Generated Narrative: StructureDefinition ext-R4B-MedicationDispense.dosageInstruction Name Flags Card. Type Description & Constraints <a href="StructureDefinition-ext-R4B-MedicationDispense.dosageInstruction-definitions.html#Extension" title="R4B: `MedicationDispense.dosageInstruction` additional types (Dosage) additional types from child elements (additionalInstruction, asNeeded[x], doseAndRate, dose[x], rate[x], type, maxDosePerAdministration, maxDosePerLifetime, maxDosePerPeriod, method, patientInstruction, route, sequence, site, text, timing)">Extension 0..* Extension R4B: dosageInstruction additional types #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:_datatype 1..1 Extension DataType slice for a FHIR R4B `Dosage` value #xD; url 1..1 uri "http://hl7.org/fhir/StructureDefinition/_datatype" #xD; value[x] 1..1 string Value of extension Fixed Value: Dosage #xD; extension:sequence 0..1 Extension R4B: sequence #xD; url 1..1 uri "sequence" #xD; value[x] 0..1 integer The order of the dosage instructions #xD; extension:text 0..1 Extension R4B: text #xD; url 1..1 uri "text" #xD; value[x] 0..1 string Free text dosage instructions e.g. SIG #xD; extension:additionalInstruction 0..* Extension R4B: Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" #xD; url 1..1 uri "additionalInstruction" #xD; <a href="StructureDefinition-ext-R4B-MedicationDispense.dosageInstruction-definitions.html#Extension.extension:additionalInstruction.value[x]" title="Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").">value[x] 0..1 CodeableConcept Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" #xD; extension:patientInstruction 0..1 Extension R4B: patientInstruction #xD; url 1..1 uri "patientInstruction" #xD; value[x] 0..1 string Patient or consumer oriented instructions #xD; extension:timing 0..1 Extension R4B: timing additional types #xD; url 1..1 uri "timing" #xD; value[x] 0..1 Timing When medication should be administered #xD; extension:asNeeded 0..1 Extension R4B: asNeeded #xD; url 1..1 uri "asNeeded" #xD; value[x] 0..1 Take "as needed" (for x) #xD; valueBoolean boolean #xD; valueCodeableConcept CodeableConcept #xD; extension:site 0..1 Extension R4B: site #xD; url 1..1 uri "site" #xD; value[x] 0..1 CodeableConcept Body site to administer to #xD; extension:route 0..1 Extension R4B: route #xD; url 1..1 uri "route" #xD; value[x] 0..1 CodeableConcept How drug should enter body #xD; extension:method 0..1 Extension R4B: method #xD; url 1..1 uri "method" #xD; value[x] 0..1 CodeableConcept Technique for administering medication #xD; extension:doseAndRate 0..* Extension R4B: Amount of medication administered (new) #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:type 0..1 Extension R4B: The kind of dose or rate specified (new) #xD; url 1..1 uri "type" #xD; value[x] 0..1 CodeableConcept The kind of dose or rate specified Binding: R4BDoseRateTypeForR3 (0.1.0) (example) #xD; extension:dose 0..1 Extension R4B: dose #xD; url 1..1 uri "dose" #xD; value[x] 0..1 Amount of medication per dose #xD; valueRange Range #xD; valueQuantity Quantity(SimpleQuantity) #xD; extension:rate 0..1 Extension R4B: rate additional types #xD; url 1..1 uri "rate" #xD; value[x] 0..1 Amount of medication per unit of time #xD; valueRatio Ratio #xD; valueRange Range #xD; url 1..1 uri "doseAndRate" #xD; value[x] 0..0 Value of extension #xD; extension:maxDosePerPeriod 0..1 Extension R4B: maxDosePerPeriod additional types #xD; url 1..1 uri "maxDosePerPeriod" #xD; value[x] 0..1 Ratio Upper limit on medication per unit of time #xD; extension:maxDosePerAdministration 0..1 Extension R4B: maxDosePerAdministration #xD; url 1..1 uri "maxDosePerAdministration" #xD; value[x] 0..1 SimpleQuantity Upper limit on medication per administration #xD; extension:maxDosePerLifetime 0..1 Extension R4B: maxDosePerLifetime #xD; url 1..1 uri "maxDosePerLifetime" #xD; value[x] 0..1 SimpleQuantity Upper limit on medication per lifetime of the patient #xD; url 1..1 uri "http://hl7.org/fhir/4.3/StructureDefinition/extension-MedicationDispense.dosageInstruction" #xD; value[x] 0..0 Value of extension #xD; Documentation for this format
R4B: `MedicationDispense.dosageInstruction` additional types (Dosage) additional types from child elements (additionalInstruction, asNeeded[x], doseAndRate, dose[x], rate[x], type, maxDosePerAdministration, maxDosePerLifetime, maxDosePerPeriod, method, patientInstruction, route, sequence, site, text, timing)
This extension is part of the cross-version definitions generated to enable use of the element `MedicationDispense.dosageInstruction` as defined in FHIR R4B in FHIR STU3. The source element is defined as: `MedicationDispense.dosageInstruction` 0..* `Dosage` Across FHIR versions, the element set has been mapped as: * R4B: `MedicationDispense.dosageInstruction` 0..* `Dosage` * R4: `MedicationDispense.dosageInstruction` 0..* `Dosage` * STU3: `MedicationDispense.dosageInstruction` 0..* `Dosage` Following are the generation technical comments: Element `MedicationDispense.dosageInstruction` is mapped to FHIR STU3 element `MedicationDispense.dosageInstruction` as `SourceIsBroaderThanTarget`. The mappings for `MedicationDispense.dosageInstruction` do not cover the following types: Dosage. The mappings for `MedicationDispense.dosageInstruction` do not cover the following types based on type expansion: additionalInstruction, asNeeded[x], dose[x], doseAndRate, maxDosePerAdministration, maxDosePerLifetime, maxDosePerPeriod, method, patientInstruction, rate[x], route, sequence, site, text, timing, type.
Element `MedicationDispense.dosageInstruction` is mapped to FHIR STU3 element `MedicationDispense.dosageInstruction` as `SourceIsBroaderThanTarget`. The mappings for `MedicationDispense.dosageInstruction` do not cover the following types: Dosage. The mappings for `MedicationDispense.dosageInstruction` do not cover the following types based on type expansion: additionalInstruction, asNeeded[x], dose[x], doseAndRate, maxDosePerAdministration, maxDosePerLifetime, maxDosePerPeriod, method, patientInstruction, rate[x], route, sequence, site, text, timing, type. When the dose or rate is intended to change over the entire administration period (e.g. Tapering dose prescriptions), multiple instances of dosage instructions will need to be supplied to convey the different doses/rates. The pharmacist reviews the medication order prior to dispense and updates the dosageInstruction based on the actual product being dispensed.
All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
DataType slice for a FHIR R4B `Dosage` value
Slice to indicate the presence of a R4B `Dosage` in FHIR STU3
Additional Content defined by implementations
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.
Source of the definition for the extension code - a logical name or a URL.
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).
Element `Dosage.sequence` is mapped to FHIR STU3 element `Dosage.sequence` as `Equivalent`.
If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential. Element `Dosage.sequence` is mapped to FHIR STU3 element `Dosage.sequence` as `Equivalent`.
Indicates the order in which the dosage instructions should be applied or interpreted.
Element `Dosage.text` is mapped to FHIR STU3 element `Dosage.text` as `Equivalent`.
Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. Additional information about administration or preparation of the medication should be included as text. Element `Dosage.text` is mapped to FHIR STU3 element `Dosage.text` as `Equivalent`.
R4B: Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
Element `Dosage.additionalInstruction` is mapped to FHIR STU3 element `Dosage.additionalInstruction` as `Equivalent`. Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.
Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded. Element `Dosage.additionalInstruction` is mapped to FHIR STU3 element `Dosage.additionalInstruction` as `Equivalent`.
Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").
Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.
Element `Dosage.patientInstruction` is mapped to FHIR STU3 element `Dosage.patientInstruction` as `Equivalent`.
Patient or consumer oriented instructions
Instructions in terms that are understood by the patient or consumer.
R4B: `Dosage.timing` additional types (Timing) additional types from child elements (code, event, repeat, bounds[x], count, countMax, dayOfWeek, duration, durationMax, durationUnit, frequency, frequencyMax, offset, period, periodMax, periodUnit, timeOfDay, when)
Element `Dosage.timing` is mapped to FHIR STU3 element `Dosage.timing` as `SourceIsBroaderThanTarget`. The mappings for `Dosage.timing` do not cover the following types: Timing. The mappings for `Dosage.timing` do not cover the following types based on type expansion: bounds[x], code, count, countMax, dayOfWeek, duration, durationMax, durationUnit, event, frequency, frequencyMax, offset, period, periodMax, periodUnit, repeat, timeOfDay, when. This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.
The timing schedule for giving the medication to the patient. This data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period. Element `Dosage.timing` is mapped to FHIR STU3 element `Dosage.timing` as `SourceIsBroaderThanTarget`. The mappings for `Dosage.timing` do not cover the following types: Timing. The mappings for `Dosage.timing` do not cover the following types based on type expansion: bounds[x], code, count, countMax, dayOfWeek, duration, durationMax, durationUnit, event, frequency, frequencyMax, offset, period, periodMax, periodUnit, repeat, timeOfDay, when.
This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.
Element `Dosage.asNeeded[x]` is mapped to FHIR STU3 element `Dosage.asNeeded[x]` as `Equivalent`. The target context `Dosage.asNeeded[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `Dosage`. Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".
Element `Dosage.asNeeded[x]` is mapped to FHIR STU3 element `Dosage.asNeeded[x]` as `Equivalent`. The target context `Dosage.asNeeded[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `Dosage`.
Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).
Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".
Element `Dosage.site` is mapped to FHIR STU3 element `Dosage.site` as `Equivalent`. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [bodySite](https://hl7.org/fhir/extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both.
A coded specification of the anatomic site where the medication first enters the body. Element `Dosage.site` is mapped to FHIR STU3 element `Dosage.site` as `Equivalent`.
If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [bodySite](https://hl7.org/fhir/extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both.
Element `Dosage.route` is mapped to FHIR STU3 element `Dosage.route` as `Equivalent`.
A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body. Element `Dosage.route` is mapped to FHIR STU3 element `Dosage.route` as `Equivalent`.
Element `Dosage.method` is mapped to FHIR STU3 element `Dosage.method` as `Equivalent`. Terminologies used often pre-coordinate this term with the route and or form of administration.
A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV. Element `Dosage.method` is mapped to FHIR STU3 element `Dosage.method` as `Equivalent`.
Terminologies used often pre-coordinate this term with the route and or form of administration.
R4B: Amount of medication administered (new)
Element `Dosage.doseAndRate` has a context of Dosage based on following the parent source element upwards and mapping to `Dosage`. Element `Dosage.doseAndRate` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).
R4B: The kind of dose or rate specified (new)
R4B: `Dosage.doseAndRate.type` (new:CodeableConcept)
Element `Dosage.doseAndRate.type` is part of an existing definition because parent element `Dosage.doseAndRate` requires a cross-version extension. Element `Dosage.doseAndRate.type` has a context of Dosage based on following the parent source element upwards and mapping to `Dosage`. Element `Dosage.doseAndRate.type` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).
If the type is not populated, assume to be "ordered". Element `Dosage.doseAndRate.type` is part of an existing definition because parent element `Dosage.doseAndRate` requires a cross-version extension. Element `Dosage.doseAndRate.type` has a context of Dosage based on following the parent source element upwards and mapping to `Dosage`. Element `Dosage.doseAndRate.type` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).
The kind of dose or rate specified, for example, ordered or calculated.
Element `Dosage.doseAndRate.dose[x]` is part of an existing definition because parent element `Dosage.doseAndRate` requires a cross-version extension. Element `Dosage.doseAndRate.dose[x]` is mapped to FHIR STU3 element `Dosage.dose[x]` as `SourceIsBroaderThanTarget`. The target context `Dosage.dose[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `Dosage`. Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.
The amount of therapeutic or other substance given at one administration event. Element `Dosage.doseAndRate.dose[x]` is part of an existing definition because parent element `Dosage.doseAndRate` requires a cross-version extension. Element `Dosage.doseAndRate.dose[x]` is mapped to FHIR STU3 element `Dosage.dose[x]` as `SourceIsBroaderThanTarget`. The target context `Dosage.dose[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `Dosage`.
Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.
R4B: `Dosage.doseAndRate.rate[x]` additional types (Ratio, Range)
Element `Dosage.doseAndRate.rate[x]` is part of an existing definition because parent element `Dosage.doseAndRate` requires a cross-version extension. Element `Dosage.doseAndRate.rate[x]` is mapped to FHIR STU3 element `Dosage.rate[x]` as `SourceIsBroaderThanTarget`. The mappings for `Dosage.doseAndRate.rate[x]` do not cover the following types: Range, Ratio. The target context `Dosage.rate[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `Dosage`. It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate. It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammer where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.
Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period. Element `Dosage.doseAndRate.rate[x]` is part of an existing definition because parent element `Dosage.doseAndRate` requires a cross-version extension. Element `Dosage.doseAndRate.rate[x]` is mapped to FHIR STU3 element `Dosage.rate[x]` as `SourceIsBroaderThanTarget`. The mappings for `Dosage.doseAndRate.rate[x]` do not cover the following types: Range, Ratio. The target context `Dosage.rate[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `Dosage`.
It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate. It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammer where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.
R4B: `Dosage.maxDosePerPeriod` additional types (Ratio) additional types from child elements (denominator, numerator)
Element `Dosage.maxDosePerPeriod` is mapped to FHIR STU3 element `Dosage.maxDosePerPeriod` as `SourceIsBroaderThanTarget`. The mappings for `Dosage.maxDosePerPeriod` do not cover the following types: Ratio. The mappings for `Dosage.maxDosePerPeriod` do not cover the following types based on type expansion: denominator, numerator. This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".
The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours. Element `Dosage.maxDosePerPeriod` is mapped to FHIR STU3 element `Dosage.maxDosePerPeriod` as `SourceIsBroaderThanTarget`. The mappings for `Dosage.maxDosePerPeriod` do not cover the following types: Ratio. The mappings for `Dosage.maxDosePerPeriod` do not cover the following types based on type expansion: denominator, numerator.
Upper limit on medication per unit of time
Upper limit on medication per unit of time.
This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".
Element `Dosage.maxDosePerAdministration` is mapped to FHIR STU3 element `Dosage.maxDosePerAdministration` as `Equivalent`. This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.
The maximum total quantity of a therapeutic substance that may be administered to a subject per administration. Element `Dosage.maxDosePerAdministration` is mapped to FHIR STU3 element `Dosage.maxDosePerAdministration` as `Equivalent`.
Upper limit on medication per administration
Upper limit on medication per administration.
This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.
Element `Dosage.maxDosePerLifetime` is mapped to FHIR STU3 element `Dosage.maxDosePerLifetime` as `Equivalent`.
The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject. Element `Dosage.maxDosePerLifetime` is mapped to FHIR STU3 element `Dosage.maxDosePerLifetime` as `Equivalent`.
Upper limit on medication per lifetime of the patient
Upper limit on medication per lifetime of the patient.