QI-Core Implementation Guide
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This page is part of the Quality Improvement Core Framework (v6.0.0-ballot: STU6 (v6.0.0) Ballot 1) based on FHIR R4. The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

Resource Profile: QICore Medication Not Requested

Official URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationnotrequested Version: 6.0.0-ballot
Active as of 2018-08-22 Computable Name: QICoreMedicationNotRequested

Negation profile of MedicationRequest for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

Usage

See the patterns page for implementation and usage patterns.

The MedicationRequest and MedicationNotRequested profiles represent the positive and negative statements for a medication order.

Examples

Negation Example using ValuesetMedication not indicated; indicates that none of the medications in the given not done value set were requested.
Negation Example using codeMedication not indicated; indicates that the medication specified by code was not requested.

Both of these example instances meet measure intent for exclusion as defined in the following example CQL:

define "Reason for Not Ordering Antithrombotic":
  ["MedicationNotRequested": "Antithrombotic Therapy"] NoAntithromboticDischarge
    where (NoAntithromboticDischarge.reasonCode in "Medical Reason"
      or NoAntithromboticDischarge.reasonCode in "Patient Refusal")
      and (NoAntithromboticDischarge.isCommunity() or NoAntithromboticDischarge.isDischarge())
      and NoAntithromboticDischarge.status in { 'active', 'completed' }
      and NoAntithromboticDischarge.intent = 'order'

For a more complete discussion of representation of negation within QICore and quality improvement artifacts, see the Negation in QI Core topic.

Usage:

Formal Views of Profile Content

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

This structure is derived from USCoreMedicationRequestProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest C0..*USCoreMedicationRequestProfileOrdering of medication for patient or group
mnr-1: To indicate what medication was not requested, either at least one coding in the medication or a notDoneValueSet extension shall be provided
... status S1..1code(USCDI) active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
... doNotPerform S1..1booleanTrue if medication was not requested
Fixed Value: true
... reported[x] S0..1Reference(QICore Practitioner S | QICore PractitionerRole | QICore Patient S | QICore RelatedPerson S)(USCDI) Reported rather than primary record
.... notDoneValueSet SC0..1canonical(ValueSet)What was not requested
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
.... coding C0..*CodingCode defined by a terminology system
... subject S1..1Reference(QICore Patient)(USCDI) Who or group medication request is for
... encounter S0..1Reference(QICore Encounter)(USCDI) Encounter created as part of encounter/admission/stay
... authoredOn S1..1dateTime(USCDI) When request was initially authored
... requester S0..1Reference(QICore Practitioner S | QICore PractitionerRole | QICore Patient)(USCDI) Who/What requested the Request
... reasonCode S1..1CodeableConcept(USCDI) Reason or indication for ordering or not ordering the medication
Binding: QICore Negation Reason Codes (extensible): The reason the medication was not requested


doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
MedicationRequest.medication[x]preferredSNOMEDCTMedicationCodes
MedicationRequest.reasonCodeextensibleNegationReasonCodes

Constraints

IdGradePath(s)DetailsRequirements
mnr-1errorMedicationRequestTo indicate what medication was not requested, either at least one coding in the medication or a notDoneValueSet extension shall be provided
: medication.extension('http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet').exists() xor medication.coding.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest C0..*USCoreMedicationRequestProfileOrdering of medication for patient or group
mnr-1: To indicate what medication was not requested, either at least one coding in the medication or a notDoneValueSet extension shall be provided
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... status ?!SΣ1..1code(USCDI) 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.

... Slices for category S0..*CodeableConcept(USCDI) 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 S0..*CodeableConcept(USCDI) Type of medication usage
Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets


... doNotPerform ?!SΣ1..1booleanTrue if medication was not requested
Fixed Value: true
... reported[x] SΣ0..1Reference(QICore Practitioner | QICore Patient | QICore RelatedPerson)(USCDI) Reported rather than primary record
... medication[x] SΣ1..1CodeableConcept(USCDI) Medication to be taken
Binding: SNOMEDCTMedicationCodes (preferred)
.... notDoneValueSet SC0..1canonical(ValueSet)What was not requested
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
.... coding ΣC0..*CodingCode defined by a terminology system
... subject SΣ1..1Reference(QICore Patient)(USCDI) Who or group medication request is for
... encounter S0..1Reference(QICore Encounter)(USCDI) Encounter created as part of encounter/admission/stay
... authoredOn SΣ1..1dateTime(USCDI) When request was initially authored
... requester SΣC0..1Reference(QICore Practitioner)(USCDI) Who/What requested the Request
... reasonCode S1..1CodeableConcept(USCDI) Reason or indication for ordering or not ordering the medication
Binding: QICore Negation Reason Codes (extensible): The reason the medication was not requested


... dosageInstruction S0..*Dosage(USCDI) How the medication should be taken
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... text SΣ0..1string(USCDI) Free text dosage instructions e.g. SIG
.... timing SΣ0..1Timing(USCDI) When medication should be administered
.... doseAndRate SΣ0..*Element(USCDI) Amount of medication administered
..... dose[x] SΣ0..1(USCDI) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
...... doseQuantityQuantity
... dispenseRequest S0..1BackboneElement(USCDI) Medication supply authorization
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... numberOfRepeatsAllowed S0..1unsignedInt(USCDI) Number of refills authorized
.... quantity S0..1SimpleQuantity(USCDI) Amount of medication to supply per dispense

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
MedicationRequest.statusrequiredmedicationrequest Status
MedicationRequest.intentrequiredmedicationRequest Intent
MedicationRequest.categoryexamplemedicationRequest Category Codes
MedicationRequest.category:us-corerequiredmedicationRequest Category Codes
MedicationRequest.medication[x]preferredSNOMEDCTMedicationCodes
MedicationRequest.reasonCodeextensibleNegationReasonCodes
MedicationRequest.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding

Constraints

IdGradePath(s)DetailsRequirements
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()
mnr-1errorMedicationRequestTo indicate what medication was not requested, either at least one coding in the medication or a notDoneValueSet extension shall be provided
: medication.extension('http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet').exists() xor medication.coding.exists()
us-core-21errorMedicationRequestrequester SHALL be present if intent is "order"
: (intent='order' or intent='original-order' or intent='reflex-order'or intent='filler-order' or intent='instance-order') implies requester.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest C0..*USCoreMedicationRequestProfileOrdering of medication for patient or group
mnr-1: To indicate what medication was not requested, either at least one coding in the medication or a notDoneValueSet extension shall be provided
... 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
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierExternal ids for this request
... status ?!SΣ1..1code(USCDI) 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 0..1CodeableConceptReason for current status
Binding: medicationRequest Status Reason Codes (example): Identifies the reasons for a given status.

... intent ?!SΣC1..1code(USCDI) proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
Binding: medicationRequest Intent (required): The kind of medication order.

... Slices for category S0..*CodeableConcept(USCDI) 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 S0..*CodeableConcept(USCDI) Type of medication usage
Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets


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

... doNotPerform ?!SΣ1..1booleanTrue if medication was not requested
Fixed Value: true
... reported[x] SΣ0..1Reference(QICore Practitioner S | QICore PractitionerRole | QICore Patient S | QICore RelatedPerson S)(USCDI) Reported rather than primary record
... medication[x] SΣ1..1CodeableConcept(USCDI) Medication to be taken
Binding: SNOMEDCTMedicationCodes (preferred)
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... notDoneValueSet SC0..1canonical(ValueSet)What was not requested
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
.... coding ΣC0..*CodingCode defined by a terminology system
.... text Σ0..1stringPlain text representation of the concept
... subject SΣ1..1Reference(QICore Patient)(USCDI) Who or group medication request is for
... encounter S0..1Reference(QICore Encounter)(USCDI) Encounter created as part of encounter/admission/stay
... supportingInformation 0..*Reference(Resource)Information to support ordering of the medication
... authoredOn SΣ1..1dateTime(USCDI) When request was initially authored
... requester SΣC0..1Reference(QICore Practitioner S | QICore PractitionerRole | QICore Patient)(USCDI) Who/What requested the Request
... performer 0..1Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam)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 S1..1CodeableConcept(USCDI) Reason or indication for ordering or not ordering the medication
Binding: QICore Negation Reason Codes (extensible): The reason the medication was not requested


... reasonReference 0..*Reference(Condition | Observation)(USCDI) US Core Condition or Observation that supports the prescription
... instantiatesCanonical Σ0..*canonical()Instantiates FHIR protocol or definition
... instantiatesUri Σ0..*uriInstantiates external protocol or definition
... basedOn Σ0..*Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation)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..*Dosage(USCDI) How 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..1string(USCDI) Free 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 SΣ0..1Timing(USCDI) When 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 SΣ0..*Element(USCDI) Amount 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] SΣ0..1(USCDI) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
...... doseQuantityQuantity S
...... doseRangeRange
..... 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..1BackboneElement(USCDI) Medication 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 S0..1unsignedInt(USCDI) Number of refills authorized
.... quantity S0..1SimpleQuantity(USCDI) Amount of medication to supply per dispense
.... expectedSupplyDuration 0..1DurationNumber of days supply per dispense
.... performer 0..1Reference(Organization)Intended dispenser
... substitution 0..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 0..1Reference(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

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
MedicationRequest.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
MedicationRequest.statusrequiredmedicationrequest Status
MedicationRequest.statusReasonexamplemedicationRequest Status Reason Codes
MedicationRequest.intentrequiredmedicationRequest Intent
MedicationRequest.categoryexamplemedicationRequest Category Codes
MedicationRequest.category:us-corerequiredmedicationRequest Category Codes
MedicationRequest.priorityrequiredRequestPriority
MedicationRequest.medication[x]preferredSNOMEDCTMedicationCodes
MedicationRequest.performerTypeexampleProcedurePerformerRoleCodes
MedicationRequest.reasonCodeextensibleNegationReasonCodes
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.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
MedicationRequest.substitution.allowed[x]exampleActSubstanceAdminSubstitutionCode
MedicationRequest.substitution.reasonexampleSubstanceAdminSubstitutionReason

Constraints

IdGradePath(s)DetailsRequirements
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()

Differential View

This structure is derived from USCoreMedicationRequestProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest C0..*USCoreMedicationRequestProfileOrdering of medication for patient or group
mnr-1: To indicate what medication was not requested, either at least one coding in the medication or a notDoneValueSet extension shall be provided
... status S1..1code(USCDI) active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
... doNotPerform S1..1booleanTrue if medication was not requested
Fixed Value: true
... reported[x] S0..1Reference(QICore Practitioner S | QICore PractitionerRole | QICore Patient S | QICore RelatedPerson S)(USCDI) Reported rather than primary record
.... notDoneValueSet SC0..1canonical(ValueSet)What was not requested
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
.... coding C0..*CodingCode defined by a terminology system
... subject S1..1Reference(QICore Patient)(USCDI) Who or group medication request is for
... encounter S0..1Reference(QICore Encounter)(USCDI) Encounter created as part of encounter/admission/stay
... authoredOn S1..1dateTime(USCDI) When request was initially authored
... requester S0..1Reference(QICore Practitioner S | QICore PractitionerRole | QICore Patient)(USCDI) Who/What requested the Request
... reasonCode S1..1CodeableConcept(USCDI) Reason or indication for ordering or not ordering the medication
Binding: QICore Negation Reason Codes (extensible): The reason the medication was not requested


doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
MedicationRequest.medication[x]preferredSNOMEDCTMedicationCodes
MedicationRequest.reasonCodeextensibleNegationReasonCodes

Constraints

IdGradePath(s)DetailsRequirements
mnr-1errorMedicationRequestTo indicate what medication was not requested, either at least one coding in the medication or a notDoneValueSet extension shall be provided
: medication.extension('http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet').exists() xor medication.coding.exists()

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest C0..*USCoreMedicationRequestProfileOrdering of medication for patient or group
mnr-1: To indicate what medication was not requested, either at least one coding in the medication or a notDoneValueSet extension shall be provided
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... status ?!SΣ1..1code(USCDI) 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.

... Slices for category S0..*CodeableConcept(USCDI) 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 S0..*CodeableConcept(USCDI) Type of medication usage
Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets


... doNotPerform ?!SΣ1..1booleanTrue if medication was not requested
Fixed Value: true
... reported[x] SΣ0..1Reference(QICore Practitioner | QICore Patient | QICore RelatedPerson)(USCDI) Reported rather than primary record
... medication[x] SΣ1..1CodeableConcept(USCDI) Medication to be taken
Binding: SNOMEDCTMedicationCodes (preferred)
.... notDoneValueSet SC0..1canonical(ValueSet)What was not requested
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
.... coding ΣC0..*CodingCode defined by a terminology system
... subject SΣ1..1Reference(QICore Patient)(USCDI) Who or group medication request is for
... encounter S0..1Reference(QICore Encounter)(USCDI) Encounter created as part of encounter/admission/stay
... authoredOn SΣ1..1dateTime(USCDI) When request was initially authored
... requester SΣC0..1Reference(QICore Practitioner)(USCDI) Who/What requested the Request
... reasonCode S1..1CodeableConcept(USCDI) Reason or indication for ordering or not ordering the medication
Binding: QICore Negation Reason Codes (extensible): The reason the medication was not requested


... dosageInstruction S0..*Dosage(USCDI) How the medication should be taken
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... text SΣ0..1string(USCDI) Free text dosage instructions e.g. SIG
.... timing SΣ0..1Timing(USCDI) When medication should be administered
.... doseAndRate SΣ0..*Element(USCDI) Amount of medication administered
..... dose[x] SΣ0..1(USCDI) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
...... doseQuantityQuantity
... dispenseRequest S0..1BackboneElement(USCDI) Medication supply authorization
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... numberOfRepeatsAllowed S0..1unsignedInt(USCDI) Number of refills authorized
.... quantity S0..1SimpleQuantity(USCDI) Amount of medication to supply per dispense

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
MedicationRequest.statusrequiredmedicationrequest Status
MedicationRequest.intentrequiredmedicationRequest Intent
MedicationRequest.categoryexamplemedicationRequest Category Codes
MedicationRequest.category:us-corerequiredmedicationRequest Category Codes
MedicationRequest.medication[x]preferredSNOMEDCTMedicationCodes
MedicationRequest.reasonCodeextensibleNegationReasonCodes
MedicationRequest.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding

Constraints

IdGradePath(s)DetailsRequirements
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()
mnr-1errorMedicationRequestTo indicate what medication was not requested, either at least one coding in the medication or a notDoneValueSet extension shall be provided
: medication.extension('http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet').exists() xor medication.coding.exists()
us-core-21errorMedicationRequestrequester SHALL be present if intent is "order"
: (intent='order' or intent='original-order' or intent='reflex-order'or intent='filler-order' or intent='instance-order') implies requester.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest C0..*USCoreMedicationRequestProfileOrdering of medication for patient or group
mnr-1: To indicate what medication was not requested, either at least one coding in the medication or a notDoneValueSet extension shall be provided
... 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
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierExternal ids for this request
... status ?!SΣ1..1code(USCDI) 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 0..1CodeableConceptReason for current status
Binding: medicationRequest Status Reason Codes (example): Identifies the reasons for a given status.

... intent ?!SΣC1..1code(USCDI) proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
Binding: medicationRequest Intent (required): The kind of medication order.

... Slices for category S0..*CodeableConcept(USCDI) 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 S0..*CodeableConcept(USCDI) Type of medication usage
Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets


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

... doNotPerform ?!SΣ1..1booleanTrue if medication was not requested
Fixed Value: true
... reported[x] SΣ0..1Reference(QICore Practitioner S | QICore PractitionerRole | QICore Patient S | QICore RelatedPerson S)(USCDI) Reported rather than primary record
... medication[x] SΣ1..1CodeableConcept(USCDI) Medication to be taken
Binding: SNOMEDCTMedicationCodes (preferred)
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... notDoneValueSet SC0..1canonical(ValueSet)What was not requested
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
.... coding ΣC0..*CodingCode defined by a terminology system
.... text Σ0..1stringPlain text representation of the concept
... subject SΣ1..1Reference(QICore Patient)(USCDI) Who or group medication request is for
... encounter S0..1Reference(QICore Encounter)(USCDI) Encounter created as part of encounter/admission/stay
... supportingInformation 0..*Reference(Resource)Information to support ordering of the medication
... authoredOn SΣ1..1dateTime(USCDI) When request was initially authored
... requester SΣC0..1Reference(QICore Practitioner S | QICore PractitionerRole | QICore Patient)(USCDI) Who/What requested the Request
... performer 0..1Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam)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 S1..1CodeableConcept(USCDI) Reason or indication for ordering or not ordering the medication
Binding: QICore Negation Reason Codes (extensible): The reason the medication was not requested


... reasonReference 0..*Reference(Condition | Observation)(USCDI) US Core Condition or Observation that supports the prescription
... instantiatesCanonical Σ0..*canonical()Instantiates FHIR protocol or definition
... instantiatesUri Σ0..*uriInstantiates external protocol or definition
... basedOn Σ0..*Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation)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..*Dosage(USCDI) How 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..1string(USCDI) Free 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 SΣ0..1Timing(USCDI) When 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 SΣ0..*Element(USCDI) Amount 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] SΣ0..1(USCDI) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
...... doseQuantityQuantity S
...... doseRangeRange
..... 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..1BackboneElement(USCDI) Medication 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 S0..1unsignedInt(USCDI) Number of refills authorized
.... quantity S0..1SimpleQuantity(USCDI) Amount of medication to supply per dispense
.... expectedSupplyDuration 0..1DurationNumber of days supply per dispense
.... performer 0..1Reference(Organization)Intended dispenser
... substitution 0..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 0..1Reference(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

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
MedicationRequest.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
MedicationRequest.statusrequiredmedicationrequest Status
MedicationRequest.statusReasonexamplemedicationRequest Status Reason Codes
MedicationRequest.intentrequiredmedicationRequest Intent
MedicationRequest.categoryexamplemedicationRequest Category Codes
MedicationRequest.category:us-corerequiredmedicationRequest Category Codes
MedicationRequest.priorityrequiredRequestPriority
MedicationRequest.medication[x]preferredSNOMEDCTMedicationCodes
MedicationRequest.performerTypeexampleProcedurePerformerRoleCodes
MedicationRequest.reasonCodeextensibleNegationReasonCodes
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.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
MedicationRequest.substitution.allowed[x]exampleActSubstanceAdminSubstitutionCode
MedicationRequest.substitution.reasonexampleSubstanceAdminSubstitutionReason

Constraints

IdGradePath(s)DetailsRequirements
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()

 

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