An order or request for both supply of the medication and the instructions for administration of the medication to a patient. The resource is called "MedicationRequest" rather than "MedicationPrescription" or "MedicationOrder" to generalize the use across inpatient and outpatient settings, including care plans, etc., and to harmonize with workflow patterns.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

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.

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

An Extension

R4: MedicationRequest.statusReason (new:CodeableConcept)

Element MedicationRequest.statusReason has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.statusReason has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). 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.

R4: MedicationRequest.reported[x] (new:boolean, Reference(Patient,Practitioner,PractitionerRole,RelatedPerson,Organization))

Element MedicationRequest.reported[x] has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.reported[x] has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: MedicationRequest.performer (new:Reference(Practitioner,PractitionerRole,Organization,Patient,Device,RelatedPerson,CareTeam))

Element MedicationRequest.performer has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.performer has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: MedicationRequest.performerType (new:CodeableConcept)

Element MedicationRequest.performerType has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.performerType has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). 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.

R4: MedicationRequest.instantiatesUri (new:uri)

Element MedicationRequest.instantiatesUri has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.instantiatesUri has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: MedicationRequest.courseOfTherapyType (new:CodeableConcept)

Element MedicationRequest.courseOfTherapyType has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.courseOfTherapyType has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This attribute should not be confused with the protocol of the medication.

R4: MedicationRequest.insurance (new:Reference(Coverage,ClaimResponse))

Element MedicationRequest.insurance has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.insurance has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

An Extension

R4: MedicationRequest.doNotPerform (new:boolean)

Element MedicationRequest.doNotPerform has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.doNotPerform has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). If do not perform is not specified, the request is a positive request e.g. "do perform".

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

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

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

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

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.

The kind of medication order

An Extension

R4: MedicationRequest.intent

Element MedicationRequest.intent is mapped to FHIR STU3 element MedicationRequest.intent as SourceIsBroaderThanTarget. The target context MedicationRequest.intent is a modifier element, so this extension does not need to be defined as a modifier. 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.

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.

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. .

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

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

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.

R4: MedicationRequest.statusReason (new:CodeableConcept)

Element MedicationRequest.statusReason has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.statusReason has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). 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.

R4: MedicationRequest.reported[x] (new:boolean, Reference(Patient,Practitioner,PractitionerRole,RelatedPerson,Organization))

Element MedicationRequest.reported[x] has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.reported[x] has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: MedicationRequest.performer (new:Reference(Practitioner,PractitionerRole,Organization,Patient,Device,RelatedPerson,CareTeam))

Element MedicationRequest.performer has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.performer has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: MedicationRequest.performerType (new:CodeableConcept)

Element MedicationRequest.performerType has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.performerType has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). 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.

R4: MedicationRequest.instantiatesUri (new:uri)

Element MedicationRequest.instantiatesUri has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.instantiatesUri has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: MedicationRequest.courseOfTherapyType (new:CodeableConcept)

Element MedicationRequest.courseOfTherapyType has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.courseOfTherapyType has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This attribute should not be confused with the protocol of the medication.

R4: MedicationRequest.insurance (new:Reference(Coverage,ClaimResponse))

Element MedicationRequest.insurance has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.insurance has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: MedicationRequest.doNotPerform (new:boolean)

Element MedicationRequest.doNotPerform has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.doNotPerform has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). If do not perform is not specified, the request is a positive request e.g. "do perform".

R4: MedicationRequest.instantiatesCanonical additional types (canonical) additional types from child elements (value)

Element MedicationRequest.instantiatesCanonical is mapped to FHIR STU3 element MedicationRequest.definition as SourceIsBroaderThanTarget. The mappings for MedicationRequest.instantiatesCanonical do not cover the following types: canonical. The mappings for MedicationRequest.instantiatesCanonical do not cover the following types based on type expansion: value.

R4: MedicationRequest.basedOn

Element MedicationRequest.basedOn is mapped to FHIR STU3 element MedicationRequest.basedOn as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element MedicationRequest.basedOn with unmapped reference targets: ImmunizationRecommendation, ServiceRequest.

R4: MedicationRequest.intent

Element MedicationRequest.intent is mapped to FHIR STU3 element MedicationRequest.intent as SourceIsBroaderThanTarget. The target context MedicationRequest.intent is a modifier element, so this extension does not need to be defined as a modifier. 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.

R4: MedicationRequest.requester

Element MedicationRequest.requester is mapped to FHIR STU3 element MedicationRequest.requester.agent as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element MedicationRequest.requester with unmapped reference targets: PractitionerRole.

R4: MedicationRequest.recorder additional types from child elements (display, identifier, reference, type)

Element MedicationRequest.recorder is mapped to FHIR STU3 element MedicationRequest.recorder as SourceIsBroaderThanTarget. The mappings for MedicationRequest.recorder do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element MedicationRequest.recorder with unmapped reference targets: PractitionerRole.

R4: MedicationRequest.dispenseRequest.initialFill (new:BackboneElement)

Element MedicationRequest.dispenseRequest.initialFill has a context of MedicationRequest.dispenseRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.dispenseRequest.initialFill has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). If populating this element, either the quantity or the duration must be included.

R4: MedicationRequest.dispenseRequest.dispenseInterval (new:Duration)

Element MedicationRequest.dispenseRequest.dispenseInterval has a context of MedicationRequest.dispenseRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.dispenseRequest.dispenseInterval has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: MedicationRequest.dispenseRequest.numberOfRepeatsAllowed additional types (unsignedInt) additional types from child elements (value)

Element MedicationRequest.dispenseRequest.numberOfRepeatsAllowed is mapped to FHIR STU3 element MedicationRequest.dispenseRequest.numberOfRepeatsAllowed as SourceIsBroaderThanTarget. The mappings for MedicationRequest.dispenseRequest.numberOfRepeatsAllowed do not cover the following types: unsignedInt. The mappings for MedicationRequest.dispenseRequest.numberOfRepeatsAllowed do not cover the following types based on type expansion: value. If displaying "number of authorized fills", add 1 to this number.

R4: MedicationRequest.substitution.allowed[x] additional types (CodeableConcept) additional types from child elements (coding, text)

Element MedicationRequest.substitution.allowed[x] is mapped to FHIR STU3 element MedicationRequest.substitution.allowed as SourceIsBroaderThanTarget. The mappings for MedicationRequest.substitution.allowed[x] do not cover the following types: CodeableConcept. The mappings for MedicationRequest.substitution.allowed[x] do not cover the following types based on type expansion: coding, text. This element is labeled as a modifier because whether substitution is allow or not, it cannot be ignored.

An order or request for both supply of the medication and the instructions for administration of the medication to a patient. The resource is called "MedicationRequest" rather than "MedicationPrescription" or "MedicationOrder" to generalize the use across inpatient and outpatient settings, including care plans, etc., and to harmonize with workflow patterns.

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

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

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

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.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's 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).

A human language.

A human-readable narrative that contains a summary of the resource, and may 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 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 in formation is added later.

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.

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.

An Extension

R4: MedicationRequest.statusReason (new:CodeableConcept)

Element MedicationRequest.statusReason has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.statusReason has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). 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.

R4: MedicationRequest.reported[x] (new:boolean, Reference(Patient,Practitioner,PractitionerRole,RelatedPerson,Organization))

Element MedicationRequest.reported[x] has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.reported[x] has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: MedicationRequest.performer (new:Reference(Practitioner,PractitionerRole,Organization,Patient,Device,RelatedPerson,CareTeam))

Element MedicationRequest.performer has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.performer has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: MedicationRequest.performerType (new:CodeableConcept)

Element MedicationRequest.performerType has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.performerType has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). 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.

R4: MedicationRequest.instantiatesUri (new:uri)

Element MedicationRequest.instantiatesUri has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.instantiatesUri has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: MedicationRequest.courseOfTherapyType (new:CodeableConcept)

Element MedicationRequest.courseOfTherapyType has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.courseOfTherapyType has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This attribute should not be confused with the protocol of the medication.

R4: MedicationRequest.insurance (new:Reference(Coverage,ClaimResponse))

Element MedicationRequest.insurance has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.insurance has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

An Extension

R4: MedicationRequest.doNotPerform (new:boolean)

Element MedicationRequest.doNotPerform has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.doNotPerform has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). If do not perform is not specified, the request is a positive request e.g. "do perform".

This records 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. For example a re-imbursement system might issue its own id for each prescription that is created. This is particularly important where FHIR only provides part of an entire workflow process where records must be tracked through an entire system.

Protocol or definition followed by this request.

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

An Extension

R4: MedicationRequest.instantiatesCanonical additional types (canonical) additional types from child elements (value)

Element MedicationRequest.instantiatesCanonical is mapped to FHIR STU3 element MedicationRequest.definition as SourceIsBroaderThanTarget. The mappings for MedicationRequest.instantiatesCanonical do not cover the following types: canonical. The mappings for MedicationRequest.instantiatesCanonical do not cover the following types based on type expansion: value.

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.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity 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.

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.

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

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

An Extension

R4: MedicationRequest.basedOn

Element MedicationRequest.basedOn is mapped to FHIR STU3 element MedicationRequest.basedOn as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element MedicationRequest.basedOn with unmapped reference targets: ImmunizationRecommendation, ServiceRequest.

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.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity 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.

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.

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.

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.

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

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

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

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

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.

The kind of medication order

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

An Extension

R4: MedicationRequest.intent

Element MedicationRequest.intent is mapped to FHIR STU3 element MedicationRequest.intent as SourceIsBroaderThanTarget. The target context MedicationRequest.intent is a modifier element, so this extension does not need to be defined as a modifier. 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.

Primitive value for code

Indicates the type of medication order and where the medication is expected to be consumed or administered.

A coded concept identifying where the medication ordered is expected to be consumed or administered

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

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

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.

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. .

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

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

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.

A link to an encounter, or episode of care, that identifies the particular occurrence or set occurrences of contact between patient and health care provider.

SubstanceAdministration->component->EncounterEvent.

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

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

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

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

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

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.

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

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.

The healthcare professional responsible for authorizing the initial prescription.

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.

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

An Extension

R4: MedicationRequest.requester

Element MedicationRequest.requester is mapped to FHIR STU3 element MedicationRequest.requester.agent as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element MedicationRequest.requester with unmapped reference targets: PractitionerRole.

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.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity 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.

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.

The organization the device or practitioner was acting on behalf of.

Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when authoring the request.

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

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

An Extension

R4: MedicationRequest.recorder additional types from child elements (display, identifier, reference, type)

Element MedicationRequest.recorder is mapped to FHIR STU3 element MedicationRequest.recorder as SourceIsBroaderThanTarget. The mappings for MedicationRequest.recorder do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element MedicationRequest.recorder with unmapped reference targets: PractitionerRole.

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.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity 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.

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.

The reason or the indication for ordering the medication.

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

A coded concept indicating why the medication was ordered.

Condition or observation that supports why the medication was ordered.

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

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

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

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.

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.

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

An Extension

R4: MedicationRequest.dispenseRequest.initialFill (new:BackboneElement)

Element MedicationRequest.dispenseRequest.initialFill has a context of MedicationRequest.dispenseRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.dispenseRequest.initialFill has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). If populating this element, either the quantity or the duration must be included.

R4: MedicationRequest.dispenseRequest.dispenseInterval (new:Duration)

Element MedicationRequest.dispenseRequest.dispenseInterval has a context of MedicationRequest.dispenseRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.dispenseRequest.dispenseInterval has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

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.

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

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.

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

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.

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

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

An Extension

R4: MedicationRequest.dispenseRequest.numberOfRepeatsAllowed additional types (unsignedInt) additional types from child elements (value)

Element MedicationRequest.dispenseRequest.numberOfRepeatsAllowed is mapped to FHIR STU3 element MedicationRequest.dispenseRequest.numberOfRepeatsAllowed as SourceIsBroaderThanTarget. The mappings for MedicationRequest.dispenseRequest.numberOfRepeatsAllowed do not cover the following types: unsignedInt. The mappings for MedicationRequest.dispenseRequest.numberOfRepeatsAllowed do not cover the following types based on type expansion: value. If displaying "number of authorized fills", add 1 to this number.

Primitive value for positiveInt

The amount that is to be dispensed for one fill.

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.

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.

Indicates the intended dispensing Organization specified by the prescriber.

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.

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

An Extension

R4: MedicationRequest.substitution.allowed[x] additional types (CodeableConcept) additional types from child elements (coding, text)

Element MedicationRequest.substitution.allowed[x] is mapped to FHIR STU3 element MedicationRequest.substitution.allowed as SourceIsBroaderThanTarget. The mappings for MedicationRequest.substitution.allowed[x] do not cover the following types: CodeableConcept. The mappings for MedicationRequest.substitution.allowed[x] do not cover the following types based on type expansion: coding, text. This element is labeled as a modifier because whether substitution is allow or not, it cannot be ignored.

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

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.

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

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

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

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

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

Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etc.

Links to Provenance records for past versions of this resource or fulfilling request or event resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resource.

This may not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).