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. 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.

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.

An Extension

R4: MedicationRequest.reported[x] additional types (Reference(http://hl7.org/fhir/StructureDefinition/Patient), Reference(http://hl7.org/fhir/StructureDefinition/Practitioner), Reference(http://hl7.org/fhir/StructureDefinition/PractitionerRole), Reference(http://hl7.org/fhir/StructureDefinition/RelatedPerson), Reference(http://hl7.org/fhir/StructureDefinition/Organization))

Element MedicationRequest.reported[x] is mapped to FHIR R5 element MedicationRequest.reported as SourceIsBroaderThanTarget. The mappings for MedicationRequest.reported[x] do not cover the following types: Reference.

R4: MedicationRequest.instantiatesCanonical (new:canonical)

Element MedicationRequest.instantiatesCanonical has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.instantiatesCanonical has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

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 R5. Typically, this is because the element has been added (is a new element).

R4: MedicationRequest.detectedIssue (new:Reference(DetectedIssue))

Element MedicationRequest.detectedIssue has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.detectedIssue has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.

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

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

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.

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.

Clinical decision support systems should take the status into account when determining which medications to include in their algorithms.

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

An Extension

R4: MedicationRequest.status additional codes

Element MedicationRequest.status is mapped to FHIR R5 element MedicationRequest.status as RelatedTo. The mappings for MedicationRequest.status do not allow expression of the necessary codes, per the bindings on the source and target. The target context MedicationRequest.status is a modifier element, so this extension does not need to be defined as a modifier. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

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.

If true, indicates that the provider is asking for the patient to either stop taking or to not start taking the specified medication. For example, the patient is taking an existing medication and the provider is changing their medication. They want to create two seperate requests: one to stop using the current medication and another to start the new medication.

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

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.

The individual or group for whom the medication has been requested.

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.reported[x] additional types (Reference(http://hl7.org/fhir/StructureDefinition/Patient), Reference(http://hl7.org/fhir/StructureDefinition/Practitioner), Reference(http://hl7.org/fhir/StructureDefinition/PractitionerRole), Reference(http://hl7.org/fhir/StructureDefinition/RelatedPerson), Reference(http://hl7.org/fhir/StructureDefinition/Organization))

Element MedicationRequest.reported[x] is mapped to FHIR R5 element MedicationRequest.reported as SourceIsBroaderThanTarget. The mappings for MedicationRequest.reported[x] do not cover the following types: Reference.

R4: MedicationRequest.instantiatesCanonical (new:canonical)

Element MedicationRequest.instantiatesCanonical has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.instantiatesCanonical has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

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 R5. Typically, this is because the element has been added (is a new element).

R4: MedicationRequest.detectedIssue (new:Reference(DetectedIssue))

Element MedicationRequest.detectedIssue has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.detectedIssue has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.

R4: MedicationRequest.status additional codes

Element MedicationRequest.status is mapped to FHIR R5 element MedicationRequest.status as RelatedTo. The mappings for MedicationRequest.status do not allow expression of the necessary codes, per the bindings on the source and target. The target context MedicationRequest.status is a modifier element, so this extension does not need to be defined as a modifier. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

R4: MedicationRequest.performer

Element MedicationRequest.performer is mapped to FHIR R5 element MedicationRequest.performer as RelatedTo. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element MedicationRequest.performer with unmapped reference targets: Device.

R4: MedicationRequest.reasonReference additional types (Reference(http://hl7.org/fhir/StructureDefinition/Observation)) additional types from child elements (display, identifier, reference, type)

Element MedicationRequest.reasonReference is mapped to FHIR R5 element MedicationRequest.reason as RelatedTo. The mappings for MedicationRequest.reasonReference do not cover the following types: Reference. The mappings for MedicationRequest.reasonReference do not cover the following types based on type expansion: display, identifier, reference, type. This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode.

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.

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.

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.

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).

IETF language tag for a human language

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.

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.

An Extension

R4: MedicationRequest.reported[x] additional types (Reference(http://hl7.org/fhir/StructureDefinition/Patient), Reference(http://hl7.org/fhir/StructureDefinition/Practitioner), Reference(http://hl7.org/fhir/StructureDefinition/PractitionerRole), Reference(http://hl7.org/fhir/StructureDefinition/RelatedPerson), Reference(http://hl7.org/fhir/StructureDefinition/Organization))

Element MedicationRequest.reported[x] is mapped to FHIR R5 element MedicationRequest.reported as SourceIsBroaderThanTarget. The mappings for MedicationRequest.reported[x] do not cover the following types: Reference.

R4: MedicationRequest.instantiatesCanonical (new:canonical)

Element MedicationRequest.instantiatesCanonical has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.instantiatesCanonical has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

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 R5. Typically, this is because the element has been added (is a new element).

R4: MedicationRequest.detectedIssue (new:Reference(DetectedIssue))

Element MedicationRequest.detectedIssue has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.detectedIssue has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.

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

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

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.

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

This is a business identifier, not a resource identifier.

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

Reference to an order/prescription that is being replaced by this MedicationRequest.

A shared identifier common to multiple independent Request instances that were activated/authorized more or less simultaneously by a single author. The presence of the same identifier on each request ties those requests together and may have business ramifications in terms of reporting of results, billing, etc. E.g. a requisition number shared by a set of lab tests ordered together, or a prescription number shared by all meds ordered at one time.

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.

Clinical decision support systems should take the status into account when determining which medications to include in their algorithms.

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

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

An Extension

R4: MedicationRequest.status additional codes

Element MedicationRequest.status is mapped to FHIR R5 element MedicationRequest.status as RelatedTo. The mappings for MedicationRequest.status do not allow expression of the necessary codes, per the bindings on the source and target. The target context MedicationRequest.status is a modifier element, so this extension does not need to be defined as a modifier. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Primitive value for code

Captures the reason for the current state of the MedicationRequest.

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.

Identifies the reasons for a given status.

The date (and perhaps time) when the status was changed.

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 arbitrary categorization or grouping of the medication request. It could be used for indicating where meds are intended to be administered, eg. in an inpatient setting or in a patient's home, or a legal category of the medication.

The category can be used to include where the medication is expected to be consumed or other types of requests. The examplar value set represents where the meds are intended to be administered and is just one example of request categorization.

A coded concept identifying where the medication is 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.

If true, indicates that the provider is asking for the patient to either stop taking or to not start taking the specified medication. For example, the patient is taking an existing medication and the provider is changing their medication. They want to create two seperate requests: one to stop using the current medication and another to start the new medication.

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

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.

The individual or group for whom the medication has been requested.

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.

The person or organization who provided the information about this request, if the source is someone other than the requestor. This is often used when the MedicationRequest is reported by another person.

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

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

Information to support fulfilling (i.e. dispensing or administering) of the medication, for example, patient height and weight, a MedicationStatement for the patient).

This attribute can be used to reference a MedicationStatement about the patients' medication use.

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.

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

If not populated, then assume that this is the original record and not reported

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

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.

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

The specified desired performer of the medication treatment (e.g. the performer of the medication administration). For devices, this is the device that is intended to perform the administration of the medication. An IV Pump would be an example of a device that is performing the administration. Both the IV Pump and the practitioner that set the rate or bolus on the pump can be listed as performers.

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.performer

Element MedicationRequest.performer is mapped to FHIR R5 element MedicationRequest.performer as RelatedTo. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element MedicationRequest.performer with unmapped reference targets: Device.

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.

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.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|5.0.0)

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

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 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.

The intended type of device that is to be used for the administration of the medication (for example, PCA Pump).

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

The reason or the indication for ordering or not 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.

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.reasonReference additional types (Reference(http://hl7.org/fhir/StructureDefinition/Observation)) additional types from child elements (display, identifier, reference, type)

Element MedicationRequest.reasonReference is mapped to FHIR R5 element MedicationRequest.reason as RelatedTo. The mappings for MedicationRequest.reasonReference do not cover the following types: Reference. The mappings for MedicationRequest.reasonReference do not cover the following types based on type expansion: display, identifier, reference, type. This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode.

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 description of the overall pattern of the administration of the medication to the patient.

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

Identifies the overall pattern of medication administratio.

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

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

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.

The period over which the medication is to be taken. Where there are multiple dosageInstruction lines (for example, tapering doses), this is the earliest date and the latest end date of the dosageInstructions.

Specific instructions for 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. In general, each prescribed drug will be a separate Medication Request.

When drug orders are grouped together at the time of order entry, but each of the drugs can be manipulated independently e.g. changing the status of one order to "completed" or "cancelled", changing another order status to "on-hold", the method to "group" all of the medication requests together is to use MedicationRequest.groupIdentifier element. All of the orders grouped together in this manner will have the same groupIdentifier, and separately, each order in the group may have a unique identifier.

There are cases that require grouping of Medication orders together when it is necessary to specify optionality e.g. order two drugs at one time, but stating either of these drugs may be used to treat the patient. The use of a RequestOrchestration should be used as a parent for the Medication orders that require this type of grouping. An example when it may be necessary to group medication orders together is when you specify timing relationships e.g. order drug "xyz" with dose 123, then taper the same drug to a different dose after some interval of time precedence: e.g. give drug "abc" followed by drug "def" e.g. give drug 30 minutes before some procedure was performed more generically this supports - hierarchical groups of actions, where each specific action references the action to be performed (in terms of a Request resource), and each group describes additional behavior, relationships, and applicable conditions between the actions in the overall group. Note that one should NOT use the List or Composition resource to accomplish the above requirements. You may use List or Composition for other business requirements, but not to address the specific requirements of grouping medication orders.

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.

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.

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 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.

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

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

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. 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.

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 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.

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

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

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

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. A prescriber may explicitly say that zero refills are permitted after the initial dispense.

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

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 performing Organization that will dispense the medication as specified by the prescriber.

Provides additional information to the dispenser, for example, counselling to be provided to the patient.

Provides information about the type of adherence packaging to be supplied for the medication dispense.

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.

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.

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 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.

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

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

Identifies the type of substitution allowed.

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

SubstanceAdminSubstitutionReason

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 might 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.).