Profile_R2_MedicationOrder_R4_MedicationRequest - Definitions - Extensions for Using Data Elements from FHIR DSTU2 in FHIR R4 v0.1.0

Is Modifier false

Summary true

4. MedicationRequest.meta

Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Short Metadata about the resource

Control 0..1

Meta

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

6. MedicationRequest.meta.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

8. MedicationRequest.meta.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())

This element introduces a set of slices on MedicationRequest.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

10. MedicationRequest.meta.extension:meta

Slice Name meta

Definition

DSTU2: MedicationOrder.meta additional types (Meta) additional types from child elements (lastUpdated, profile, security, tag, versionId)

Short DSTU2: meta additional types

Comments

Element MedicationOrder.meta is mapped to FHIR R4 element MedicationRequest.meta as SourceIsBroaderThanTarget. The mappings for MedicationOrder.meta do not cover the following types: Meta. The mappings for MedicationOrder.meta do not cover the following types based on type expansion: lastUpdated, profile, security, tag, versionId.

Control 0..1

Type Extension(DSTU2: meta additional types) (Extension Type: Meta)

Is Modifier false

Summary false

12. MedicationRequest.meta.versionId

Definition

The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

Short Version specific identifier

Comments

The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

14. MedicationRequest.meta.lastUpdated

Definition

When the resource last changed - e.g. when the version changed.

Short When the resource version last changed

Comments

This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

Control 0..1

instant

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

16. MedicationRequest.meta.source

Definition

A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

Short Identifies where the resource comes from

Comments

In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

18. MedicationRequest.meta.profile

Definition

A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

Short Profiles this resource claims to conform to

Comments

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

Control 0..*

Type canonical(StructureDefinition)

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

20. MedicationRequest.meta.security

Definition

Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

Short Security Labels applied to this resource

Comments

The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

Control 0..*

Unless not suitable, these codes SHALL be taken from All Security Labels

(extensible to http://hl7.org/fhir/ValueSet/security-labels|4.0.1)

Security Labels from the Healthcare Privacy and Security Classification System.

Coding

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

22. MedicationRequest.meta.tag

Definition

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

Short Tags applied to this resource

Comments

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

Control 0..*

For example codes, see CommonTags
(example to http://hl7.org/fhir/ValueSet/common-tags|4.0.1)

Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

Coding

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

24. MedicationRequest.implicitRules

Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Short A set of rules under which this content was created

Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control 0..1

Is Modifier true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

26. MedicationRequest.language

Definition

The base language in which the resource is written.

Short Language of the resource content

Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Control 0..1

The codes SHOULD be taken from CommonLanguages
(preferred to http://hl7.org/fhir/ValueSet/languages|4.0.1)

A human language.

Additional Bindings

Purpose

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

28. MedicationRequest.text

Definition

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Short Text summary of the resource, for human interpretation

Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

Control 0..1

Narrative

Is Modifier false

Summary false

Alternate Names narrative, html, xhtml, display

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

30. MedicationRequest.text.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

32. MedicationRequest.text.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.text.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

34. MedicationRequest.text.extension:text

Slice Name text

Definition

DSTU2: MedicationOrder.text additional types (Narrative) additional types from child elements (div, status)

Short DSTU2: text additional types

Comments

Element MedicationOrder.text is mapped to FHIR R4 element MedicationRequest.text as SourceIsBroaderThanTarget. The mappings for MedicationOrder.text do not cover the following types: Narrative. The mappings for MedicationOrder.text do not cover the following types based on type expansion: div, status. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

Control 0..1

Type Extension(DSTU2: text additional types) (Complex Extension)

Is Modifier false

36. MedicationRequest.text.status

Definition

The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.

Short generated | extensions | additional | empty

Control 1..1

The codes SHALL be taken from NarrativeStatus
(required to http://hl7.org/fhir/ValueSet/narrative-status|4.0.1)

The status of a resource narrative.

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

38. MedicationRequest.text.div

Definition

The actual narrative content, a stripped down version of XHTML.

Short Limited xhtml content

Comments

The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.

Control 1..1

xhtml

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
txt-1: The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes (htmlChecks())
txt-2: The narrative SHALL have some non-whitespace content (htmlChecks())

40. MedicationRequest.contained

Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Short Contained, inline Resources

Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Control 0..*

Resource

Is Modifier false

Summary false

Alternate Names inline resources, anonymous resources, contained resources

42. MedicationRequest.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

44. MedicationRequest.extension:dateEnded

Slice Name dateEnded

Definition

DSTU2: MedicationOrder.dateEnded (new:dateTime)

Short DSTU2: When prescription was stopped (new)

Comments

Element MedicationOrder.dateEnded has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationOrder.dateEnded has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

Control 0..1
This element is affected by the following invariants: ele-1

Type Extension(DSTU2: When prescription was stopped (new)) (Extension Type: dateTime)

Is Modifier false

Summary false

46. MedicationRequest.extension:reasonEnded

Slice Name reasonEnded

Definition

DSTU2: MedicationOrder.reasonEnded (new:CodeableConcept)

Short DSTU2: Why prescription was stopped (new)

Comments

Element MedicationOrder.reasonEnded has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationOrder.reasonEnded has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

Control 0..1
This element is affected by the following invariants: ele-1

Type Extension(DSTU2: Why prescription was stopped (new)) (Extension Type: CodeableConcept)

Is Modifier false

Summary false

48. MedicationRequest.extension:reason

Slice Name reason

Definition

DSTU2: MedicationOrder.reason[x] additional types from child elements (display, reference)

Short DSTU2: Reason or indication for writing the prescription additional types

Comments

Element MedicationOrder.reason[x] is mapped to FHIR R4 element MedicationRequest.reasonCode as RelatedTo. Element MedicationOrder.reason[x] is mapped to FHIR R4 element MedicationRequest.reasonReference as RelatedTo. The mappings for MedicationOrder.reason[x] do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element MedicationOrder.reason[x] with unmapped reference targets: Condition.

Control 0..1

Type Extension(Alternate Reference) (Extension Type: Reference(Resource))

Is Modifier false

Summary false

50. MedicationRequest.modifierExtension

Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them

Summary false

Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Names extensions, user content

52. MedicationRequest.identifier

Definition

Identifiers associated with this medication request that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.

Short External ids for this request

Comments

This is a business identifier, not a resource identifier.

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..*

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

54. MedicationRequest.identifier.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

56. MedicationRequest.identifier.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

58. MedicationRequest.identifier.extension:identifier

Slice Name identifier

Definition

DSTU2: MedicationOrder.identifier additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)

Short DSTU2: External identifier additional types

Comments

Element MedicationOrder.identifier is mapped to FHIR R4 element MedicationRequest.identifier as SourceIsBroaderThanTarget. The mappings for MedicationOrder.identifier do not cover the following types: Identifier. The mappings for MedicationOrder.identifier do not cover the following types based on type expansion: assigner, period, system, type, use, value.

Control 0..*

Type Extension(DSTU2: External identifier additional types) (Extension Type: Identifier)

Is Modifier false

Summary false

60. MedicationRequest.identifier.use

Definition

The purpose of this identifier.

Short usual | official | temp | secondary | old (If known)

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Control 0..1

The codes SHALL be taken from IdentifierUse
(required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

Identifies the purpose for this identifier, if known .

Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

62. MedicationRequest.identifier.type

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Short Description of identifier

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

Control 0..1

Unless not suitable, these codes SHALL be taken from Identifier Type Codes
(extensible to http://hl7.org/fhir/ValueSet/identifier-type|4.0.1)

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Is Modifier false

Summary true

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

64. MedicationRequest.identifier.system

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Short The namespace for the identifier value

Comments

Identifier.system is always case sensitive.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Example General: http://www.acme.com/identifiers/patient

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

66. MedicationRequest.identifier.value

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Short The value that is unique

Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Example General: 123456

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

68. MedicationRequest.identifier.period

Definition

Time period during which identifier is/was valid for use.

Short Time period when id is/was valid for use

Control 0..1

Period

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

70. MedicationRequest.identifier.assigner

Definition

Organization that issued/manages the identifier.

Short Organization that issued id (may be just text)

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Control 0..1

Type Reference(Organization)

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

72. MedicationRequest.status

Definition

A code specifying the current state of the order. Generally, this will be active or completed state.

Comments

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Control 1..1

The codes SHALL be taken from medicationrequest Status
(required to http://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1)

A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.

Is Modifier true because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

74. MedicationRequest.status.id

Definition

unique id for the element within a resource (for internal references)

Short xml:id (or equivalent in JSON)

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

76. MedicationRequest.status.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.status.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

78. MedicationRequest.status.extension:status

Slice Name status

Definition

DSTU2: MedicationOrder.status additional codes

Comments

Element MedicationOrder.status is mapped to FHIR R4 element MedicationRequest.status as RelatedTo. The mappings for MedicationOrder.status do not allow expression of the necessary codes, per the bindings on the source and target. The target context MedicationRequest.status is a modifier element, so this extension does not need to be defined as a modifier.

Control 0..1
This element is affected by the following invariants: ele-1

Is Modifier false

Summary false

80. MedicationRequest.status.value

Definition

Primitive value for code

Short Primitive value for code

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

82. MedicationRequest.statusReason

Definition

Captures the reason for the current state of the MedicationRequest.

Short Reason for current status

Comments

This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the MedicationRequest was created at all is captured in reasonCode, not here.

Control 0..1

For example codes, see medicationRequest Status Reason Codes
(example to http://hl7.org/fhir/ValueSet/medicationrequest-status-reason|4.0.1)

Identifies the reasons for a given status.

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

84. MedicationRequest.intent

Definition

Whether the request is a proposal, plan, or an original order.

Comments

It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only.

An instance-order is an instantiation of a request or order and may be used to populate Medication Administration Record.

This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.

Control 1..1

The codes SHALL be taken from medicationRequest Intent
(required to http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1)

The kind of medication order.

Is Modifier true because This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

86. MedicationRequest.category

Definition

Indicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).

Short Type of medication usage

Comments

The category can be used to include where the medication is expected to be consumed or other types of requests.

Control 0..*

For example codes, see medicationRequest Category Codes
(example to http://hl7.org/fhir/ValueSet/medicationrequest-category|4.0.1)

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.

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

88. MedicationRequest.priority

Definition

Indicates how quickly the Medication Request should be addressed with respect to other requests.

Short routine | urgent | asap | stat

Control 0..1

The codes SHALL be taken from RequestPriority
(required to http://hl7.org/fhir/ValueSet/request-priority|4.0.1)

Identifies the level of importance to be assigned to actioning the request.

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

90. MedicationRequest.doNotPerform

Definition

If true indicates that the provider is asking for the medication request not to occur.

Short True if request is prohibiting action

Comments

If do not perform is not specified, the request is a positive request e.g. "do perform".

Control 0..1

boolean

Is Modifier true because This element is labeled as a modifier because this element negates the request to occur (ie, this is a request for the medication not to be ordered or prescribed, etc)

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

92. MedicationRequest.reported[x]

Definition

Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the report.

Short Reported rather than primary record

Control 0..1

Type Choice of: boolean, Reference(Patient, Practitioner, PractitionerRole, RelatedPerson, Organization)

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

94. MedicationRequest.medication[x]

Definition

Identifies the medication being requested. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medications.

Short Medication to be taken

Comments

If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the Medication resource is recommended. For example, if you require form or lot number or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource.

Control 1..1

For example codes, see SNOMEDCTMedicationCodes
(example to http://hl7.org/fhir/ValueSet/medication-codes|4.0.1)

A coded concept identifying substance or product that can be ordered.

Type Choice of: CodeableConcept, Reference(Medication)

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

96. MedicationRequest.medication[x].id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

98. MedicationRequest.medication[x].extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.medication[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

100. MedicationRequest.medication[x].extension:alternateReference

Slice Name alternateReference

Definition

DSTU2: MedicationOrder.medication[x] additional types from child elements (display, reference)

Short DSTU2: medication additional types

Comments

Element MedicationOrder.medication[x] is mapped to FHIR R4 element MedicationRequest.medication[x] as SourceIsBroaderThanTarget. The mappings for MedicationOrder.medication[x] do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element MedicationOrder.medication[x] with unmapped reference targets: Medication. Source element MedicationOrder.medication[x] has unmapped reference types. While the target element MedicationRequest.medication[x] is a choice type and does not allow extensions, the alternate-reference extension can be applied to Reference values within it. If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. Note: do not use Medication.name to describe the prescribed medication. When the only available information is a text description of the medication, Medication.code.text should be used.

Control 0..1

Type Extension(Alternate Reference) (Extension Type: Reference(Resource))

Is Modifier false

Summary false

102. MedicationRequest.subject

Definition

A link to a resource representing the person or set of individuals to whom the medication will be given.

Short Who or group medication request is for

Comments

The subject on a medication request is mandatory. For the secondary use case where the actual subject is not provided, there still must be an anonymized subject specified.

Control 1..1

Type Reference(Patient, Group)

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

104. MedicationRequest.subject.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

106. MedicationRequest.subject.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.subject.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

108. MedicationRequest.subject.extension:patient

Slice Name patient

Definition

DSTU2: MedicationOrder.patient additional types from child elements (display, reference)

Short DSTU2: Who prescription is for additional types

Comments

Element MedicationOrder.patient is mapped to FHIR R4 element MedicationRequest.subject as SourceIsBroaderThanTarget. The mappings for MedicationOrder.patient do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element MedicationOrder.patient with unmapped reference targets: Patient. SubstanceAdministration->subject->Patient.

Control 0..1

Type Extension(Alternate Reference) (Extension Type: Reference(Resource))

Is Modifier false

Summary false

110. MedicationRequest.subject.reference

Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Short Literal reference, Relative, internal or absolute URL

Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Control 0..1
This element is affected by the following invariants: ref-1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

112. MedicationRequest.subject.type

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

Short Type the reference refers to (e.g. "Patient")

Comments

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Control 0..1

Unless not suitable, these codes SHALL be taken from ResourceType

(extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

Aa resource (or, for logical models, the URI of the logical model).

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

114. MedicationRequest.subject.identifier

Definition

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

Short Logical reference, when literal reference is not known

Comments

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..1

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

116. MedicationRequest.subject.display

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Short Text alternative for the resource

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

118. MedicationRequest.encounter

Definition

The Encounter during which this [x] was created or to which the creation of this record is tightly associated.

Short Encounter created as part of encounter/admission/stay

Comments

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter." If there is a need to link to episodes of care they will be handled with an extension.

Control 0..1

Type Reference(Encounter)

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

120. MedicationRequest.encounter.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

122. MedicationRequest.encounter.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.encounter.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

124. MedicationRequest.encounter.extension:encounter

Slice Name encounter

Definition

DSTU2: MedicationOrder.encounter additional types from child elements (display, reference)

Short DSTU2: Created during encounter/admission/stay additional types

Comments

Element MedicationOrder.encounter is mapped to FHIR R4 element MedicationRequest.encounter as SourceIsBroaderThanTarget. The mappings for MedicationOrder.encounter do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element MedicationOrder.encounter with unmapped reference targets: Encounter. SubstanceAdministration->component->EncounterEvent.

Control 0..1

Type Extension(Alternate Reference) (Extension Type: Reference(Resource))

Is Modifier false

Summary false

126. MedicationRequest.encounter.reference

Definition

Short Literal reference, Relative, internal or absolute URL

Comments

Control 0..1
This element is affected by the following invariants: ref-1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

128. MedicationRequest.encounter.type

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Short Type the reference refers to (e.g. "Patient")

Comments

Control 0..1

Unless not suitable, these codes SHALL be taken from ResourceType

(extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

Aa resource (or, for logical models, the URI of the logical model).

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

130. MedicationRequest.encounter.identifier

Definition

Short Logical reference, when literal reference is not known

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..1

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

132. MedicationRequest.encounter.display

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Short Text alternative for the resource

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

134. MedicationRequest.supportingInformation

Definition

Include additional information (for example, patient height and weight) that supports the ordering of the medication.

Short Information to support ordering of the medication

Control 0..*

Type Reference(Resource)

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

136. MedicationRequest.authoredOn

Definition

The date (and perhaps time) when the prescription was initially written or authored on.

Short When request was initially authored

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

138. MedicationRequest.requester

Definition

The individual, organization, or device that initiated the request and has responsibility for its activation.

Short Who/What requested the Request

Control 0..1

Type Reference(Practitioner, PractitionerRole, Organization, Patient, RelatedPerson, Device)

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

140. MedicationRequest.requester.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

142. MedicationRequest.requester.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.requester.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

144. MedicationRequest.requester.extension:prescriber

Slice Name prescriber

Definition

DSTU2: MedicationOrder.prescriber additional types from child elements (display, reference)

Short DSTU2: Who ordered the medication(s) additional types

Comments

Element MedicationOrder.prescriber is mapped to FHIR R4 element MedicationRequest.requester as RelatedTo. The mappings for MedicationOrder.prescriber do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element MedicationOrder.prescriber with unmapped reference targets: Practitioner.

Control 0..1

Type Extension(Alternate Reference) (Extension Type: Reference(Resource))

Is Modifier false

Summary false

146. MedicationRequest.requester.reference

Definition

Short Literal reference, Relative, internal or absolute URL

Comments

Control 0..1
This element is affected by the following invariants: ref-1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

148. MedicationRequest.requester.type

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Short Type the reference refers to (e.g. "Patient")

Comments

Control 0..1

Unless not suitable, these codes SHALL be taken from ResourceType

(extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

Aa resource (or, for logical models, the URI of the logical model).

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

150. MedicationRequest.requester.identifier

Definition

Short Logical reference, when literal reference is not known

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..1

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

152. MedicationRequest.requester.display

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Short Text alternative for the resource

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

154. MedicationRequest.performer

Definition

The specified desired performer of the medication treatment (e.g. the performer of the medication administration).

Short Intended performer of administration

Control 0..1

Type Reference(Practitioner, PractitionerRole, Organization, Patient, Device, RelatedPerson, CareTeam)

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

156. MedicationRequest.performerType

Definition

Indicates the type of performer of the administration of the medication.

Short Desired kind of performer of the medication administration

Comments

If specified without indicating a performer, this indicates that the performer must be of the specified type. If specified with a performer then it indicates the requirements of the performer if the designated performer is not available.

Control 0..1

For example codes, see ProcedurePerformerRoleCodes
(example to http://hl7.org/fhir/ValueSet/performer-role|4.0.1)

Identifies the type of individual that is desired to administer the medication.

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

158. MedicationRequest.recorder

Definition

The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order.

Short Person who entered the request

Control 0..1

Type Reference(Practitioner, PractitionerRole)

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

160. MedicationRequest.reasonCode

Definition

The reason or the indication for ordering or not ordering the medication.

Short Reason or indication for ordering or not ordering the medication

Comments

This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference.

Control 0..*

For example codes, see Condition/Problem/DiagnosisCodes
(example to http://hl7.org/fhir/ValueSet/condition-code|4.0.1)

A coded concept indicating why the medication was ordered.

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

162. MedicationRequest.reasonReference

Definition

Condition or observation that supports why the medication was ordered.

Short Condition or observation that supports why the prescription is being written

Comments

This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode.

Control 0..*

Type Reference(Condition, Observation)

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

164. MedicationRequest.instantiatesCanonical

Definition

The URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest.

Short Instantiates FHIR protocol or definition

Control 0..*

canonical

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

166. MedicationRequest.instantiatesUri

Definition

The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this MedicationRequest.

Short Instantiates external protocol or definition

Control 0..*

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

168. MedicationRequest.basedOn

Definition

A plan or request that is fulfilled in whole or in part by this medication request.

Short What request fulfills

Control 0..*

Type Reference(CarePlan, MedicationRequest, ServiceRequest, ImmunizationRecommendation)

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

170. MedicationRequest.groupIdentifier

Definition

A shared identifier common to all requests that were authorized more or less simultaneously by a single author, representing the identifier of the requisition or prescription.

Short Composite request this is part of

Control 0..1

Is Modifier false

Summary true

Requirements

Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

172. MedicationRequest.courseOfTherapyType

Definition

The description of the overall patte3rn of the administration of the medication to the patient.

Short Overall pattern of medication administration

Comments

This attribute should not be confused with the protocol of the medication.

Control 0..1

For example codes, see medicationRequest Course of Therapy Codes
(example to http://hl7.org/fhir/ValueSet/medicationrequest-course-of-therapy|4.0.1)

Identifies the overall pattern of medication administratio.

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

174. MedicationRequest.insurance

Definition

Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service.

Short Associated insurance coverage

Control 0..*

Type Reference(Coverage, ClaimResponse)

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

176. MedicationRequest.note

Definition

Extra information about the prescription that could not be conveyed by the other attributes.

Short Information about the prescription

Control 0..*

Annotation

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

178. MedicationRequest.note.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

180. MedicationRequest.note.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.note.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

182. MedicationRequest.note.extension:note

Slice Name note

Definition

DSTU2: MedicationOrder.note additional types (string) additional types from child elements (value)

Short DSTU2: note additional types

Comments

Element MedicationOrder.note is mapped to FHIR R4 element MedicationRequest.note as RelatedTo. The mappings for MedicationOrder.note do not cover the following types: string. The mappings for MedicationOrder.note do not cover the following types based on type expansion: value.

Control 0..1

Type Extension(DSTU2: note additional types) (Extension Type: string)

Is Modifier false

Summary false

184. MedicationRequest.note.author[x]

Definition

The individual responsible for making the annotation.

Short Individual responsible for the annotation

Comments

Organization is used when there's no need for specific attribution as to who made the comment.

Control 0..1

Type Choice of: Reference(Practitioner, Patient, RelatedPerson, Organization), string

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

186. MedicationRequest.note.time

Definition

Indicates when this particular annotation was made.

Short When the annotation was made

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

188. MedicationRequest.note.text

Definition

The text of the annotation in markdown format.

Short The annotation - text content (as markdown)

Control 1..1

markdown

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

190. MedicationRequest.dosageInstruction

Definition

Indicates how the medication is to be used by the patient.

Short How the medication should be taken

Comments

There are examples where a medication request may include the option of an oral dose or an Intravenous or Intramuscular dose. For example, "Ondansetron 8mg orally or IV twice a day as needed for nausea" or "Compazine® (prochlorperazine) 5-10mg PO or 25mg PR bid prn nausea or vomiting". In these cases, two medication requests would be created that could be grouped together. The decision on which dose and route of administration to use is based on the patient's condition at the time the dose is needed.

Control 0..*

Dosage

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

192. MedicationRequest.dosageInstruction.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

194. MedicationRequest.dosageInstruction.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.dosageInstruction.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

196. MedicationRequest.dosageInstruction.extension:text

Slice Name text

Definition

DSTU2: MedicationOrder.dosageInstruction.text additional types (string) additional types from child elements (value)

Short DSTU2: Dosage instructions expressed as text additional types

Comments

Element MedicationOrder.dosageInstruction.text is mapped to FHIR R4 element MedicationRequest.dosageInstruction as RelatedTo. The mappings for MedicationOrder.dosageInstruction.text do not cover the following types: string. The mappings for MedicationOrder.dosageInstruction.text do not cover the following types based on type expansion: value.

Control 0..1

Type Extension(DSTU2: Dosage instructions expressed as text additional types) (Extension Type: string)

Is Modifier false

Summary false

198. MedicationRequest.dosageInstruction.extension:additionalInstructions

Slice Name additionalInstructions

Definition

DSTU2: MedicationOrder.dosageInstruction.additionalInstructions additional types (CodeableConcept) additional types from child elements (coding, text)

Short DSTU2: Supplemental instructions - e.g. "with meals" additional types

Comments

Element MedicationOrder.dosageInstruction.additionalInstructions is mapped to FHIR R4 element MedicationRequest.dosageInstruction as RelatedTo. The mappings for MedicationOrder.dosageInstruction.additionalInstructions do not cover the following types: CodeableConcept. The mappings for MedicationOrder.dosageInstruction.additionalInstructions do not cover the following types based on type expansion: coding, text.

Control 0..1

Type Extension(DSTU2: Supplemental instructions - e.g. "with meals" additional types) (Extension Type: CodeableConcept)

Is Modifier false

Summary false

200. MedicationRequest.dosageInstruction.extension:timing

Slice Name timing

Definition

DSTU2: MedicationOrder.dosageInstruction.timing additional types (Timing) additional types from child elements (code, event, repeat, bounds[x], count, duration, durationMax, durationUnits, frequency, frequencyMax, period, periodMax, periodUnits, when)

Short DSTU2: When medication should be administered additional types

Comments

Element MedicationOrder.dosageInstruction.timing is mapped to FHIR R4 element MedicationRequest.dosageInstruction as RelatedTo. The mappings for MedicationOrder.dosageInstruction.timing do not cover the following types: Timing. The mappings for MedicationOrder.dosageInstruction.timing do not cover the following types based on type expansion: bounds[x], code, count, duration, durationMax, durationUnits, event, frequency, frequencyMax, period, periodMax, periodUnits, repeat, when. This attribute may not always be populated while the DosageInstruction.text is expected to be populated. If both are populated, then the DosageInstruction.text should reflect the content of the Dosage.timing.

Control 0..1

Type Extension(DSTU2: When medication should be administered additional types) (Extension Type: Timing)

Is Modifier false

Summary false

202. MedicationRequest.dosageInstruction.extension:asNeeded

Slice Name asNeeded

Definition

DSTU2: MedicationOrder.dosageInstruction.asNeeded[x] additional types (boolean, CodeableConcept) additional types from child elements (value, coding, text)

Short DSTU2: Take "as needed" (for x) additional types

Comments

Element MedicationOrder.dosageInstruction.asNeeded[x] is mapped to FHIR R4 element MedicationRequest.dosageInstruction as RelatedTo. The mappings for MedicationOrder.dosageInstruction.asNeeded[x] do not cover the following types: boolean, CodeableConcept. The mappings for MedicationOrder.dosageInstruction.asNeeded[x] do not cover the following types based on type expansion: coding, text, value. Specifically if 'boolean' datatype is selected, then the following logic applies: If set to True, this indicates that the medication is only taken when needed, within the specified schedule.

Control 0..1

Type Extension(DSTU2: Take "as needed" (for x) additional types) (Extension Type: Choice of: boolean, CodeableConcept)

Is Modifier false

Summary false

204. MedicationRequest.dosageInstruction.extension:site

Slice Name site

Definition

DSTU2: MedicationOrder.dosageInstruction.site[x] additional types (CodeableConcept, Reference(http://hl7.org/fhir/StructureDefinition/BodySite)) additional types from child elements (coding, text, display, reference)

Short DSTU2: Body site to administer to additional types

Comments

Element MedicationOrder.dosageInstruction.site[x] is mapped to FHIR R4 element MedicationRequest.dosageInstruction as RelatedTo. The mappings for MedicationOrder.dosageInstruction.site[x] do not cover the following types: CodeableConcept, Reference. The mappings for MedicationOrder.dosageInstruction.site[x] do not cover the following types based on type expansion: coding, display, reference, text.

Control 0..1

Type Extension(DSTU2: Body site to administer to additional types) (Extension Type: Choice of: CodeableConcept, Reference(Cross-version Profile for DSTU2.BodySite for use in FHIR R4, BodyStructure))

Is Modifier false

Summary false

206. MedicationRequest.dosageInstruction.extension:route

Slice Name route

Definition

DSTU2: MedicationOrder.dosageInstruction.route additional types (CodeableConcept) additional types from child elements (coding, text)

Short DSTU2: How drug should enter body additional types

Comments

Element MedicationOrder.dosageInstruction.route is mapped to FHIR R4 element MedicationRequest.dosageInstruction as RelatedTo. The mappings for MedicationOrder.dosageInstruction.route do not cover the following types: CodeableConcept. The mappings for MedicationOrder.dosageInstruction.route do not cover the following types based on type expansion: coding, text.

Control 0..1

Type Extension(DSTU2: How drug should enter body additional types) (Extension Type: CodeableConcept)

Is Modifier false

Summary false

208. MedicationRequest.dosageInstruction.extension:method

Slice Name method

Definition

DSTU2: MedicationOrder.dosageInstruction.method additional types (CodeableConcept) additional types from child elements (coding, text)

Short DSTU2: Technique for administering medication additional types

Comments

Element MedicationOrder.dosageInstruction.method is mapped to FHIR R4 element MedicationRequest.dosageInstruction as RelatedTo. The mappings for MedicationOrder.dosageInstruction.method do not cover the following types: CodeableConcept. The mappings for MedicationOrder.dosageInstruction.method do not cover the following types based on type expansion: coding, text. Terminologies used often pre-coordinate this term with the route and or form of administration.

Control 0..1

Type Extension(DSTU2: Technique for administering medication additional types) (Extension Type: CodeableConcept)

Is Modifier false

Summary false

210. MedicationRequest.dosageInstruction.extension:dose

Slice Name dose

Definition

DSTU2: MedicationOrder.dosageInstruction.dose[x] additional types (Range, Quantity[http://hl7.org/fhir/StructureDefinition/SimpleQuantity]) additional types from child elements (high, low, code, comparator, system, unit, value)

Short DSTU2: Amount of medication per dose additional types

Comments

Element MedicationOrder.dosageInstruction.dose[x] is mapped to FHIR R4 element MedicationRequest.dosageInstruction as RelatedTo. The mappings for MedicationOrder.dosageInstruction.dose[x] do not cover the following types: Quantity, Range. The mappings for MedicationOrder.dosageInstruction.dose[x] do not cover the following types based on type expansion: code, comparator, high, low, system, unit, value. Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

Control 0..1

Type Extension(DSTU2: Amount of medication per dose additional types) (Extension Type: Choice of: Range, Quantity(SimpleQuantity))

Is Modifier false

Summary false

212. MedicationRequest.dosageInstruction.extension:rate

Slice Name rate

Definition

DSTU2: MedicationOrder.dosageInstruction.rate[x] additional types (Ratio, Range) additional types from child elements (denominator, numerator, high, low)

Short DSTU2: Amount of medication per unit of time additional types

Comments

Element MedicationOrder.dosageInstruction.rate[x] is mapped to FHIR R4 element MedicationRequest.dosageInstruction as RelatedTo. The mappings for MedicationOrder.dosageInstruction.rate[x] do not cover the following types: Range, Ratio. The mappings for MedicationOrder.dosageInstruction.rate[x] do not cover the following types based on type expansion: denominator, high, low, numerator. It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationOrder with an updated rate, or captured with a new MedicationOrder with the new rate.

Control 0..1

Type Extension(DSTU2: Amount of medication per unit of time additional types) (Extension Type: Choice of: Ratio, Range)

Is Modifier false

Summary false

214. MedicationRequest.dosageInstruction.extension:maxDosePerPeriod

Slice Name maxDosePerPeriod

Definition

DSTU2: MedicationOrder.dosageInstruction.maxDosePerPeriod additional types (Ratio) additional types from child elements (denominator, numerator)

Short DSTU2: Upper limit on medication per unit of time additional types

Comments

Element MedicationOrder.dosageInstruction.maxDosePerPeriod is mapped to FHIR R4 element MedicationRequest.dosageInstruction as RelatedTo. The mappings for MedicationOrder.dosageInstruction.maxDosePerPeriod do not cover the following types: Ratio. The mappings for MedicationOrder.dosageInstruction.maxDosePerPeriod do not cover the following types based on type expansion: denominator, numerator. This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

Control 0..1

Type Extension(DSTU2: Upper limit on medication per unit of time additional types) (Extension Type: Ratio)

Is Modifier false

Summary false

216. MedicationRequest.dosageInstruction.modifierExtension

Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

218. MedicationRequest.dosageInstruction.sequence

Definition

Indicates the order in which the dosage instructions should be applied or interpreted.

Short The order of the dosage instructions

Control 0..1

integer

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

220. MedicationRequest.dosageInstruction.text

Definition

Free text dosage instructions e.g. SIG.

Short Free text dosage instructions e.g. SIG

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. Additional information about administration or preparation of the medication should be included as text.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

222. MedicationRequest.dosageInstruction.additionalInstruction

Definition

Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").

Short Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"

Comments

Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.

Control 0..*

For example codes, see SNOMEDCTAdditionalDosageInstructions
(example to http://hl7.org/fhir/ValueSet/additional-instruction-codes|4.0.1)

A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

Is Modifier false

Summary true

Requirements

Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

224. MedicationRequest.dosageInstruction.patientInstruction

Definition

Instructions in terms that are understood by the patient or consumer.

Short Patient or consumer oriented instructions

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

226. MedicationRequest.dosageInstruction.timing

Definition

When medication should be administered.

Short When medication should be administered

Comments

This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.

Control 0..1

Timing

Is Modifier false

Summary true

Requirements

The timing schedule for giving the medication to the patient. This data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

228. MedicationRequest.dosageInstruction.asNeeded[x]

Definition

Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).

Short Take "as needed" (for x)

Comments

Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".

Control 0..1

For example codes, see SNOMEDCTMedicationAsNeededReasonCodes
(example to http://hl7.org/fhir/ValueSet/medication-as-needed-reason|4.0.1)

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.

Type Choice of: boolean, CodeableConcept

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

230. MedicationRequest.dosageInstruction.site

Definition

Body site to administer to.

Short Body site to administer to

Comments

If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

Control 0..1

For example codes, see SNOMEDCTAnatomicalStructureForAdministrationSiteCodes
(example to http://hl7.org/fhir/ValueSet/approach-site-codes|4.0.1)

A coded concept describing the site location the medicine enters into or onto the body.

Is Modifier false

Summary true

Requirements

A coded specification of the anatomic site where the medication first enters the body.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

232. MedicationRequest.dosageInstruction.route

Definition

How drug should enter body.

Short How drug should enter body

Control 0..1

For example codes, see SNOMEDCTRouteCodes
(example to http://hl7.org/fhir/ValueSet/route-codes|4.0.1)

A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

Is Modifier false

Summary true

Requirements

A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

234. MedicationRequest.dosageInstruction.method

Definition

Technique for administering medication.

Short Technique for administering medication

Comments

Terminologies used often pre-coordinate this term with the route and or form of administration.

Control 0..1

For example codes, see SNOMEDCTAdministrationMethodCodes
(example to http://hl7.org/fhir/ValueSet/administration-method-codes|4.0.1)

A coded concept describing the technique by which the medicine is administered.

Is Modifier false

Summary true

Requirements

A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

236. MedicationRequest.dosageInstruction.doseAndRate

Definition

The amount of medication administered.

Short Amount of medication administered

Control 0..*

Element

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

238. MedicationRequest.dosageInstruction.doseAndRate.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

240. MedicationRequest.dosageInstruction.doseAndRate.extension

Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

This element introduces a set of slices on MedicationRequest.dosageInstruction.doseAndRate.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

242. MedicationRequest.dosageInstruction.doseAndRate.type

Definition

The kind of dose or rate specified, for example, ordered or calculated.

Short The kind of dose or rate specified

Control 0..1

For example codes, see DoseAndRateType
(example to http://hl7.org/fhir/ValueSet/dose-rate-type|4.0.1)

The kind of dose or rate specified.

Is Modifier false

Summary true

Requirements

If the type is not populated, assume to be "ordered".

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

244. MedicationRequest.dosageInstruction.doseAndRate.dose[x]

Definition

Amount of medication per dose.

Short Amount of medication per dose

Comments

Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

Control 0..1

Type Choice of: Range, Quantity(SimpleQuantity)

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Summary true

Requirements

The amount of therapeutic or other substance given at one administration event.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

246. MedicationRequest.dosageInstruction.doseAndRate.rate[x]

Definition

Amount of medication per unit of time.

Short Amount of medication per unit of time

Comments

It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.

It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammer where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.

Control 0..1

Type Choice of: Ratio, Range, Quantity(SimpleQuantity)

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Summary true

Requirements

Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

248. MedicationRequest.dosageInstruction.maxDosePerPeriod

Definition

Upper limit on medication per unit of time.

Short Upper limit on medication per unit of time

Comments

This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

Control 0..1

Ratio

Is Modifier false

Summary true

Requirements

The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

250. MedicationRequest.dosageInstruction.maxDosePerAdministration

Definition

Upper limit on medication per administration.

Short Upper limit on medication per administration

Comments

This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.

Control 0..1

Type Quantity(SimpleQuantity)

Is Modifier false

Summary true

Requirements

The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

252. MedicationRequest.dosageInstruction.maxDosePerLifetime

Definition

Upper limit on medication per lifetime of the patient.

Short Upper limit on medication per lifetime of the patient

Control 0..1

Type Quantity(SimpleQuantity)

Is Modifier false

Summary true

Requirements

The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

254. MedicationRequest.dispenseRequest

Definition

Indicates the specific details for the dispense or medication supply part of a medication request (also known as a Medication Prescription or Medication Order). Note that this information is not always sent with the order. There may be in some settings (e.g. hospitals) institutional or system support for completing the dispense details in the pharmacy department.

Short Medication supply authorization

Control 0..1

BackboneElement

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

256. MedicationRequest.dispenseRequest.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

258. MedicationRequest.dispenseRequest.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.dispenseRequest.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

260. MedicationRequest.dispenseRequest.extension:medication

Slice Name medication

Definition

DSTU2: MedicationOrder.dispenseRequest.medication[x] (new:CodeableConcept, Reference(Medication))

Short DSTU2: Product to be supplied (new)

Comments

Element MedicationOrder.dispenseRequest.medication[x] has a context of MedicationRequest.dispenseRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationOrder.dispenseRequest.medication[x] has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended.

Control 0..1
This element is affected by the following invariants: ele-1

Type Extension(DSTU2: Product to be supplied (new)) (Extension Type: Choice of: CodeableConcept, Reference(Cross-version Profile for DSTU2.Medication for use in FHIR R4, Medication))

Is Modifier false

Summary false

262. MedicationRequest.dispenseRequest.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

264. MedicationRequest.dispenseRequest.initialFill

Definition

Indicates the quantity or duration for the first dispense of the medication.

Short First fill details

Comments

If populating this element, either the quantity or the duration must be included.

Control 0..1

BackboneElement

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

266. MedicationRequest.dispenseRequest.initialFill.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

268. MedicationRequest.dispenseRequest.initialFill.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

270. MedicationRequest.dispenseRequest.initialFill.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

272. MedicationRequest.dispenseRequest.initialFill.quantity

Definition

The amount or quantity to provide as part of the first dispense.

Short First fill quantity

Control 0..1

Type Quantity(SimpleQuantity)

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

274. MedicationRequest.dispenseRequest.initialFill.duration

Definition

The length of time that the first dispense is expected to last.

Short First fill duration

Control 0..1

Duration

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

276. MedicationRequest.dispenseRequest.dispenseInterval

Definition

The minimum period of time that must occur between dispenses of the medication.

Short Minimum period of time between dispenses

Control 0..1

Duration

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

278. MedicationRequest.dispenseRequest.validityPeriod

Definition

This indicates the validity period of a prescription (stale dating the Prescription).

Short Time period supply is authorized for

Comments

It reflects the prescribers' perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations.

Control 0..1

Period

Is Modifier false

Summary false

Requirements

Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

280. MedicationRequest.dispenseRequest.validityPeriod.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

282. MedicationRequest.dispenseRequest.validityPeriod.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.dispenseRequest.validityPeriod.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

284. MedicationRequest.dispenseRequest.validityPeriod.extension:validityPeriod

Slice Name validityPeriod

Definition

DSTU2: MedicationOrder.dispenseRequest.validityPeriod additional types (Period) additional types from child elements (end, start)

Short DSTU2: validityPeriod additional types

Comments

Element MedicationOrder.dispenseRequest.validityPeriod is mapped to FHIR R4 element MedicationRequest.dispenseRequest.validityPeriod as SourceIsBroaderThanTarget. The mappings for MedicationOrder.dispenseRequest.validityPeriod do not cover the following types: Period. The mappings for MedicationOrder.dispenseRequest.validityPeriod do not cover the following types based on type expansion: end, start. It reflects the prescriber perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations.

Control 0..1

Type Extension(DSTU2: validityPeriod additional types) (Extension Type: Period)

Is Modifier false

Summary false

286. MedicationRequest.dispenseRequest.validityPeriod.start

Definition

The start of the period. The boundary is inclusive.

Short Starting time with inclusive boundary

Comments

If the low element is missing, the meaning is that the low boundary is not known.

Control 0..1
This element is affected by the following invariants: per-1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

288. MedicationRequest.dispenseRequest.validityPeriod.end

Definition

The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

Short End time with inclusive boundary, if not ongoing

Comments

The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.

Control 0..1
This element is affected by the following invariants: per-1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Meaning if Missing If the end of the period is missing, it means that the period is ongoing

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

290. MedicationRequest.dispenseRequest.numberOfRepeatsAllowed

Definition

An integer indicating the number of times, in addition to the original dispense, (aka refills or repeats) that the patient can receive the prescribed medication. Usage Notes: This integer does not include the original order dispense. This means that if an order indicates dispense 30 tablets plus "3 repeats", then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets. A prescriber may explicitly say that zero refills are permitted after the initial dispense.

Short Number of refills authorized

Comments

If displaying "number of authorized fills", add 1 to this number.

Control 0..1

unsignedInt

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

292. MedicationRequest.dispenseRequest.quantity

Definition

The amount that is to be dispensed for one fill.

Short Amount of medication to supply per dispense

Control 0..1

Type Quantity(SimpleQuantity)

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

294. MedicationRequest.dispenseRequest.expectedSupplyDuration

Definition

Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last.

Short Number of days supply per dispense

Comments

In some situations, this attribute may be used instead of quantity to identify the amount supplied by how long it is expected to last, rather than the physical quantity issued, e.g. 90 days supply of medication (based on an ordered dosage). When possible, it is always better to specify quantity, as this tends to be more precise. expectedSupplyDuration will always be an estimate that can be influenced by external factors.

Control 0..1

Duration

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

296. MedicationRequest.dispenseRequest.performer

Definition

Indicates the intended dispensing Organization specified by the prescriber.

Short Intended dispenser

Control 0..1

Type Reference(Organization)

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

298. MedicationRequest.substitution

Definition

Indicates whether or not substitution can or should be part of the dispense. In some cases, substitution must happen, in other cases substitution must not happen. This block explains the prescriber's intent. If nothing is specified substitution may be done.

Short Any restrictions on medication substitution

Control 0..1

BackboneElement

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

300. MedicationRequest.substitution.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

302. MedicationRequest.substitution.extension

Definition

An Extension

Short Extension

Control 1..*

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.substitution.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

304. MedicationRequest.substitution.extension:type

Slice Name type

Definition

DSTU2: MedicationOrder.substitution.type (new:CodeableConcept)

Short DSTU2: generic | formulary + (new)

Comments

Element MedicationOrder.substitution.type has a context of MedicationRequest.substitution based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationOrder.substitution.type has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

Control 1..1
This element is affected by the following invariants: ele-1

Type Extension(DSTU2: generic | formulary + (new)) (Extension Type: CodeableConcept)

Is Modifier false

Summary false

306. MedicationRequest.substitution.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

308. MedicationRequest.substitution.allowed[x]

Definition

True if the prescriber allows a different drug to be dispensed from what was prescribed.

Short Whether substitution is allowed or not

Comments

This element is labeled as a modifier because whether substitution is allow or not, it cannot be ignored.

Control 1..1

For example codes, see ActSubstanceAdminSubstitutionCode (3.0.0)
(example to http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode|3.0.0)

Identifies the type of substitution allowed.

Type Choice of: boolean, CodeableConcept

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

310. MedicationRequest.substitution.reason

Definition

Indicates the reason for the substitution, or why substitution must or must not be performed.

Short Why should (not) substitution be made

Control 0..1

For example codes, see SubstanceAdminSubstitutionReason (3.0.0)
(example to http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason|3.0.0)

A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

312. MedicationRequest.priorPrescription

Definition

A link to a resource representing an earlier order related order or prescription.

Short An order/prescription that is being replaced

Control 0..1

Type Reference(MedicationRequest)

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

314. MedicationRequest.priorPrescription.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

316. MedicationRequest.priorPrescription.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.priorPrescription.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

318. MedicationRequest.priorPrescription.extension:priorPrescription

Slice Name priorPrescription

Definition

DSTU2: MedicationOrder.priorPrescription additional types from child elements (display, reference)

Short DSTU2: An order/prescription that this supersedes additional types

Comments

Element MedicationOrder.priorPrescription is mapped to FHIR R4 element MedicationRequest.priorPrescription as SourceIsBroaderThanTarget. The mappings for MedicationOrder.priorPrescription do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element MedicationOrder.priorPrescription with unmapped reference targets: MedicationOrder.

Control 0..1

Type Extension(Alternate Reference) (Extension Type: Reference(Resource))

Is Modifier false

Summary false

320. MedicationRequest.priorPrescription.reference

Definition

Short Literal reference, Relative, internal or absolute URL

Comments

Control 0..1
This element is affected by the following invariants: ref-1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

322. MedicationRequest.priorPrescription.type

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Short Type the reference refers to (e.g. "Patient")

Comments

Control 0..1

Unless not suitable, these codes SHALL be taken from ResourceType

(extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

Aa resource (or, for logical models, the URI of the logical model).

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

324. MedicationRequest.priorPrescription.identifier

Definition

Short Logical reference, when literal reference is not known

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..1

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

326. MedicationRequest.priorPrescription.display

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Short Text alternative for the resource

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Control 0..1