Generated Narrative: StructureDefinition profile-MedicationStatement Name Flags Card. Type Description & Constraints MedicationStatement 0..* MedicationStatement(5.0.0) Record of medication being taken by a patient #xD; meta #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:meta 0..1 Meta DSTU2: meta additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-MedicationStatement.meta #xD; text #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:text 0..1 (Complex) DSTU2: text additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-MedicationStatement.text #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:reasonNotTaken 0..* CodeableConcept DSTU2: True if asserting medication was not given (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-MedicationStatement.reasonNotTaken Binding: SNOMEDCTReasonMedicationNotGivenCodes (example): A set of codes indicating the reason why the MedicationAdministration is negated. #xD; extension:reasonForUse 0..1 CodeableConcept, Reference(Cross-version Profile for DSTU2.Condition for use in FHIR R5(0.1.0) | Condition) DSTU2: (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-MedicationStatement.reasonForUse #xD; Slices for modifierExtension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; modifierExtension:wasNotTaken 0..1 boolean DSTU2: True if medication is/was not being taken (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-MedicationStatement.wasNotTaken #xD; identifier #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:identifier 0..* Identifier DSTU2: identifier additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-MedicationStatement.identifier #xD; status #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:status 0..1 code DSTU2: active | completed | entered-in-error | intended additional codes URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-MedicationStatement.status Binding: R2MedicationStatementStatusForR5 (0.1.0) (required): A set of codes indicating the current status of a MedicationStatement. #xD; medication #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:medication 0..1 Reference(Cross-version Profile for DSTU2.Medication for use in FHIR R5(0.1.0) | Medication) DSTU2: medication additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-MedicationStatement.medication #xD; subject #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:patient 0..1 Reference(Resource) DSTU2: patient additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference #xD; informationSource #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:informationSource 0..1 Reference(Resource) DSTU2: URL: http://hl7.org/fhir/StructureDefinition/alternate-reference #xD; derivedFrom #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:supportingInformation 0..* Reference(Resource) DSTU2: Additional supporting information additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference #xD; note #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:note 0..1 string DSTU2: Further information about the statement additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-MedicationStatement.note #xD; dosage #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:text 0..1 string DSTU2: Reported dosage information additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-MedicationStatement.dosage.text #xD; extension:timing 0..1 Timing DSTU2: When/how often was medication taken additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-MedicationStatement.dosage.timing #xD; extension:asNeeded 0..1 boolean, CodeableConcept DSTU2: Take "as needed" (for x) additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-MedicationStatement.dosage.asNeeded #xD; extension:site 0..1 CodeableConcept, Reference(Cross-version Profile for DSTU2.BodySite for use in FHIR R5(0.1.0) | BodyStructure) DSTU2: Where (on body) medication is/was administered additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-MedicationStatement.dosage.site #xD; extension:route 0..1 CodeableConcept DSTU2: How the medication entered the body additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-MedicationStatement.dosage.route #xD; extension:method 0..1 CodeableConcept DSTU2: Technique used to administer medication additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-MedicationStatement.dosage.method #xD; extension:quantity 0..1 SimpleQuantity(5.0.0), Range DSTU2: Amount administered in one dose additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-MedicationStatement.dosage.quantity #xD; extension:rate 0..1 Ratio, Range DSTU2: Dose quantity per unit of time additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-MedicationStatement.dosage.rate #xD; extension:maxDosePerPeriod 0..1 Ratio DSTU2: Maximum dose that was consumed per unit of time additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-MedicationStatement.dosage.maxDosePerPeriod #xD; Documentation for this format
Cross-version Profile for DSTU2.MedicationStatement for use in FHIR R5
This cross-version profile allows DSTU2 MedicationStatement content to be represented via FHIR R5 MedicationStatement resources.
Record of medication being taken by a patient
A record of a medication that is being consumed by a patient. A MedicationStatement may indicate that the patient may be taking the medication now or has taken the medication in the past or will be taking the medication in the future. The source of this information can be the patient, significant other (such as a family member or spouse), or a clinician. A common scenario where this information is captured is during the history taking process during a patient visit or stay. The medication information may come from sources such as the patient's memory, from a prescription bottle, or from a list of medications the patient, clinician or other party maintains. The primary difference between a medicationstatement and a medicationadministration is that the medication administration has complete administration information and is based on actual administration information from the person who administered the medication. A medicationstatement is often, if not always, less specific. There is no required date/time when the medication was administered, in fact we only know that a source has reported the patient is taking this medication, where details such as time, quantity, or rate or even medication product may be incomplete or missing or less precise. As stated earlier, the Medication Statement information may come from the patient's memory, from a prescription bottle or from a list of medications the patient, clinician or other party maintains. Medication administration is more formal and is not missing detailed information. The MedicationStatement resource was previously called MedicationStatement.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
Entity, Role, or Act,SubstanceAdministration
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.
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.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Must have either extensions or value[x], not both
DSTU2: `MedicationStatement.meta` additional types (Meta) additional types from child elements (lastUpdated, profile, security, tag, versionId)
Element `MedicationStatement.meta` is mapped to FHIR R5 element `MedicationStatement.meta` as `SourceIsBroaderThanTarget`. The mappings for `MedicationStatement.meta` do not cover the following types: Meta. The mappings for `MedicationStatement.meta` do not cover the following types based on type expansion: lastUpdated, profile, security, tag, versionId.
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.
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.
When the resource last changed - e.g. when the version changed.
This element is generally omitted in instances submitted in a PUT or POST. Instead, it is populated in the response instance and when retrieving information using a GET. 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](http://hl7.org/fhir/R5/http.html#read) interaction.
Identifies where the resource comes from
A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](http://hl7.org/fhir/R5/provenance.html#) 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.
The exact use of the source (and the possible implied Provenance.entity.role and agent.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. The source may correspond to Provenance.entity.what[x] or Provenance.agent.who[x], though it may be a more general or abstract reference. 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.
Profiles this resource claims to conform to
A list of profiles (references to [StructureDefinition](http://hl7.org/fhir/R5/structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](http://hl7.org/fhir/R5/structuredefinition-definitions.html#StructureDefinition.url).
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.
Security Labels applied to this resource
Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.
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.
Security Labels from the Healthcare Privacy and Security Classification System.
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.
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.
Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
A set of rules under which this content was created
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.
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 its narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
The base language in which the resource is written.
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).
Text summary of the resource, for human interpretation
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.
Contained resources do not have a 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.
DSTU2: `MedicationStatement.text` additional types (Narrative) additional types from child elements (div, status)
Element `MedicationStatement.text` is mapped to FHIR R5 element `MedicationStatement.text` as `SourceIsBroaderThanTarget`. The mappings for `MedicationStatement.text` do not cover the following types: Narrative. The mappings for `MedicationStatement.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.
generated | extensions | additional | empty
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.
The actual narrative content, a stripped down version of XHTML.
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, 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.
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, elements (either name or href), images and internally contained style attributes
The narrative SHALL have some non-whitespace content
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.
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.
DSTU2: True if asserting medication was not given (new)
DSTU2: `MedicationStatement.reasonNotTaken` (new:CodeableConcept)
Element `MedicationStatement.reasonNotTaken` has a context of MedicationStatement based on following the parent source element upwards and mapping to `MedicationStatement`. Element `MedicationStatement.reasonNotTaken` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).
DSTU2: `MedicationStatement.reasonForUse[x]` (new:CodeableConcept, Reference(Condition))
Element `MedicationStatement.reasonForUse[x]` has a context of MedicationStatement based on following the parent source element upwards and mapping to `MedicationStatement`. Element `MedicationStatement.reasonForUse[x]` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
DSTU2: True if medication is/was not being taken (new)
DSTU2: `MedicationStatement.wasNotTaken` (new:boolean)
Element `MedicationStatement.wasNotTaken` has a context of MedicationStatement based on following the parent source element upwards and mapping to `MedicationStatement`. Element `MedicationStatement.wasNotTaken` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).
This extension is a modifier because the source element `MedicationStatement.wasNotTaken` is flagged as a modifier element.
Identifiers associated with this Medication Statement 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.
This is a business identifier, not a resource identifier.
DSTU2: `MedicationStatement.identifier` additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)
Element `MedicationStatement.identifier` is mapped to FHIR R5 element `MedicationStatement.identifier` as `SourceIsBroaderThanTarget`. The mappings for `MedicationStatement.identifier` do not cover the following types: Identifier. The mappings for `MedicationStatement.identifier` do not cover the following types based on type expansion: assigner, period, system, type, use, value.
usual | official | temp | secondary | old (If known)
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Identifies the purpose for this identifier, if known .
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
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.
Allows users to make use of identifiers when the identifier system is not known.
A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Identifier.system is always case sensitive.
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.
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
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 [http://hl7.org/fhir/StructureDefinition/rendered-value](http://hl7.org/fhir/extensions/StructureDefinition-rendered-value.html)). 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.
II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
Time period when id is/was valid for use
Time period during which identifier is/was valid for use.
Role.effectiveTime or implied by context
Organization that issued id (may be just text)
Organization that issued/manages the identifier.
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.
II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
A larger event of which this particular MedicationStatement is a component or step.
.outboundRelationship[typeCode=COMP]/target[classCode=SPLY or SBADM or PROC or OBS,moodCode=EVN]
A code representing the status of recording the medication statement.
This status concerns just the recording of the medication statement. MedicationStatement.adherence should be used for indicating a patient's adherence to the information in this resource. Note, the statuses are different than in previous releases for MedicationStatement or MedicationStatement. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
This element is labelled 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
A coded concept indicating the current status of a MedicationStatement.
unique id for the element within a resource (for internal references)
DSTU2: active | completed | entered-in-error | intended additional codes
DSTU2: `MedicationStatement.status` additional codes
Element `MedicationStatement.status` is mapped to FHIR R5 element `MedicationStatement.status` as `RelatedTo`. The mappings for `MedicationStatement.status` do not allow expression of the necessary codes, per the bindings on the source and target. The target context `MedicationStatement.status` is a modifier element, so this extension does not need to be defined as a modifier.
Type of medication statement (for example, drug classification like ATC, where meds would be administered, legal category of the medication.).
A coded concept identifying where the medication included in the MedicationStatement is expected to be consumed or administered.
.inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication statement"].value
Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.
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, then you must reference the Medication resource.
A coded concept identifying the substance or product being taken.
.participation[typeCode=CSM].role[classCode=ADMM or MANU]
DSTU2: `MedicationStatement.medication[x]` additional types (Reference(http://hl7.org/fhir/StructureDefinition/Medication)) additional types from child elements (display, reference)
Element `MedicationStatement.medication[x]` is mapped to FHIR R5 element `MedicationStatement.medication` as `RelatedTo`. The mappings for `MedicationStatement.medication[x]` do not cover the following types: Reference. The mappings for `MedicationStatement.medication[x]` do not cover the following types based on type expansion: display, reference. 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 medication this statement concerns. When the only available information is a text description of the medication, Medication.code.text should be used.
A reference to a concept - e.g. the information is identified by its general class to the degree of precision found in the terminology.
A reference to a resource the provides exact details about the information being referenced.
The person, animal or group who is/was taking the medication.
DSTU2: `MedicationStatement.patient` additional types from child elements (display, reference)
Element `MedicationStatement.patient` is mapped to FHIR R5 element `MedicationStatement.subject` as `SourceIsBroaderThanTarget`. The mappings for `MedicationStatement.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 `MedicationStatement.patient` with unmapped reference targets: Patient.
Literal reference, Relative, internal or absolute URL
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.
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.
Type the reference refers to (e.g. "Patient") - must be a resource in resources
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).
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 known RESTful URL) or by resolving the target of the reference.
Aa resource (or, for logical models, the URI of the logical model).
Logical reference, when literal reference is not known
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.
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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.
Plain text narrative that identifies the resource in addition to the resource reference.
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.
Encounter associated with MedicationStatement
The encounter that establishes the context for this MedicationStatement.
.inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]
The date/time or interval when the medication is/was/will be taken
The interval of time during which it is being asserted that the patient is/was/will be taking the medication (or was not taking, when the MedicationStatement.adherence element is Not Taking).
This attribute reflects the period over which the patient consumed the medication and is expected to be populated on the majority of Medication Statements. If the medication is still being taken and is expected to continue indefinitely at the time the usage is recorded, the "end" date will be omitted. If the end date is known, then it is included as the "end date". The date/time attribute supports a variety of dates - year, year/month and exact date. If something more than this is required, this should be conveyed as text.
The date when the Medication Statement was asserted by the information source.
Person or organization that provided the information about the taking of this medication
The person or organization that provided the information about the taking of this medication. Note: Use derivedFrom when a MedicationStatement is derived from other resources, e.g. Claim or MedicationRequest.
.participation[typeCode=INF].role[classCode=PAT, or codes for Practitioner or Related Person (if PAT is the informer, then syntax for self-reported =true)
DSTU2: `MedicationStatement.informationSource`
Element `MedicationStatement.informationSource` is mapped to FHIR R5 element `MedicationStatement.informationSource` as `RelatedTo`. The standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `MedicationStatement.informationSource` with unmapped reference targets: Patient, Practitioner, RelatedPerson.
Link to information used to derive the MedicationStatement
Allows linking the MedicationStatement to the underlying MedicationRequest, or to other information that supports or is used to derive the MedicationStatement.
Likely references would be to MedicationRequest, MedicationDispense, Claim, Observation or QuestionnaireAnswers. The most common use cases for deriving a MedicationStatement comes from creating a MedicationStatement from a MedicationRequest or from a lab observation or a claim. it should be noted that the amount of information that is available varies from the type resource that you derive the MedicationStatement from.
DSTU2: Additional supporting information additional types
DSTU2: `MedicationStatement.supportingInformation` additional types from child elements (display, reference)
Element `MedicationStatement.supportingInformation` is mapped to FHIR R5 element `MedicationStatement.derivedFrom` as `SourceIsBroaderThanTarget`. The mappings for `MedicationStatement.supportingInformation` 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 `MedicationStatement.supportingInformation` with unmapped reference targets: Resource. Likely references would be to MedicationOrder, MedicationDispense, Claim, Observation or QuestionnaireAnswers.
Reason for why the medication is being/was taken
A concept, Condition or observation that supports why the medication is being/was taken.
This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonForUseReference.
A coded concept identifying why the medication is being taken.
Provides extra information about the Medication Statement that is not conveyed by the other attributes.
DSTU2: Further information about the statement additional types
DSTU2: `MedicationStatement.note` additional types (string) additional types from child elements (value)
Element `MedicationStatement.note` is mapped to FHIR R5 element `MedicationStatement.note` as `RelatedTo`. The mappings for `MedicationStatement.note` do not cover the following types: string. The mappings for `MedicationStatement.note` do not cover the following types based on type expansion: value.
Individual responsible for the annotation
The individual responsible for making the annotation.
Organization is used when there's no need for specific attribution as to who made the comment.
Indicates when this particular annotation was made.
The annotation - text content (as markdown)
The text of the annotation in markdown format.
Link to information relevant to the usage of a medication
Link to information that is relevant to a medication statement, for example, illicit drug use, gestational age, etc.
Full representation of the dosage instructions
The full representation of the dose of the medication included in all dosage instructions. To be used when multiple dosage instructions are included to represent complex dosing such as increasing or tapering doses.
The content of the renderedDosageInstructions must not be different than the dose represented in the dosageInstruction content.
Details of how medication is/was taken or should be taken
Indicates how the medication is/was or should be taken by the patient.
The dates included in the dosage on a Medication Statement reflect the dates for a given dose. For example, "from November 1, 2016 to November 3, 2016, take one tablet daily and from November 4, 2016 to November 7, 2016, take two tablets daily." It is expected that this specificity may only be populated where the patient brings in their labeled container or where the Medication Statement is derived from a MedicationRequest.
DSTU2: Reported dosage information additional types
DSTU2: `MedicationStatement.dosage.text` additional types (string) additional types from child elements (value)
Element `MedicationStatement.dosage.text` is mapped to FHIR R5 element `MedicationStatement.dosage` as `RelatedTo`. The mappings for `MedicationStatement.dosage.text` do not cover the following types: string. The mappings for `MedicationStatement.dosage.text` do not cover the following types based on type expansion: value.
DSTU2: When/how often was medication taken additional types
DSTU2: `MedicationStatement.dosage.timing` additional types (Timing) additional types from child elements (code, event, repeat, bounds[x], count, duration, durationMax, durationUnits, frequency, frequencyMax, period, periodMax, periodUnits, when)
Element `MedicationStatement.dosage.timing` is mapped to FHIR R5 element `MedicationStatement.dosage` as `RelatedTo`. The mappings for `MedicationStatement.dosage.timing` do not cover the following types: Timing. The mappings for `MedicationStatement.dosage.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.
DSTU2: Take "as needed" (for x) additional types
DSTU2: `MedicationStatement.dosage.asNeeded[x]` additional types (boolean, CodeableConcept) additional types from child elements (value, coding, text)
Element `MedicationStatement.dosage.asNeeded[x]` is mapped to FHIR R5 element `MedicationStatement.dosage` as `RelatedTo`. The mappings for `MedicationStatement.dosage.asNeeded[x]` do not cover the following types: boolean, CodeableConcept. The mappings for `MedicationStatement.dosage.asNeeded[x]` do not cover the following types based on type expansion: coding, text, value.
DSTU2: Where (on body) medication is/was administered additional types
DSTU2: `MedicationStatement.dosage.site[x]` additional types (CodeableConcept, Reference(http://hl7.org/fhir/StructureDefinition/BodySite)) additional types from child elements (coding, text, display, reference)
Element `MedicationStatement.dosage.site[x]` is mapped to FHIR R5 element `MedicationStatement.dosage` as `RelatedTo`. The mappings for `MedicationStatement.dosage.site[x]` do not cover the following types: CodeableConcept, Reference. The mappings for `MedicationStatement.dosage.site[x]` do not cover the following types based on type expansion: coding, display, reference, text.
DSTU2: How the medication entered the body additional types
DSTU2: `MedicationStatement.dosage.route` additional types (CodeableConcept) additional types from child elements (coding, text)
Element `MedicationStatement.dosage.route` is mapped to FHIR R5 element `MedicationStatement.dosage` as `RelatedTo`. The mappings for `MedicationStatement.dosage.route` do not cover the following types: CodeableConcept. The mappings for `MedicationStatement.dosage.route` do not cover the following types based on type expansion: coding, text.
DSTU2: Technique used to administer medication additional types
DSTU2: `MedicationStatement.dosage.method` additional types (CodeableConcept) additional types from child elements (coding, text)
Element `MedicationStatement.dosage.method` is mapped to FHIR R5 element `MedicationStatement.dosage` as `RelatedTo`. The mappings for `MedicationStatement.dosage.method` do not cover the following types: CodeableConcept. The mappings for `MedicationStatement.dosage.method` do not cover the following types based on type expansion: coding, text. One of the reasons this attribute is not used often, is that the method is often pre-coordinated with the route and/or form of administration. This means the codes used in route or form may pre-coordinate the method in the route code or the form code. The implementation decision about what coding system to use for route or form code will determine how frequently the method code will be populated e.g. if route or form code pre-coordinate method code, then this attribute will not be populated often; if there is no pre-coordination then method code may be used frequently.
DSTU2: Amount administered in one dose additional types
DSTU2: `MedicationStatement.dosage.quantity[x]` additional types (Quantity[http://hl7.org/fhir/StructureDefinition/SimpleQuantity], Range) additional types from child elements (code, comparator, system, unit, value, high, low)
Element `MedicationStatement.dosage.quantity[x]` is mapped to FHIR R5 element `MedicationStatement.dosage` as `RelatedTo`. The mappings for `MedicationStatement.dosage.quantity[x]` do not cover the following types: Quantity, Range. The mappings for `MedicationStatement.dosage.quantity[x]` do not cover the following types based on type expansion: code, comparator, high, low, system, unit, value.
DSTU2: Dose quantity per unit of time additional types
DSTU2: `MedicationStatement.dosage.rate[x]` additional types (Ratio, Range) additional types from child elements (denominator, numerator, high, low)
Element `MedicationStatement.dosage.rate[x]` is mapped to FHIR R5 element `MedicationStatement.dosage` as `RelatedTo`. The mappings for `MedicationStatement.dosage.rate[x]` do not cover the following types: Range, Ratio. The mappings for `MedicationStatement.dosage.rate[x]` do not cover the following types based on type expansion: denominator, high, low, numerator.
DSTU2: Maximum dose that was consumed per unit of time additional types
DSTU2: `MedicationStatement.dosage.maxDosePerPeriod` additional types (Ratio) additional types from child elements (denominator, numerator)
Element `MedicationStatement.dosage.maxDosePerPeriod` is mapped to FHIR R5 element `MedicationStatement.dosage` as `RelatedTo`. The mappings for `MedicationStatement.dosage.maxDosePerPeriod` do not cover the following types: Ratio. The mappings for `MedicationStatement.dosage.maxDosePerPeriod` do not cover the following types based on type expansion: denominator, numerator.
Extensions that cannot be ignored even if unrecognized
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 managable, 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).
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.
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](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Indicates the order in which the dosage instructions should be applied or interpreted.
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.
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.
Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
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").
Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or take "immediately following drug x") should be populated in dosage.text.
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.
A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
Patient or consumer oriented instructions
Instructions in terms that are understood by the patient or consumer.
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.
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.
Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option).
Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated.
.outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept
Indicates whether the Medication is only taken based on a precondition for taking the Medication (CodeableConcept).
Can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be False, then the dose is given according to the schedule and is not "prn" or "as needed".
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.
If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [http://hl7.org/fhir/StructureDefinition/bodySite](http://hl7.org/fhir/extensions/StructureDefinition-bodySite.html). May be a summary code, or a reference to a very precise definition of the location, or both.
A coded specification of the anatomic site where the medication first enters the body.
A coded concept describing the site location the medicine enters into or onto the body.
A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.
A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
Terminologies used often pre-coordinate this term with the route and or form of administration.
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.
A coded concept describing the technique by which the medicine is administered.
Amount of medication administered, to be administered or typical amount to be administered
Depending on the resource,this is the amount of medication administered, to be administered or typical amount to be administered.
SubstanceAdministration.doseQuantity; SubstanceAdministration.RateQuantity
Additional content defined by implementations
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 managable, 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.
The kind of dose or rate specified, for example, ordered or calculated.
If the type is not populated, assume to be "ordered".
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.
The amount of therapeutic or other substance given at one administration event.
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 grammar 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.
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.
Upper limit on medication per unit of time
Upper limit on medication per unit of time.
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".
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.
Upper limit on medication per administration
Upper limit on medication per administration.
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.
The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.
Upper limit on medication per lifetime of the patient
Upper limit on medication per lifetime of the patient.
The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.
Indicates whether the medication is or is not being consumed or administered
Indicates whether the medication is or is not being consumed or administered.
This element can be used to indicate whether a patient is following a course of treatment as instructed/prescribed or whether they are taking medications of their own volition. It can also be used to indicate that a patient is not taking a medication, either because they were told not to or because they decided on their own.
Type of the adherence for the medication.
Details of the reason for the current use of the medication
Captures the reason for the current use or adherence of a medication.
This is generally only used for "exception" statuses such as "entered-in-error". The reason for performing the event at all is captured in reasonCode, not here.
.inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCode