reference(Organization)
Requirements | Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when authoring the request.
Comments | potentially relevant for CRD in some situations.
30. MedicationRequest.recorder
Definition | The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order.
Control | 0..1
Type | Reference(Practitioner)
31. MedicationRequest.reasonCode
Definition | The reason or the indication for ordering the medication.
Control | 0..*
Binding | A coded concept indicating why the medication was ordered. For example codes, see Condition/Problem/Diagnosis Codes
Type | CodeableConcept
Must Support | true
Comments | potentially relevant for CRD in some situations.
32. MedicationRequest.reasonReference
Definition | Condition or observation that supports why the medication was ordered.
Control | 0..*
Type | Reference(US Core Condition Profile | US Core Result Observation)
Must Support | true
Comments | potentially relevant for CRD in some situations.
33. MedicationRequest.note
Definition | Extra information about the prescription that could not be conveyed by the other attributes.
Control | 0..*
Type | Annotation
Comments | potentially relevant for CRD in some situations.
34. MedicationRequest.dosageInstruction
Definition | Indicates how the medication is to be used by the patient.
Control | 0..*
Type | Dosage
Must Support | true
Comments | There are examples where a medication request may include the option of an oral dose or an Intravenous or Intramuscular dose. For example, "Ondansetron 8mg orally or IV twice a day as needed for nausea" or "Compazine® (prochlorperazine) 5-10mg PO or 25mg PR bid prn nausea or vomiting". In these cases, two medication requests would be created that could be grouped together. The decision on which dose and route of administration to use is based on the patient's condition at the time the dose is needed.
35. MedicationRequest.dispenseRequest
Definition | Indicates the specific details for the dispense or medication supply part of a medication request (also known as a Medication Prescription or Medication Order). Note that this information is not always sent with the order. There may be in some settings (e.g. hospitals) institutional or system support for completing the dispense details in the pharmacy department.
Control | 0..1
Type | BackboneElement
Must Support | true
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
36. MedicationRequest.dispenseRequest.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
37. MedicationRequest.dispenseRequest.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
38. MedicationRequest.dispenseRequest.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Control | 0..*
Type | Extension
Is Modifier | true
Alternate Names | extensions, user content, modifiers
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
39. MedicationRequest.dispenseRequest.validityPeriod
Definition | This indicates the validity period of a prescription (stale dating the Prescription).
Control | 0..1
Type | Period
Requirements | Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.
Comments | It reflects the prescribers' perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations.
40. MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
Definition | An integer indicating the number of times, in addition to the original dispense, (aka refills or repeats) that the patient can receive the prescribed medication. Usage Notes: This integer does not include the original order dispense. This means that if an order indicates dispense 30 tablets plus "3 repeats", then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets.
Control | 0..1
Type | positiveInt
Comments | If displaying "number of authorized fills", add 1 to this number.
41. MedicationRequest.dispenseRequest.quantity
Definition | The amount that is to be dispensed for one fill.
Control | 0..1
Type | Quantity(SimpleQuantity)
42. MedicationRequest.dispenseRequest.expectedSupplyDuration
Definition | Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last.
Control | 0..1
Type | Duration
Comments | In some situations, this attribute may be used instead of quantity to identify the amount supplied by how long it is expected to last, rather than the physical quantity issued, e.g. 90 days supply of medication (based on an ordered dosage) When possible, it is always better to specify quantity, as this tends to be more precise. expectedSupplyDuration will always be an estimate that can be influenced by external factors.
43. MedicationRequest.dispenseRequest.performer
Definition | Indicates the intended dispensing Organization specified by the prescriber.
Control | 0..1
Type | Reference(Organization)
44. MedicationRequest.substitution
Definition | Indicates whether or not substitution can or should be part of the dispense. In some cases substitution must happen, in other cases substitution must not happen. This block explains the prescriber's intent. If nothing is specified substitution may be done.
Control | 0..1
Type | BackboneElement
Must Support | true
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
45. MedicationRequest.substitution.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
46. MedicationRequest.substitution.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
47. MedicationRequest.substitution.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Control | 0..*
Type | Extension
Is Modifier | true
Alternate Names | extensions, user content, modifiers
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
48. MedicationRequest.substitution.allowed
Definition | True if the prescriber allows a different drug to be dispensed from what was prescribed.
Control | 1..1
Type | boolean
Is Modifier | true
Comments | This element is labeled as a modifer because whether substitution is allow or not cannot be ignored.
49. MedicationRequest.substitution.reason
Definition | Indicates the reason for the substitution, or why substitution must or must not be performed.
Control | 0..1
Binding | A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed. For example codes, see SubstanceAdminSubstitutionReason
Type | CodeableConcept
50. MedicationRequest.priorPrescription
Definition | A link to a resource representing an earlier order related order or prescription.
Control | 0..1
Type | Reference(MedicationRequestSTU3)
Must Support | true
51. MedicationRequest.detectedIssue
Definition | Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etc.
Control | 0..*
Type | Reference(DetectedIssue)
Alternate Names | Contraindication, Drug Utilization Review (DUR), Alert
52. MedicationRequest.eventHistory
Definition | Links to Provenance records for past versions of this resource or fulfilling request or event resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resource.
Control | 0..*
Type | Reference(Provenance)
Comments | This may not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).