This page is part of the HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE) Release 1 - US Realm | STU1 (v4.0.0-ballot: STU4 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 3.0.0. For a full list of available versions, see the Directory of published versions

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Resource Profile: Cancer-Related Medication Request Profile

A record of a medication prescription or consumption associated with cancer treatment. The medication may reported by the prescriber, prescribing organization, or patient. It does not have to be directly observed.

Usage:

• Examples for this Resource Profile: MedicationRequest/cancer-related-medication-request-anastrozole-jenny-m, MedicationRequest/cancer-related-medication-request-cisplatin-stopped, MedicationRequest/cancer-related-medication-request-cisplatin, MedicationRequest/cancer-related-medication-request-cyclophosphamide-brian-l... Show 7 more, MedicationRequest/cancer-related-medication-request-cyclophosphamide-jenny-m, MedicationRequest/cancer-related-medication-request-doxorubicin-jenny-m, MedicationRequest/cancer-related-medication-request-gefitinib, MedicationRequest/cancer-related-medication-request-idarubicin-brian-l, MedicationRequest/cancer-related-medication-request-paclitaxel-jenny-m, MedicationRequest/cancer-related-medication-request-prednisone-brian-l and MedicationRequest/cancer-related-medication-request-vincristine-brian-l

Formal Views of Profile Content

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

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

This structure is derived from USCoreMedicationRequestProfile

Name	Flags	Card.	Type	Description & Constraints
MedicationRequest	C	0..*	USCoreMedicationRequestProfile	Ordering of medication for patient or group mcode-reason-required: One of reasonCode or reasonReference SHALL be present termination-reason-code-invariant: When status is stopped, only certain statusReason values are allowed termination-reason-invariant: Certain statusReason values are allowed only when status is stopped
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
treatmentIntent	S	0..1	CodeableConcept	Procedure Intent Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent Binding: Procedure Intent Value Set (extensible)
normalizationBasis		0..1	CodeableConcept	Normalization Basis Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-normalization-basis Binding: Normalization Basis Value Set (required)
statusReason	S	0..1	CodeableConcept	Reason for current status Binding: Treatment Termination Reason Value Set (preferred)
subject		1..1	Reference(Cancer Patient Profile)	Who or group medication request is for
requester		1..1	Reference(US Core Practitioner Profile | US Core Organization Profile | Cancer Patient Profile)	Who/What requested the Request
reasonCode	S	0..*	CodeableConcept	Reason or indication for ordering or not ordering the medication Binding: Cancer Disorder Value Set (extensible)
reasonReference	S	0..*	Reference(US Core Condition Problems and Health Concerns Profile)	Condition or observation that supports why the prescription is being written
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
MedicationRequest.statusReason	preferred	TreatmentTerminationReasonVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-treatment-termination-reason-vs from this IG
MedicationRequest.reasonCode	extensible	CancerDisorderVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-cancer-disorder-vs from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
mcode-reason-required	warning	MedicationRequest	One of reasonCode or reasonReference SHALL be present : reasonCode.exists() or reasonReference.exists()
termination-reason-code-invariant	error	MedicationRequest	When status is stopped, only certain statusReason values are allowed : status = 'stopped' and statusReason.exists() and statusReason.coding.exists() implies statusReason.coding.exists(system = 'http://snomed.info/sct' and (code = '182992009' or code = '266721009' or code = '407563006' or code = '160932005' or code = '105480006' or code = '184081006' or code = '309846006' or code = '399307001' or code = '419620001' or code = '7058009' or code = '443729008' or code = '77386006'))
termination-reason-invariant	error	MedicationRequest	Certain statusReason values are allowed only when status is stopped : statusReason.exists() and statusReason.coding.exists( system = 'http://snomed.info/sct' and (code = '182992009' or code = '266721009' or code = '407563006' or code = '160932005' or code = '105480006' or code = '184081006' or code = '309846006' or code = '399307001' or code = '419620001' or code = '7058009' or code = '443729008' or code = '77386006')) implies status = 'stopped'

Name	Flags	Card.	Type	Description & Constraints
MedicationRequest	C	0..*	USCoreMedicationRequestProfile	Ordering of medication for patient or group mcode-reason-required: One of reasonCode or reasonReference SHALL be present termination-reason-code-invariant: When status is stopped, only certain statusReason values are allowed termination-reason-invariant: Certain statusReason values are allowed only when status is stopped
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
treatmentIntent	S	0..1	CodeableConcept	Procedure Intent Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent Binding: Procedure Intent Value Set (extensible)
normalizationBasis		0..1	CodeableConcept	Normalization Basis Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-normalization-basis Binding: Normalization Basis Value Set (required)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.
statusReason	S	0..1	CodeableConcept	Reason for current status Binding: Treatment Termination Reason Value Set (preferred)
intent	?!SΣ	1..1	code	proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order.
Slices for category	S	0..*	CodeableConcept	Type of medication usage Slice: Unordered, Open by pattern:$this 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.
category:us-core	S	0..*	CodeableConcept	Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order.
doNotPerform	?!Σ	0..1	boolean	True if request is prohibiting action
reported[x]	SΣ	0..1		Reported rather than primary record
reportedBoolean			boolean
reportedReference			Reference(US Core Practitioner Profile)
medication[x]	SΣ	1..1		Medication to be taken Binding: Medication Clinical Drug (extensible)
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(US Core Medication Profile)
subject	SΣ	1..1	Reference(Cancer Patient Profile)	Who or group medication request is for
encounter	S	0..1	Reference(US Core Encounter Profile)	Encounter created as part of encounter/admission/stay
authoredOn	SΣ	0..1	dateTime	When request was initially authored
requester	SΣ	1..1	Reference(US Core Practitioner Profile)	Who/What requested the Request
reasonCode	S	0..*	CodeableConcept	Reason or indication for ordering or not ordering the medication Binding: Cancer Disorder Value Set (extensible)
reasonReference	S	0..*	Reference(US Core Condition Problems and Health Concerns Profile)	Condition or observation that supports why the prescription is being written
dosageInstruction	S	0..*	Dosage	How the medication should be taken
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
text	SΣ	0..1	string	Free text dosage instructions e.g. SIG
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
MedicationRequest.status	required	medicationrequest Status http://hl7.org/fhir/ValueSet/medicationrequest-status from the FHIR Standard
MedicationRequest.statusReason	preferred	TreatmentTerminationReasonVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-treatment-termination-reason-vs from this IG
MedicationRequest.intent	required	medicationRequest Intent http://hl7.org/fhir/ValueSet/medicationrequest-intent from the FHIR Standard
MedicationRequest.category	example	medicationRequest Category Codes http://hl7.org/fhir/ValueSet/medicationrequest-category from the FHIR Standard
MedicationRequest.category:us-core	required	medicationRequest Category Codes http://hl7.org/fhir/ValueSet/medicationrequest-category from the FHIR Standard
MedicationRequest.medication[x]	extensible	Medication Clinical Drug http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4 from https://vsac.nlm.nih.gov
MedicationRequest.reasonCode	extensible	CancerDisorderVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-cancer-disorder-vs from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
mcode-reason-required	warning	MedicationRequest	One of reasonCode or reasonReference SHALL be present : reasonCode.exists() or reasonReference.exists()
termination-reason-code-invariant	error	MedicationRequest	When status is stopped, only certain statusReason values are allowed : status = 'stopped' and statusReason.exists() and statusReason.coding.exists() implies statusReason.coding.exists(system = 'http://snomed.info/sct' and (code = '182992009' or code = '266721009' or code = '407563006' or code = '160932005' or code = '105480006' or code = '184081006' or code = '309846006' or code = '399307001' or code = '419620001' or code = '7058009' or code = '443729008' or code = '77386006'))
termination-reason-invariant	error	MedicationRequest	Certain statusReason values are allowed only when status is stopped : statusReason.exists() and statusReason.coding.exists( system = 'http://snomed.info/sct' and (code = '182992009' or code = '266721009' or code = '407563006' or code = '160932005' or code = '105480006' or code = '184081006' or code = '309846006' or code = '399307001' or code = '419620001' or code = '7058009' or code = '443729008' or code = '77386006')) implies status = 'stopped'

Name	Flags	Card.	Type	Description & Constraints
MedicationRequest	C	0..*	USCoreMedicationRequestProfile	Ordering of medication for patient or group mcode-reason-required: One of reasonCode or reasonReference SHALL be present termination-reason-code-invariant: When status is stopped, only certain statusReason values are allowed termination-reason-invariant: Certain statusReason values are allowed only when status is stopped
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
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
treatmentIntent	S	0..1	CodeableConcept	Procedure Intent Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent Binding: Procedure Intent Value Set (extensible)
normalizationBasis		0..1	CodeableConcept	Normalization Basis Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-normalization-basis Binding: Normalization Basis Value Set (required)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	External ids for this request
status	?!SΣ	1..1	code	active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.
statusReason	S	0..1	CodeableConcept	Reason for current status Binding: Treatment Termination Reason Value Set (preferred)
intent	?!SΣ	1..1	code	proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order.
Slices for category	S	0..*	CodeableConcept	Type of medication usage Slice: Unordered, Open by pattern:$this 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.
category:us-core	S	0..*	CodeableConcept	Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order.
priority	Σ	0..1	code	routine | urgent | asap | stat Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.
doNotPerform	?!Σ	0..1	boolean	True if request is prohibiting action
reported[x]	SΣ	0..1		Reported rather than primary record
reportedBoolean			boolean S
reportedReference			Reference S(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile)
medication[x]	SΣ	1..1		Medication to be taken Binding: Medication Clinical Drug (extensible)
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(US Core Medication Profile)
subject	SΣ	1..1	Reference(Cancer Patient Profile)	Who or group medication request is for
encounter	S	0..1	Reference(US Core Encounter Profile)	Encounter created as part of encounter/admission/stay
supportingInformation		0..*	Reference(Resource)	Information to support ordering of the medication
authoredOn	SΣ	0..1	dateTime	When request was initially authored
requester	SΣ	1..1	Reference(US Core Practitioner Profile S | US Core Organization Profile | Cancer Patient Profile)	Who/What requested the Request
performer		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam)	Intended performer of administration
performerType	Σ	0..1	CodeableConcept	Desired kind of performer of the medication administration Binding: ProcedurePerformerRoleCodes (example): Identifies the type of individual that is desired to administer the medication.
recorder		0..1	Reference(Practitioner | PractitionerRole)	Person who entered the request
reasonCode	S	0..*	CodeableConcept	Reason or indication for ordering or not ordering the medication Binding: Cancer Disorder Value Set (extensible)
reasonReference	S	0..*	Reference(US Core Condition Problems and Health Concerns Profile)	Condition or observation that supports why the prescription is being written
instantiatesCanonical	Σ	0..*	canonical()	Instantiates FHIR protocol or definition
instantiatesUri	Σ	0..*	uri	Instantiates external protocol or definition
basedOn	Σ	0..*	Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation)	What request fulfills
groupIdentifier	Σ	0..1	Identifier	Composite request this is part of
courseOfTherapyType		0..1	CodeableConcept	Overall 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..*	Annotation	Information about the prescription
dosageInstruction	S	0..*	Dosage	How the medication should be taken
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	0..1	integer	The order of the dosage instructions
text	SΣ	0..1	string	Free text dosage instructions e.g. SIG
additionalInstruction	Σ	0..*	CodeableConcept	Supplemental 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	Σ	0..1	string	Patient or consumer oriented instructions
timing	Σ	0..1	Timing	When medication should be administered
asNeeded[x]	Σ	0..1		Take "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.
asNeededBoolean			boolean
asNeededCodeableConcept			CodeableConcept
site	Σ	0..1	CodeableConcept	Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route	Σ	0..1	CodeableConcept	How 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	Σ	0..1	CodeableConcept	Technique for administering medication Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
doseAndRate	Σ	0..*	Element	Amount of medication administered
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
type	Σ	0..1	CodeableConcept	The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
dose[x]	Σ	0..1		Amount of medication per dose
doseRange			Range
doseQuantity			Quantity(SimpleQuantity)
rate[x]	Σ	0..1		Amount of medication per unit of time
rateRatio			Ratio
rateRange			Range
rateQuantity			Quantity(SimpleQuantity)
maxDosePerPeriod	Σ	0..1	Ratio	Upper limit on medication per unit of time
maxDosePerAdministration	Σ	0..1	SimpleQuantity	Upper limit on medication per administration
maxDosePerLifetime	Σ	0..1	SimpleQuantity	Upper limit on medication per lifetime of the patient
dispenseRequest		0..1	BackboneElement	Medication supply authorization
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
initialFill		0..1	BackboneElement	First fill details
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
quantity		0..1	SimpleQuantity	First fill quantity
duration		0..1	Duration	First fill duration
dispenseInterval		0..1	Duration	Minimum period of time between dispenses
validityPeriod		0..1	Period	Time period supply is authorized for
numberOfRepeatsAllowed		0..1	unsignedInt	Number of refills authorized
quantity		0..1	SimpleQuantity	Amount of medication to supply per dispense
expectedSupplyDuration		0..1	Duration	Number of days supply per dispense
performer		0..1	Reference(Organization)	Intended dispenser
substitution		0..1	BackboneElement	Any restrictions on medication substitution
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
allowed[x]		1..1		Whether substitution is allowed or not Binding: ActSubstanceAdminSubstitutionCode (example): Identifies the type of substitution allowed.
allowedBoolean			boolean
allowedCodeableConcept			CodeableConcept
reason		0..1	CodeableConcept	Why 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		0..1	Reference(MedicationRequest)	An order/prescription that is being replaced
detectedIssue		0..*	Reference(DetectedIssue)	Clinical Issue with action
eventHistory		0..*	Reference(Provenance)	A list of events of interest in the lifecycle
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
MedicationRequest.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
MedicationRequest.status	required	medicationrequest Status http://hl7.org/fhir/ValueSet/medicationrequest-status from the FHIR Standard
MedicationRequest.statusReason	preferred	TreatmentTerminationReasonVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-treatment-termination-reason-vs from this IG
MedicationRequest.intent	required	medicationRequest Intent http://hl7.org/fhir/ValueSet/medicationrequest-intent from the FHIR Standard
MedicationRequest.category	example	medicationRequest Category Codes http://hl7.org/fhir/ValueSet/medicationrequest-category from the FHIR Standard
MedicationRequest.category:us-core	required	medicationRequest Category Codes http://hl7.org/fhir/ValueSet/medicationrequest-category from the FHIR Standard
MedicationRequest.priority	required	RequestPriority http://hl7.org/fhir/ValueSet/request-priority|4.0.1 from the FHIR Standard
MedicationRequest.medication[x]	extensible	Medication Clinical Drug http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4 from https://vsac.nlm.nih.gov
MedicationRequest.performerType	example	ProcedurePerformerRoleCodes http://hl7.org/fhir/ValueSet/performer-role from the FHIR Standard
MedicationRequest.reasonCode	extensible	CancerDisorderVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-cancer-disorder-vs from this IG
MedicationRequest.courseOfTherapyType	example	medicationRequest Course of Therapy Codes http://hl7.org/fhir/ValueSet/medicationrequest-course-of-therapy from the FHIR Standard
MedicationRequest.dosageInstruction.additionalInstruction	example	SNOMEDCTAdditionalDosageInstructions http://hl7.org/fhir/ValueSet/additional-instruction-codes from the FHIR Standard
MedicationRequest.dosageInstruction.asNeeded[x]	example	SNOMEDCTMedicationAsNeededReasonCodes http://hl7.org/fhir/ValueSet/medication-as-needed-reason from the FHIR Standard
MedicationRequest.dosageInstruction.site	example	SNOMEDCTAnatomicalStructureForAdministrationSiteCodes http://hl7.org/fhir/ValueSet/approach-site-codes from the FHIR Standard
MedicationRequest.dosageInstruction.route	example	SNOMEDCTRouteCodes http://hl7.org/fhir/ValueSet/route-codes from the FHIR Standard
MedicationRequest.dosageInstruction.method	example	SNOMEDCTAdministrationMethodCodes http://hl7.org/fhir/ValueSet/administration-method-codes from the FHIR Standard
MedicationRequest.dosageInstruction.doseAndRate.type	example	DoseAndRateType http://hl7.org/fhir/ValueSet/dose-rate-type from the FHIR Standard
MedicationRequest.substitution.allowed[x]	example	ActSubstanceAdminSubstitutionCode http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode
MedicationRequest.substitution.reason	example	SubstanceAdminSubstitutionReason http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason

Constraints

Id	Grade	Path(s)	Details	Requirements
mcode-reason-required	warning	MedicationRequest	One of reasonCode or reasonReference SHALL be present : reasonCode.exists() or reasonReference.exists()
termination-reason-code-invariant	error	MedicationRequest	When status is stopped, only certain statusReason values are allowed : status = 'stopped' and statusReason.exists() and statusReason.coding.exists() implies statusReason.coding.exists(system = 'http://snomed.info/sct' and (code = '182992009' or code = '266721009' or code = '407563006' or code = '160932005' or code = '105480006' or code = '184081006' or code = '309846006' or code = '399307001' or code = '419620001' or code = '7058009' or code = '443729008' or code = '77386006'))
termination-reason-invariant	error	MedicationRequest	Certain statusReason values are allowed only when status is stopped : statusReason.exists() and statusReason.coding.exists( system = 'http://snomed.info/sct' and (code = '182992009' or code = '266721009' or code = '407563006' or code = '160932005' or code = '105480006' or code = '184081006' or code = '309846006' or code = '399307001' or code = '419620001' or code = '7058009' or code = '443729008' or code = '77386006')) implies status = 'stopped'

This structure is derived from USCoreMedicationRequestProfile

Summary

Must-Support: 5 elements

Structures

This structure refers to these other structures:

• Cancer Patient Profile (http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-cancer-patient)
• US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
• US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
• US Core Condition Problems and Health Concerns Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-problems-health-concerns)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent
• http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-normalization-basis

Maturity: 3

Differential View

This structure is derived from USCoreMedicationRequestProfile

Name	Flags	Card.	Type	Description & Constraints
MedicationRequest	C	0..*	USCoreMedicationRequestProfile	Ordering of medication for patient or group mcode-reason-required: One of reasonCode or reasonReference SHALL be present termination-reason-code-invariant: When status is stopped, only certain statusReason values are allowed termination-reason-invariant: Certain statusReason values are allowed only when status is stopped
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
treatmentIntent	S	0..1	CodeableConcept	Procedure Intent Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent Binding: Procedure Intent Value Set (extensible)
normalizationBasis		0..1	CodeableConcept	Normalization Basis Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-normalization-basis Binding: Normalization Basis Value Set (required)
statusReason	S	0..1	CodeableConcept	Reason for current status Binding: Treatment Termination Reason Value Set (preferred)
subject		1..1	Reference(Cancer Patient Profile)	Who or group medication request is for
requester		1..1	Reference(US Core Practitioner Profile | US Core Organization Profile | Cancer Patient Profile)	Who/What requested the Request
reasonCode	S	0..*	CodeableConcept	Reason or indication for ordering or not ordering the medication Binding: Cancer Disorder Value Set (extensible)
reasonReference	S	0..*	Reference(US Core Condition Problems and Health Concerns Profile)	Condition or observation that supports why the prescription is being written
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
MedicationRequest.statusReason	preferred	TreatmentTerminationReasonVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-treatment-termination-reason-vs from this IG
MedicationRequest.reasonCode	extensible	CancerDisorderVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-cancer-disorder-vs from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
mcode-reason-required	warning	MedicationRequest	One of reasonCode or reasonReference SHALL be present : reasonCode.exists() or reasonReference.exists()
termination-reason-code-invariant	error	MedicationRequest	When status is stopped, only certain statusReason values are allowed : status = 'stopped' and statusReason.exists() and statusReason.coding.exists() implies statusReason.coding.exists(system = 'http://snomed.info/sct' and (code = '182992009' or code = '266721009' or code = '407563006' or code = '160932005' or code = '105480006' or code = '184081006' or code = '309846006' or code = '399307001' or code = '419620001' or code = '7058009' or code = '443729008' or code = '77386006'))
termination-reason-invariant	error	MedicationRequest	Certain statusReason values are allowed only when status is stopped : statusReason.exists() and statusReason.coding.exists( system = 'http://snomed.info/sct' and (code = '182992009' or code = '266721009' or code = '407563006' or code = '160932005' or code = '105480006' or code = '184081006' or code = '309846006' or code = '399307001' or code = '419620001' or code = '7058009' or code = '443729008' or code = '77386006')) implies status = 'stopped'

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
MedicationRequest	C	0..*	USCoreMedicationRequestProfile	Ordering of medication for patient or group mcode-reason-required: One of reasonCode or reasonReference SHALL be present termination-reason-code-invariant: When status is stopped, only certain statusReason values are allowed termination-reason-invariant: Certain statusReason values are allowed only when status is stopped
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
treatmentIntent	S	0..1	CodeableConcept	Procedure Intent Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent Binding: Procedure Intent Value Set (extensible)
normalizationBasis		0..1	CodeableConcept	Normalization Basis Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-normalization-basis Binding: Normalization Basis Value Set (required)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.
statusReason	S	0..1	CodeableConcept	Reason for current status Binding: Treatment Termination Reason Value Set (preferred)
intent	?!SΣ	1..1	code	proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order.
Slices for category	S	0..*	CodeableConcept	Type of medication usage Slice: Unordered, Open by pattern:$this 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.
category:us-core	S	0..*	CodeableConcept	Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order.
doNotPerform	?!Σ	0..1	boolean	True if request is prohibiting action
reported[x]	SΣ	0..1		Reported rather than primary record
reportedBoolean			boolean
reportedReference			Reference(US Core Practitioner Profile)
medication[x]	SΣ	1..1		Medication to be taken Binding: Medication Clinical Drug (extensible)
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(US Core Medication Profile)
subject	SΣ	1..1	Reference(Cancer Patient Profile)	Who or group medication request is for
encounter	S	0..1	Reference(US Core Encounter Profile)	Encounter created as part of encounter/admission/stay
authoredOn	SΣ	0..1	dateTime	When request was initially authored
requester	SΣ	1..1	Reference(US Core Practitioner Profile)	Who/What requested the Request
reasonCode	S	0..*	CodeableConcept	Reason or indication for ordering or not ordering the medication Binding: Cancer Disorder Value Set (extensible)
reasonReference	S	0..*	Reference(US Core Condition Problems and Health Concerns Profile)	Condition or observation that supports why the prescription is being written
dosageInstruction	S	0..*	Dosage	How the medication should be taken
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
text	SΣ	0..1	string	Free text dosage instructions e.g. SIG
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
MedicationRequest.status	required	medicationrequest Status http://hl7.org/fhir/ValueSet/medicationrequest-status from the FHIR Standard
MedicationRequest.statusReason	preferred	TreatmentTerminationReasonVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-treatment-termination-reason-vs from this IG
MedicationRequest.intent	required	medicationRequest Intent http://hl7.org/fhir/ValueSet/medicationrequest-intent from the FHIR Standard
MedicationRequest.category	example	medicationRequest Category Codes http://hl7.org/fhir/ValueSet/medicationrequest-category from the FHIR Standard
MedicationRequest.category:us-core	required	medicationRequest Category Codes http://hl7.org/fhir/ValueSet/medicationrequest-category from the FHIR Standard
MedicationRequest.medication[x]	extensible	Medication Clinical Drug http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4 from https://vsac.nlm.nih.gov
MedicationRequest.reasonCode	extensible	CancerDisorderVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-cancer-disorder-vs from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
mcode-reason-required	warning	MedicationRequest	One of reasonCode or reasonReference SHALL be present : reasonCode.exists() or reasonReference.exists()
termination-reason-code-invariant	error	MedicationRequest	When status is stopped, only certain statusReason values are allowed : status = 'stopped' and statusReason.exists() and statusReason.coding.exists() implies statusReason.coding.exists(system = 'http://snomed.info/sct' and (code = '182992009' or code = '266721009' or code = '407563006' or code = '160932005' or code = '105480006' or code = '184081006' or code = '309846006' or code = '399307001' or code = '419620001' or code = '7058009' or code = '443729008' or code = '77386006'))
termination-reason-invariant	error	MedicationRequest	Certain statusReason values are allowed only when status is stopped : statusReason.exists() and statusReason.coding.exists( system = 'http://snomed.info/sct' and (code = '182992009' or code = '266721009' or code = '407563006' or code = '160932005' or code = '105480006' or code = '184081006' or code = '309846006' or code = '399307001' or code = '419620001' or code = '7058009' or code = '443729008' or code = '77386006')) implies status = 'stopped'

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
MedicationRequest	C	0..*	USCoreMedicationRequestProfile	Ordering of medication for patient or group mcode-reason-required: One of reasonCode or reasonReference SHALL be present termination-reason-code-invariant: When status is stopped, only certain statusReason values are allowed termination-reason-invariant: Certain statusReason values are allowed only when status is stopped
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
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
treatmentIntent	S	0..1	CodeableConcept	Procedure Intent Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent Binding: Procedure Intent Value Set (extensible)
normalizationBasis		0..1	CodeableConcept	Normalization Basis Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-normalization-basis Binding: Normalization Basis Value Set (required)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	External ids for this request
status	?!SΣ	1..1	code	active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.
statusReason	S	0..1	CodeableConcept	Reason for current status Binding: Treatment Termination Reason Value Set (preferred)
intent	?!SΣ	1..1	code	proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order.
Slices for category	S	0..*	CodeableConcept	Type of medication usage Slice: Unordered, Open by pattern:$this 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.
category:us-core	S	0..*	CodeableConcept	Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order.
priority	Σ	0..1	code	routine | urgent | asap | stat Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.
doNotPerform	?!Σ	0..1	boolean	True if request is prohibiting action
reported[x]	SΣ	0..1		Reported rather than primary record
reportedBoolean			boolean S
reportedReference			Reference S(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile)
medication[x]	SΣ	1..1		Medication to be taken Binding: Medication Clinical Drug (extensible)
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(US Core Medication Profile)
subject	SΣ	1..1	Reference(Cancer Patient Profile)	Who or group medication request is for
encounter	S	0..1	Reference(US Core Encounter Profile)	Encounter created as part of encounter/admission/stay
supportingInformation		0..*	Reference(Resource)	Information to support ordering of the medication
authoredOn	SΣ	0..1	dateTime	When request was initially authored
requester	SΣ	1..1	Reference(US Core Practitioner Profile S | US Core Organization Profile | Cancer Patient Profile)	Who/What requested the Request
performer		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam)	Intended performer of administration
performerType	Σ	0..1	CodeableConcept	Desired kind of performer of the medication administration Binding: ProcedurePerformerRoleCodes (example): Identifies the type of individual that is desired to administer the medication.
recorder		0..1	Reference(Practitioner | PractitionerRole)	Person who entered the request
reasonCode	S	0..*	CodeableConcept	Reason or indication for ordering or not ordering the medication Binding: Cancer Disorder Value Set (extensible)
reasonReference	S	0..*	Reference(US Core Condition Problems and Health Concerns Profile)	Condition or observation that supports why the prescription is being written
instantiatesCanonical	Σ	0..*	canonical()	Instantiates FHIR protocol or definition
instantiatesUri	Σ	0..*	uri	Instantiates external protocol or definition
basedOn	Σ	0..*	Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation)	What request fulfills
groupIdentifier	Σ	0..1	Identifier	Composite request this is part of
courseOfTherapyType		0..1	CodeableConcept	Overall 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..*	Annotation	Information about the prescription
dosageInstruction	S	0..*	Dosage	How the medication should be taken
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	0..1	integer	The order of the dosage instructions
text	SΣ	0..1	string	Free text dosage instructions e.g. SIG
additionalInstruction	Σ	0..*	CodeableConcept	Supplemental 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	Σ	0..1	string	Patient or consumer oriented instructions
timing	Σ	0..1	Timing	When medication should be administered
asNeeded[x]	Σ	0..1		Take "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.
asNeededBoolean			boolean
asNeededCodeableConcept			CodeableConcept
site	Σ	0..1	CodeableConcept	Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route	Σ	0..1	CodeableConcept	How 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	Σ	0..1	CodeableConcept	Technique for administering medication Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
doseAndRate	Σ	0..*	Element	Amount of medication administered
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
type	Σ	0..1	CodeableConcept	The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
dose[x]	Σ	0..1		Amount of medication per dose
doseRange			Range
doseQuantity			Quantity(SimpleQuantity)
rate[x]	Σ	0..1		Amount of medication per unit of time
rateRatio			Ratio
rateRange			Range
rateQuantity			Quantity(SimpleQuantity)
maxDosePerPeriod	Σ	0..1	Ratio	Upper limit on medication per unit of time
maxDosePerAdministration	Σ	0..1	SimpleQuantity	Upper limit on medication per administration
maxDosePerLifetime	Σ	0..1	SimpleQuantity	Upper limit on medication per lifetime of the patient
dispenseRequest		0..1	BackboneElement	Medication supply authorization
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
initialFill		0..1	BackboneElement	First fill details
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
quantity		0..1	SimpleQuantity	First fill quantity
duration		0..1	Duration	First fill duration
dispenseInterval		0..1	Duration	Minimum period of time between dispenses
validityPeriod		0..1	Period	Time period supply is authorized for
numberOfRepeatsAllowed		0..1	unsignedInt	Number of refills authorized
quantity		0..1	SimpleQuantity	Amount of medication to supply per dispense
expectedSupplyDuration		0..1	Duration	Number of days supply per dispense
performer		0..1	Reference(Organization)	Intended dispenser
substitution		0..1	BackboneElement	Any restrictions on medication substitution
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
allowed[x]		1..1		Whether substitution is allowed or not Binding: ActSubstanceAdminSubstitutionCode (example): Identifies the type of substitution allowed.
allowedBoolean			boolean
allowedCodeableConcept			CodeableConcept
reason		0..1	CodeableConcept	Why 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		0..1	Reference(MedicationRequest)	An order/prescription that is being replaced
detectedIssue		0..*	Reference(DetectedIssue)	Clinical Issue with action
eventHistory		0..*	Reference(Provenance)	A list of events of interest in the lifecycle
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
MedicationRequest.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
MedicationRequest.status	required	medicationrequest Status http://hl7.org/fhir/ValueSet/medicationrequest-status from the FHIR Standard
MedicationRequest.statusReason	preferred	TreatmentTerminationReasonVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-treatment-termination-reason-vs from this IG
MedicationRequest.intent	required	medicationRequest Intent http://hl7.org/fhir/ValueSet/medicationrequest-intent from the FHIR Standard
MedicationRequest.category	example	medicationRequest Category Codes http://hl7.org/fhir/ValueSet/medicationrequest-category from the FHIR Standard
MedicationRequest.category:us-core	required	medicationRequest Category Codes http://hl7.org/fhir/ValueSet/medicationrequest-category from the FHIR Standard
MedicationRequest.priority	required	RequestPriority http://hl7.org/fhir/ValueSet/request-priority|4.0.1 from the FHIR Standard
MedicationRequest.medication[x]	extensible	Medication Clinical Drug http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4 from https://vsac.nlm.nih.gov
MedicationRequest.performerType	example	ProcedurePerformerRoleCodes http://hl7.org/fhir/ValueSet/performer-role from the FHIR Standard
MedicationRequest.reasonCode	extensible	CancerDisorderVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-cancer-disorder-vs from this IG
MedicationRequest.courseOfTherapyType	example	medicationRequest Course of Therapy Codes http://hl7.org/fhir/ValueSet/medicationrequest-course-of-therapy from the FHIR Standard
MedicationRequest.dosageInstruction.additionalInstruction	example	SNOMEDCTAdditionalDosageInstructions http://hl7.org/fhir/ValueSet/additional-instruction-codes from the FHIR Standard
MedicationRequest.dosageInstruction.asNeeded[x]	example	SNOMEDCTMedicationAsNeededReasonCodes http://hl7.org/fhir/ValueSet/medication-as-needed-reason from the FHIR Standard
MedicationRequest.dosageInstruction.site	example	SNOMEDCTAnatomicalStructureForAdministrationSiteCodes http://hl7.org/fhir/ValueSet/approach-site-codes from the FHIR Standard
MedicationRequest.dosageInstruction.route	example	SNOMEDCTRouteCodes http://hl7.org/fhir/ValueSet/route-codes from the FHIR Standard
MedicationRequest.dosageInstruction.method	example	SNOMEDCTAdministrationMethodCodes http://hl7.org/fhir/ValueSet/administration-method-codes from the FHIR Standard
MedicationRequest.dosageInstruction.doseAndRate.type	example	DoseAndRateType http://hl7.org/fhir/ValueSet/dose-rate-type from the FHIR Standard
MedicationRequest.substitution.allowed[x]	example	ActSubstanceAdminSubstitutionCode http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode
MedicationRequest.substitution.reason	example	SubstanceAdminSubstitutionReason http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason

Constraints

Id	Grade	Path(s)	Details	Requirements
mcode-reason-required	warning	MedicationRequest	One of reasonCode or reasonReference SHALL be present : reasonCode.exists() or reasonReference.exists()
termination-reason-code-invariant	error	MedicationRequest	When status is stopped, only certain statusReason values are allowed : status = 'stopped' and statusReason.exists() and statusReason.coding.exists() implies statusReason.coding.exists(system = 'http://snomed.info/sct' and (code = '182992009' or code = '266721009' or code = '407563006' or code = '160932005' or code = '105480006' or code = '184081006' or code = '309846006' or code = '399307001' or code = '419620001' or code = '7058009' or code = '443729008' or code = '77386006'))
termination-reason-invariant	error	MedicationRequest	Certain statusReason values are allowed only when status is stopped : statusReason.exists() and statusReason.coding.exists( system = 'http://snomed.info/sct' and (code = '182992009' or code = '266721009' or code = '407563006' or code = '160932005' or code = '105480006' or code = '184081006' or code = '309846006' or code = '399307001' or code = '419620001' or code = '7058009' or code = '443729008' or code = '77386006')) implies status = 'stopped'

This structure is derived from USCoreMedicationRequestProfile

Summary

Must-Support: 5 elements

Structures

This structure refers to these other structures:

• Cancer Patient Profile (http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-cancer-patient)
• US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
• US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
• US Core Condition Problems and Health Concerns Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-problems-health-concerns)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent
• http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-normalization-basis

Maturity: 3

Other representations of profile: CSV, Excel, Schematron