Da Vinci - Coverage Requirements Discovery
2.0.1 - STU 2 United States of America flag

This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v2.0.1: STU 2.0) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Resource Profile: CRD Medication Request

Official URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest Version: 2.0.1
Standards status: Trial-use Maturity Level: 2 Computable Name: MedicationRequest

This profile specifies additional constraints on the US Core MedicationRequest profile to support coverage requirements discovery.

Usage


CRD Clients SHALL use this profile to resolve references to MedicationRequest resources passed to CRD Servers (e.g. selections context references) and to populate draftOrders context objects when invoking the when invoking the following CDS Hooks:

Information provided in Must Support elements will commonly be required for CRD Servers to perform coverage requirements discovery.

NOTE: This profile is not currently based on US Core because US Core accidentally constrained out PractitionerRole. When a future version of US-Core adds support back in, this profile will be revised to extend the US Core profile

Usage:

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 MedicationRequest
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... Coverage-Information S0..*(Complex)Coverage Info
URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information
... identifier S0..*IdentifierExternal ids for this request
... intent S1..1codeproposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
... doNotPerform 0..0
... reported[x] S0..1Reported rather than primary record
.... reportedBooleanboolean
.... reportedReferenceReference(US Core Patient Profile | US Core Practitioner Profile | US Core Organization Profile)
... medication[x] S1..1Medication to be taken
Binding: US Core Medication Codes (RxNorm) (extensible)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject S1..1Reference(CRD Patient)Who or group medication request is for
... encounter S0..1Reference(CRD Encounter)Encounter created as part of encounter/admission/stay
... authoredOn S1..1dateTimeWhen request was initially authored
... requester S1..1Reference(CRD Practitioner | US Core PractitionerRole Profile)Who/What requested the Request
... performer S0..1Reference(CRD Practitioner | US Core PractitionerRole Profile)Intended performer of administration
... reasonCode S0..*CodeableConceptReason or indication for ordering or not ordering the medication
... reasonReference S0..*Reference(US Core Condition Profile | US Core Laboratory Result Observation Profile)Condition or observation that supports why the prescription is being written
... basedOn 0..*Reference(CRD Medication Request | CRD Service Request)What request fulfills
... dosageInstruction S0..*DosageHow the medication should be taken
.... text S0..1stringFree text dosage instructions e.g. SIG
... dispenseRequest S0..1BackboneElementMedication supply authorization
... substitution S0..1BackboneElementAny restrictions on medication substitution
... priorPrescription S0..1Reference(CRD Medication Request)An order/prescription that is being replaced

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
MedicationRequest.medication[x]extensibleUSCoreMedicationCodes
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest 0..*MedicationRequestOrdering of medication for patient or group
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... Coverage-Information SC0..*(Complex)Coverage Info
URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information
... identifier S0..*IdentifierExternal ids for this request
... status ?!SΣ1..1codeactive | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Binding: medicationrequest Status (required): A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.


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

... reported[x] SΣ0..1Reported rather than primary record
.... reportedBooleanboolean
.... reportedReferenceReference(US Core Patient Profile | US Core Practitioner Profile | US Core Organization Profile)
... medication[x] SΣ1..1Medication to be taken
Binding: US Core Medication Codes (RxNorm) (extensible)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject SΣ1..1Reference(CRD Patient)Who or group medication request is for
... encounter S0..1Reference(CRD Encounter)Encounter created as part of encounter/admission/stay
... authoredOn SΣ1..1dateTimeWhen request was initially authored
... requester SΣ1..1Reference(CRD Practitioner | US Core PractitionerRole Profile)Who/What requested the Request
... performer S0..1Reference(CRD Practitioner | US Core PractitionerRole Profile)Intended performer of administration
... reasonCode S0..*CodeableConceptReason or indication for ordering or not ordering the medication
Binding: Condition/Problem/DiagnosisCodes (example): A coded concept indicating why the medication was ordered.


... reasonReference S0..*Reference(US Core Condition Profile | US Core Laboratory Result Observation Profile)Condition or observation that supports why the prescription is being written
... basedOn Σ0..*Reference(CRD Medication Request | CRD Service Request)What request fulfills
... 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
... dispenseRequest S0..1BackboneElementMedication supply authorization
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
... substitution S0..1BackboneElementAny restrictions on medication substitution
.... 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
... priorPrescription S0..1Reference(CRD Medication Request)An order/prescription that is being replaced

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
MedicationRequest.statusrequiredFixed Value: draft
MedicationRequest.intentrequiredmedicationRequest Intent
MedicationRequest.medication[x]extensibleUSCoreMedicationCodes
MedicationRequest.reasonCodeexampleCondition/Problem/DiagnosisCodes
MedicationRequest.substitution.allowed[x]exampleActSubstanceAdminSubstitutionCode

Constraints

IdGradePath(s)DetailsRequirements
crd-ci-q1errorMedicationRequest.extension:Coverage-InformationQuestionnaire and QuestionnaireResponse are only allowed when doc-needed exists and not equal to 'no-doc'
: extension.where(url='questionnaire' or url='response').exists() implies (extension.where(url = 'doc-needed').exists() and extension.where(url = 'doc-needed').all(value != 'no-doc'))
crd-ci-q2errorMedicationRequest.extension:Coverage-InformationIf covered is set to 'not-covered', then 'pa-needed' should not exist.
: extension.where(url = 'covered' and value != 'not-covered') implies extension.where(url = 'pa-needed').exists()
crd-ci-q3errorMedicationRequest.extension:Coverage-InformationIf 'info-needed' exists, then at least one of 'covered', 'pa-needed', or 'doc-needed' must be 'conditional'.
: extension.where(url = 'info-needed').exists() implies extension.where((url = 'covered' or url = 'pa-needed' or url = 'doc-needed') and value = 'conditional').count() >= 1
crd-ci-q4errorMedicationRequest.extension:Coverage-InformationIf 'pa-needed' is 'satisfied', then 'Doc-purpose' can't be 'PA'.
: extension.where(url = 'pa-needed' and value = 'satisfied') and extension.where(url = 'doc-purpose').exists() implies extension.where(url = 'doc-purpose').all(value != 'PA')
crd-ci-q5errorMedicationRequest.extension:Coverage-Information'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'.
: extension.where(url = 'pa-needed' and value = 'satisfied').exists() = extension.where(url = 'satisfied-pa-id').exists()
dom-2errorMedicationRequestIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationRequestIf 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-4errorMedicationRequestIf 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-5errorMedicationRequestIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationRequestA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
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
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... Coverage-Information SC0..*(Complex)Coverage Info
URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier S0..*IdentifierExternal ids for this request
... status ?!SΣ1..1codeactive | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Binding: medicationrequest Status (required): A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.


Fixed Value: draft
... 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.

... category 0..*CodeableConceptType of medication usage
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.


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

... reported[x] SΣ0..1Reported rather than primary record
.... reportedBooleanboolean
.... reportedReferenceReference(US Core Patient Profile | US Core Practitioner Profile | US Core Organization Profile)
... medication[x] SΣ1..1Medication to be taken
Binding: US Core Medication Codes (RxNorm) (extensible)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject SΣ1..1Reference(CRD Patient)Who or group medication request is for
... encounter S0..1Reference(CRD 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(CRD Practitioner | US Core PractitionerRole Profile)Who/What requested the Request
... performer S0..1Reference(CRD Practitioner | US Core PractitionerRole Profile)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 S0..*CodeableConceptReason or indication for ordering or not ordering the medication
Binding: Condition/Problem/DiagnosisCodes (example): A coded concept indicating why the medication was ordered.


... reasonReference S0..*Reference(US Core Condition Profile | US Core Laboratory Result Observation 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(CRD Medication Request | CRD Service Request)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 Σ0..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 Σ0..*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] Σ0..1Amount of medication per dose
...... doseRangeRange
...... doseQuantityQuantity(SimpleQuantity)
..... 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 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 S0..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 S0..1Reference(CRD Medication Request)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 / Code
MedicationRequest.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
MedicationRequest.statusrequiredFixed Value: draft
MedicationRequest.statusReasonexamplemedicationRequest Status Reason Codes
MedicationRequest.intentrequiredmedicationRequest Intent
MedicationRequest.categoryexamplemedicationRequest Category Codes
MedicationRequest.priorityrequiredRequestPriority
MedicationRequest.medication[x]extensibleUSCoreMedicationCodes
MedicationRequest.performerTypeexampleProcedurePerformerRoleCodes
MedicationRequest.reasonCodeexampleCondition/Problem/DiagnosisCodes
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.substitution.allowed[x]exampleActSubstanceAdminSubstitutionCode
MedicationRequest.substitution.reasonexampleSubstanceAdminSubstitutionReason

Constraints

IdGradePath(s)DetailsRequirements
crd-ci-q1errorMedicationRequest.extension:Coverage-InformationQuestionnaire and QuestionnaireResponse are only allowed when doc-needed exists and not equal to 'no-doc'
: extension.where(url='questionnaire' or url='response').exists() implies (extension.where(url = 'doc-needed').exists() and extension.where(url = 'doc-needed').all(value != 'no-doc'))
crd-ci-q2errorMedicationRequest.extension:Coverage-InformationIf covered is set to 'not-covered', then 'pa-needed' should not exist.
: extension.where(url = 'covered' and value != 'not-covered') implies extension.where(url = 'pa-needed').exists()
crd-ci-q3errorMedicationRequest.extension:Coverage-InformationIf 'info-needed' exists, then at least one of 'covered', 'pa-needed', or 'doc-needed' must be 'conditional'.
: extension.where(url = 'info-needed').exists() implies extension.where((url = 'covered' or url = 'pa-needed' or url = 'doc-needed') and value = 'conditional').count() >= 1
crd-ci-q4errorMedicationRequest.extension:Coverage-InformationIf 'pa-needed' is 'satisfied', then 'Doc-purpose' can't be 'PA'.
: extension.where(url = 'pa-needed' and value = 'satisfied') and extension.where(url = 'doc-purpose').exists() implies extension.where(url = 'doc-purpose').all(value != 'PA')
crd-ci-q5errorMedicationRequest.extension:Coverage-Information'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'.
: extension.where(url = 'pa-needed' and value = 'satisfied').exists() = extension.where(url = 'satisfied-pa-id').exists()
dom-2errorMedicationRequestIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationRequestIf 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-4errorMedicationRequestIf 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-5errorMedicationRequestIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationRequestA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from MedicationRequest

Differential View

This structure is derived from MedicationRequest

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest MedicationRequest
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... Coverage-Information S0..*(Complex)Coverage Info
URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information
... identifier S0..*IdentifierExternal ids for this request
... intent S1..1codeproposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
... doNotPerform 0..0
... reported[x] S0..1Reported rather than primary record
.... reportedBooleanboolean
.... reportedReferenceReference(US Core Patient Profile | US Core Practitioner Profile | US Core Organization Profile)
... medication[x] S1..1Medication to be taken
Binding: US Core Medication Codes (RxNorm) (extensible)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject S1..1Reference(CRD Patient)Who or group medication request is for
... encounter S0..1Reference(CRD Encounter)Encounter created as part of encounter/admission/stay
... authoredOn S1..1dateTimeWhen request was initially authored
... requester S1..1Reference(CRD Practitioner | US Core PractitionerRole Profile)Who/What requested the Request
... performer S0..1Reference(CRD Practitioner | US Core PractitionerRole Profile)Intended performer of administration
... reasonCode S0..*CodeableConceptReason or indication for ordering or not ordering the medication
... reasonReference S0..*Reference(US Core Condition Profile | US Core Laboratory Result Observation Profile)Condition or observation that supports why the prescription is being written
... basedOn 0..*Reference(CRD Medication Request | CRD Service Request)What request fulfills
... dosageInstruction S0..*DosageHow the medication should be taken
.... text S0..1stringFree text dosage instructions e.g. SIG
... dispenseRequest S0..1BackboneElementMedication supply authorization
... substitution S0..1BackboneElementAny restrictions on medication substitution
... priorPrescription S0..1Reference(CRD Medication Request)An order/prescription that is being replaced

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
MedicationRequest.medication[x]extensibleUSCoreMedicationCodes

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
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... Coverage-Information SC0..*(Complex)Coverage Info
URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information
... identifier S0..*IdentifierExternal ids for this request
... status ?!SΣ1..1codeactive | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Binding: medicationrequest Status (required): A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.


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

... reported[x] SΣ0..1Reported rather than primary record
.... reportedBooleanboolean
.... reportedReferenceReference(US Core Patient Profile | US Core Practitioner Profile | US Core Organization Profile)
... medication[x] SΣ1..1Medication to be taken
Binding: US Core Medication Codes (RxNorm) (extensible)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject SΣ1..1Reference(CRD Patient)Who or group medication request is for
... encounter S0..1Reference(CRD Encounter)Encounter created as part of encounter/admission/stay
... authoredOn SΣ1..1dateTimeWhen request was initially authored
... requester SΣ1..1Reference(CRD Practitioner | US Core PractitionerRole Profile)Who/What requested the Request
... performer S0..1Reference(CRD Practitioner | US Core PractitionerRole Profile)Intended performer of administration
... reasonCode S0..*CodeableConceptReason or indication for ordering or not ordering the medication
Binding: Condition/Problem/DiagnosisCodes (example): A coded concept indicating why the medication was ordered.


... reasonReference S0..*Reference(US Core Condition Profile | US Core Laboratory Result Observation Profile)Condition or observation that supports why the prescription is being written
... basedOn Σ0..*Reference(CRD Medication Request | CRD Service Request)What request fulfills
... 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
... dispenseRequest S0..1BackboneElementMedication supply authorization
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
... substitution S0..1BackboneElementAny restrictions on medication substitution
.... 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
... priorPrescription S0..1Reference(CRD Medication Request)An order/prescription that is being replaced

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
MedicationRequest.statusrequiredFixed Value: draft
MedicationRequest.intentrequiredmedicationRequest Intent
MedicationRequest.medication[x]extensibleUSCoreMedicationCodes
MedicationRequest.reasonCodeexampleCondition/Problem/DiagnosisCodes
MedicationRequest.substitution.allowed[x]exampleActSubstanceAdminSubstitutionCode

Constraints

IdGradePath(s)DetailsRequirements
crd-ci-q1errorMedicationRequest.extension:Coverage-InformationQuestionnaire and QuestionnaireResponse are only allowed when doc-needed exists and not equal to 'no-doc'
: extension.where(url='questionnaire' or url='response').exists() implies (extension.where(url = 'doc-needed').exists() and extension.where(url = 'doc-needed').all(value != 'no-doc'))
crd-ci-q2errorMedicationRequest.extension:Coverage-InformationIf covered is set to 'not-covered', then 'pa-needed' should not exist.
: extension.where(url = 'covered' and value != 'not-covered') implies extension.where(url = 'pa-needed').exists()
crd-ci-q3errorMedicationRequest.extension:Coverage-InformationIf 'info-needed' exists, then at least one of 'covered', 'pa-needed', or 'doc-needed' must be 'conditional'.
: extension.where(url = 'info-needed').exists() implies extension.where((url = 'covered' or url = 'pa-needed' or url = 'doc-needed') and value = 'conditional').count() >= 1
crd-ci-q4errorMedicationRequest.extension:Coverage-InformationIf 'pa-needed' is 'satisfied', then 'Doc-purpose' can't be 'PA'.
: extension.where(url = 'pa-needed' and value = 'satisfied') and extension.where(url = 'doc-purpose').exists() implies extension.where(url = 'doc-purpose').all(value != 'PA')
crd-ci-q5errorMedicationRequest.extension:Coverage-Information'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'.
: extension.where(url = 'pa-needed' and value = 'satisfied').exists() = extension.where(url = 'satisfied-pa-id').exists()
dom-2errorMedicationRequestIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationRequestIf 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-4errorMedicationRequestIf 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-5errorMedicationRequestIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationRequestA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

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
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... Coverage-Information SC0..*(Complex)Coverage Info
URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier S0..*IdentifierExternal ids for this request
... status ?!SΣ1..1codeactive | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Binding: medicationrequest Status (required): A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.


Fixed Value: draft
... 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.

... category 0..*CodeableConceptType of medication usage
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.


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

... reported[x] SΣ0..1Reported rather than primary record
.... reportedBooleanboolean
.... reportedReferenceReference(US Core Patient Profile | US Core Practitioner Profile | US Core Organization Profile)
... medication[x] SΣ1..1Medication to be taken
Binding: US Core Medication Codes (RxNorm) (extensible)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject SΣ1..1Reference(CRD Patient)Who or group medication request is for
... encounter S0..1Reference(CRD 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(CRD Practitioner | US Core PractitionerRole Profile)Who/What requested the Request
... performer S0..1Reference(CRD Practitioner | US Core PractitionerRole Profile)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 S0..*CodeableConceptReason or indication for ordering or not ordering the medication
Binding: Condition/Problem/DiagnosisCodes (example): A coded concept indicating why the medication was ordered.


... reasonReference S0..*Reference(US Core Condition Profile | US Core Laboratory Result Observation 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(CRD Medication Request | CRD Service Request)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 Σ0..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 Σ0..*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] Σ0..1Amount of medication per dose
...... doseRangeRange
...... doseQuantityQuantity(SimpleQuantity)
..... 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 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 S0..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 S0..1Reference(CRD Medication Request)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 / Code
MedicationRequest.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
MedicationRequest.statusrequiredFixed Value: draft
MedicationRequest.statusReasonexamplemedicationRequest Status Reason Codes
MedicationRequest.intentrequiredmedicationRequest Intent
MedicationRequest.categoryexamplemedicationRequest Category Codes
MedicationRequest.priorityrequiredRequestPriority
MedicationRequest.medication[x]extensibleUSCoreMedicationCodes
MedicationRequest.performerTypeexampleProcedurePerformerRoleCodes
MedicationRequest.reasonCodeexampleCondition/Problem/DiagnosisCodes
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.substitution.allowed[x]exampleActSubstanceAdminSubstitutionCode
MedicationRequest.substitution.reasonexampleSubstanceAdminSubstitutionReason

Constraints

IdGradePath(s)DetailsRequirements
crd-ci-q1errorMedicationRequest.extension:Coverage-InformationQuestionnaire and QuestionnaireResponse are only allowed when doc-needed exists and not equal to 'no-doc'
: extension.where(url='questionnaire' or url='response').exists() implies (extension.where(url = 'doc-needed').exists() and extension.where(url = 'doc-needed').all(value != 'no-doc'))
crd-ci-q2errorMedicationRequest.extension:Coverage-InformationIf covered is set to 'not-covered', then 'pa-needed' should not exist.
: extension.where(url = 'covered' and value != 'not-covered') implies extension.where(url = 'pa-needed').exists()
crd-ci-q3errorMedicationRequest.extension:Coverage-InformationIf 'info-needed' exists, then at least one of 'covered', 'pa-needed', or 'doc-needed' must be 'conditional'.
: extension.where(url = 'info-needed').exists() implies extension.where((url = 'covered' or url = 'pa-needed' or url = 'doc-needed') and value = 'conditional').count() >= 1
crd-ci-q4errorMedicationRequest.extension:Coverage-InformationIf 'pa-needed' is 'satisfied', then 'Doc-purpose' can't be 'PA'.
: extension.where(url = 'pa-needed' and value = 'satisfied') and extension.where(url = 'doc-purpose').exists() implies extension.where(url = 'doc-purpose').all(value != 'PA')
crd-ci-q5errorMedicationRequest.extension:Coverage-Information'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'.
: extension.where(url = 'pa-needed' and value = 'satisfied').exists() = extension.where(url = 'satisfied-pa-id').exists()
dom-2errorMedicationRequestIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationRequestIf 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-4errorMedicationRequestIf 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-5errorMedicationRequestIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationRequestA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from MedicationRequest

 

Other representations of profile: CSV, Excel, Schematron

Notes:

Notes

While the codes for the medication are expected to be drawn from RxNorm, EHRs MAY send additional coding repetions to communicate other code systems (e.g. HCPCS J codes). This may be necessary for the payer to appropriately respond to coverage information regarding medications associated with medical and DME benefits.