Describes the event of a patient consuming or otherwise being administered a medication. This may be as simple as swallowing a tablet or it may be a long running infusion. Related resources tie this event to the authorizing prescription, and the specific encounter between patient and health care practitioner.

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 it's narrative along with other profiles, value sets, etc.

An Extension

R5: MedicationAdministration.basedOn (new:Reference(CarePlan))

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

R5: MedicationAdministration.occurence[x] additional types (Timing)

Element MedicationAdministration.occurence[x] is mapped to FHIR R4 element MedicationAdministration.effective[x] as SourceIsBroaderThanTarget. The mappings for MedicationAdministration.occurence[x] do not cover the following types: Timing. The target context MedicationAdministration.effective[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element MedicationAdministration.

R5: MedicationAdministration.recorded (new:dateTime)

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

R5: MedicationAdministration.isSubPotent (new:boolean)

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

R5: MedicationAdministration.subPotentReason (new:CodeableConcept)

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

R5: MedicationAdministration.reason additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/Condition), CodeableReference(http://hl7.org/fhir/StructureDefinition/Observation), CodeableReference(http://hl7.org/fhir/StructureDefinition/DiagnosticReport))

Element MedicationAdministration.reason is mapped to FHIR R4 element MedicationAdministration.reasonCode as SourceIsBroaderThanTarget. Element MedicationAdministration.reason is mapped to FHIR R4 element MedicationAdministration.reasonReference as SourceIsBroaderThanTarget. The mappings for MedicationAdministration.reason do not cover the following types: CodeableReference.

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

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

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.

Will generally be set to show that the administration has been completed. For some long running administrations such as infusions, it is possible for an administration to be started but not completed or it may be paused while some other process is under way.

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

A set of codes indicating the current status of a MedicationAdministration.

Identifies the medication that was administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.

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

Codes identifying substance or product that can be administered.

The person or animal or group receiving the medication.

A specific date/time or interval of time during which the administration took place (or did not take place, when the 'notGiven' attribute is true). For many administrations, such as swallowing a tablet the use of dateTime is more appropriate.

R5: MedicationAdministration.basedOn (new:Reference(CarePlan))

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

R5: MedicationAdministration.occurence[x] additional types (Timing)

Element MedicationAdministration.occurence[x] is mapped to FHIR R4 element MedicationAdministration.effective[x] as SourceIsBroaderThanTarget. The mappings for MedicationAdministration.occurence[x] do not cover the following types: Timing. The target context MedicationAdministration.effective[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element MedicationAdministration.

R5: MedicationAdministration.recorded (new:dateTime)

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

R5: MedicationAdministration.isSubPotent (new:boolean)

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

R5: MedicationAdministration.subPotentReason (new:CodeableConcept)

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

R5: MedicationAdministration.reason additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/Condition), CodeableReference(http://hl7.org/fhir/StructureDefinition/Observation), CodeableReference(http://hl7.org/fhir/StructureDefinition/DiagnosticReport))

Element MedicationAdministration.reason is mapped to FHIR R4 element MedicationAdministration.reasonCode as SourceIsBroaderThanTarget. Element MedicationAdministration.reason is mapped to FHIR R4 element MedicationAdministration.reasonReference as SourceIsBroaderThanTarget. The mappings for MedicationAdministration.reason do not cover the following types: CodeableReference.

R5: MedicationAdministration.partOf

Element MedicationAdministration.partOf is mapped to FHIR R4 element MedicationAdministration.partOf as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element MedicationAdministration.partOf with unmapped reference targets: MedicationDispense. MedicationDispense will be used to indicate waste.

R5: MedicationAdministration.performer.actor additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/Practitioner), CodeableReference(http://hl7.org/fhir/StructureDefinition/PractitionerRole), CodeableReference(http://hl7.org/fhir/StructureDefinition/Patient), CodeableReference(http://hl7.org/fhir/StructureDefinition/RelatedPerson), CodeableReference(http://hl7.org/fhir/StructureDefinition/Device))

Element MedicationAdministration.performer.actor is mapped to FHIR R4 element MedicationAdministration.performer.actor as SourceIsBroaderThanTarget. The mappings for MedicationAdministration.performer.actor do not cover the following types: CodeableReference.

R5: MedicationAdministration.device additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/Device)) additional types from child elements (concept)

Element MedicationAdministration.device is mapped to FHIR R4 element MedicationAdministration.device as SourceIsBroaderThanTarget. The mappings for MedicationAdministration.device do not cover the following types: CodeableReference. The mappings for MedicationAdministration.device do not cover the following types based on type expansion: concept.

Describes the event of a patient consuming or otherwise being administered a medication. This may be as simple as swallowing a tablet or it may be a long running infusion. Related resources tie this event to the authorizing prescription, and the specific encounter between patient and health care practitioner.

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 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 it's 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).

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

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 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, 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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

An Extension

R5: MedicationAdministration.basedOn (new:Reference(CarePlan))

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

R5: MedicationAdministration.occurence[x] additional types (Timing)

Element MedicationAdministration.occurence[x] is mapped to FHIR R4 element MedicationAdministration.effective[x] as SourceIsBroaderThanTarget. The mappings for MedicationAdministration.occurence[x] do not cover the following types: Timing. The target context MedicationAdministration.effective[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element MedicationAdministration.

R5: MedicationAdministration.recorded (new:dateTime)

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

R5: MedicationAdministration.isSubPotent (new:boolean)

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

R5: MedicationAdministration.subPotentReason (new:CodeableConcept)

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

R5: MedicationAdministration.reason additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/Condition), CodeableReference(http://hl7.org/fhir/StructureDefinition/Observation), CodeableReference(http://hl7.org/fhir/StructureDefinition/DiagnosticReport))

Element MedicationAdministration.reason is mapped to FHIR R4 element MedicationAdministration.reasonCode as SourceIsBroaderThanTarget. Element MedicationAdministration.reason is mapped to FHIR R4 element MedicationAdministration.reasonReference as SourceIsBroaderThanTarget. The mappings for MedicationAdministration.reason do not cover the following types: CodeableReference.

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

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

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 Administration 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 protocol, guideline, orderset, or other definition that was adhered to in whole or in part by this event.

A larger event of which this particular event is a component or step.

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

An Extension

R5: MedicationAdministration.partOf

Element MedicationAdministration.partOf is mapped to FHIR R4 element MedicationAdministration.partOf as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element MedicationAdministration.partOf with unmapped reference targets: MedicationDispense. MedicationDispense will be used to indicate waste.

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 RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

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

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).

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.

Will generally be set to show that the administration has been completed. For some long running administrations such as infusions, it is possible for an administration to be started but not completed or it may be paused while some other process is under way.

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

A set of codes indicating the current status of a MedicationAdministration.

A code indicating why the administration was not performed.

A set of codes indicating the reason why the MedicationAdministration is negated.

Indicates where the medication is expected to be consumed or administered.

A coded concept describing where the medication administered is expected to occur.

Identifies the medication that was administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.

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

Codes identifying substance or product that can be administered.

The person or animal or group receiving the medication.

The visit, admission, or other contact between patient and health care provider during which the medication administration was performed.

Additional information (for example, patient height and weight) that supports the administration of the medication.

A specific date/time or interval of time during which the administration took place (or did not take place, when the 'notGiven' attribute is true). For many administrations, such as swallowing a tablet the use of dateTime is more appropriate.

Indicates who or what performed the medication administration and how they were involved.

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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

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.

Distinguishes the type of involvement of the performer in the medication administration.

A code describing the role an individual played in administering the medication.

Indicates who or what performed the medication administration.

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

An Extension

R5: MedicationAdministration.performer.actor additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/Practitioner), CodeableReference(http://hl7.org/fhir/StructureDefinition/PractitionerRole), CodeableReference(http://hl7.org/fhir/StructureDefinition/Patient), CodeableReference(http://hl7.org/fhir/StructureDefinition/RelatedPerson), CodeableReference(http://hl7.org/fhir/StructureDefinition/Device))

Element MedicationAdministration.performer.actor is mapped to FHIR R4 element MedicationAdministration.performer.actor as SourceIsBroaderThanTarget. The mappings for MedicationAdministration.performer.actor do not cover the following types: CodeableReference.

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 RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

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

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).

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 code indicating why the medication was given.

A set of codes indicating the reason why the MedicationAdministration was made.

Condition or observation that supports why the medication was administered.

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

The original request, instruction or authority to perform the administration.

This is a reference to the MedicationRequest where the intent is either order or instance-order. It should not reference MedicationRequests where the intent is any other value.

The device used in administering the medication to the patient. For example, a particular infusion pump.

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

An Extension

R5: MedicationAdministration.device additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/Device)) additional types from child elements (concept)

Element MedicationAdministration.device is mapped to FHIR R4 element MedicationAdministration.device as SourceIsBroaderThanTarget. The mappings for MedicationAdministration.device do not cover the following types: CodeableReference. The mappings for MedicationAdministration.device do not cover the following types based on type expansion: concept.

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 RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

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

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).

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.

Extra information about the medication administration that is not conveyed by the other attributes.

Describes the medication dosage information details e.g. dose, rate, site, route, etc.

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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

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.

Free text dosage can be used for cases where the dosage administered is too complex to code. When coded dosage is present, the free text dosage may still be present for display to humans.

The dosage instructions should reflect the dosage of the medication that was administered.

A coded specification of the anatomic site where the medication first entered the body. For example, "left arm".

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

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

A code specifying the route or physiological path of administration of a therapeutic agent into or onto the patient. For example, topical, intravenous, etc.

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

A coded value indicating the method by which the medication is intended to be or was introduced into or on the body. This attribute will most often NOT be populated. It is most commonly used for injections. For example, Slow Push, Deep IV.

One of the reasons this attribute is not used often, is that the method is often pre-coordinated with the route and/or form of administration. This means the codes used in route or form may pre-coordinate the method in the route code or the form code. The implementation decision about what coding system to use for route or form code will determine how frequently the method code will be populated e.g. if route or form code pre-coordinate method code, then this attribute will not be populated often; if there is no pre-coordination then method code may be used frequently.

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

The amount of the medication given at one administration event. Use this value when the administration is essentially an instantaneous event such as a swallowing a tablet or giving an injection.

If the administration is not instantaneous (rate is present), this can be specified to convey the total amount administered over period of time of a single administration.

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.

If the rate changes over time, and you want to capture this in MedicationAdministration, then each change should be captured as a distinct MedicationAdministration, with a specific MedicationAdministration.dosage.rate, and the date time when the rate change occurred. Typically, the MedicationAdministration.dosage.rate element is not used to convey an average rate.

A summary of the events of interest that have occurred, such as when the administration was verified.

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.