DSTU2 Ballot Source
This page is part of the FHIR Specification (v0.5.0: DSTU 2 Ballot 2). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
StructureDefinition for Profile of MedicationStatement for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.
{
"resourceType": "StructureDefinition",
"id": "medicationstatement-qicore-qicore-medicationstatement",
"text": {
"status": "generated",
"div": "<div>!-- Snipped for Brevity --></div>"
},
"url": "http://hl7.org/fhir/StructureDefinition/medicationstatement-qicore-qicore-medicationstatement",
"name": "QICore-MedicationStatement",
"publisher": "Health Level Seven, Inc. - CQI WG",
"contact": [
{
"telecom": [
{
"system": "url",
"value": "http://hl7.org/special/committees/CQI"
}
]
}
],
"description": "Profile of MedicationStatement for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.",
"status": "draft",
"date": "2015-02-27",
"mapping": [
{
"identity": "qdm",
"uri": "http://www.healthit.gov/quality-data-model",
"name": "Quality Data Model"
}
],
"type": "constraint",
"abstract": false,
"base": "http://hl7.org/fhir/StructureDefinition/MedicationStatement",
"snapshot": {
"element": [
{
"path": "MedicationStatement",
"name": "QICore-MedicationStatement",
"short": "Administration of medication to a patient",
"definition": "A record of medication being taken by a patient, or that the medication has been given to a patient where the record is the result of a report from the patient or another clinician.",
"min": 1,
"max": "1",
"type": [
{
"code": "MedicationStatement"
}
],
"mapping": [
{
"identity": "rim",
"map": "SubstanceAdministration"
},
{
"identity": "qdm",
"map": "Medication, Active"
}
]
},
{
"path": "MedicationStatement.id",
"short": "Logical id of this artefact",
"definition": "The logical id of the resource, as used in the url for the resoure. Once assigned, this value never changes.",
"comments": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Bundles always have an id, though it is usually a generated UUID.",
"min": 0,
"max": "1",
"type": [
{
"code": "id"
}
]
},
{
"path": "MedicationStatement.meta",
"short": "Metadata about the resource",
"definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.",
"min": 0,
"max": "1",
"type": [
{
"code": "Meta"
}
]
},
{
"path": "MedicationStatement.implicitRules",
"short": "A set of rules under which this content was created",
"definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.",
"comments": "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 as much as possible.",
"min": 0,
"max": "1",
"type": [
{
"code": "uri"
}
],
"isModifier": true
},
{
"path": "MedicationStatement.language",
"short": "Language of the resource content",
"definition": "The base language in which the resource is written.",
"comments": "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\n\nNot 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).",
"min": 0,
"max": "1",
"type": [
{
"code": "code"
}
],
"binding": {
"name": "Language",
"strength": "required",
"description": "A human language",
"valueSetUri": "http://tools.ietf.org/html/bcp47"
}
},
{
"path": "MedicationStatement.text",
"short": "Text summary of the resource, for human interpretation",
"definition": "A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
"comments": "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.",
"alias": [
"narrative",
"html",
"xhtml",
"display"
],
"min": 0,
"max": "1",
"type": [
{
"code": "Narrative"
}
],
"condition": [
"dom-1"
],
"mapping": [
{
"identity": "rim",
"map": "Act.text?"
}
]
},
{
"path": "MedicationStatement.contained",
"short": "Contained, inline Resources",
"definition": "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.",
"comments": "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.",
"alias": [
"inline resources",
"anonymous resources",
"contained resources"
],
"min": 0,
"max": "*",
"type": [
{
"code": "Resource"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"path": "MedicationStatement.extension",
"short": "Additional Content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the resource. 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.",
"comments": "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.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"type": [
{
"code": "Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"path": "MedicationStatement.modifierExtension",
"short": "Extensions that cannot be ignored",
"definition": "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. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"comments": "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.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"path": "MedicationStatement.identifier",
"short": "External Identifier",
"definition": "External identifier - FHIR will generate its own internal IDs (probably URLs) which do not need to be explicitly managed by the resource. The identifier here is one that would be used by another non-FHIR system - for example an automated medication pump would provide a record each time it operated; an administration while the patient was off the ward might be made with a different system and entered after the event. Particularly important if these records have to be updated.",
"min": 0,
"max": "*",
"type": [
{
"code": "Identifier"
}
],
"mapping": [
{
"identity": "v2",
"map": "RXA-25-Administered Barcode Identifier?"
},
{
"identity": "rim",
"map": "SubstanceAdministration.id"
}
]
},
{
"path": "MedicationStatement.patient",
"short": "Who was/is taking medication",
"definition": "The person or animal who is /was taking the medication.",
"min": 0,
"max": "1",
"type": [
{
"code": "Reference",
"profile": "http://hl7.org/fhir/StructureDefinition/patient-qicore-qicore-patient"
}
],
"mustSupport": true,
"mapping": [
{
"identity": "v2",
"map": "PID-3-Patient ID List"
},
{
"identity": "rim",
"map": "SubstanceAdministration->subject->Patient"
}
]
},
{
"path": "MedicationStatement.informationSource",
"short": "The person who provided the information about the taking of this medication.",
"definition": "The person who provided the information about the taking of this medication.",
"min": 0,
"max": "1",
"type": [
{
"code": "Reference",
"profile": "http://hl7.org/fhir/StructureDefinition/patient-qicore-qicore-patient"
},
{
"code": "Reference",
"profile": "http://hl7.org/fhir/StructureDefinition/practitioner-qicore-qicore-practitioner"
},
{
"code": "Reference",
"profile": "http://hl7.org/fhir/StructureDefinition/relatedperson-qicore-qicore-relatedperson"
}
]
},
{
"path": "MedicationStatement.dateAsserted",
"short": "When the statement was asserted?",
"definition": "The date when the medication statement was asserted by the information source.",
"min": 0,
"max": "1",
"type": [
{
"code": "dateTime"
}
],
"mustSupport": true
},
{
"path": "MedicationStatement.status",
"short": "in-progress | completed | entered-in-error",
"definition": "A code specifying the state of the statement. Generally this will be in-progress or completed state.",
"min": 1,
"max": "1",
"type": [
{
"code": "code"
}
],
"mustSupport": true,
"isModifier": true,
"binding": {
"name": "MedicationStatementStatus",
"strength": "required",
"description": "A set of codes indicating the current status of a MedicationStatement",
"valueSetReference": {
"reference": "http://hl7.org/fhir/vs/medication-statement-status"
}
}
},
{
"path": "MedicationStatement.wasNotGiven",
"short": "True if medication is/was not being taken",
"definition": "Set this to true if the record is saying that the medication was NOT taken.",
"min": 0,
"max": "1",
"type": [
{
"code": "boolean"
}
],
"mustSupport": true,
"isModifier": true,
"mapping": [
{
"identity": "v2",
"map": "RXA-20-Completion Status='NA'"
},
{
"identity": "rim",
"map": "SubstanceAdministration.actionNegationInd"
},
{
"identity": "qdm",
"map": "negation rationale"
}
]
},
{
"path": "MedicationStatement.reasonNotGiven",
"short": "True if asserting medication was not given",
"definition": "A code indicating why the medication was not taken.",
"min": 0,
"max": "*",
"type": [
{
"code": "CodeableConcept"
}
],
"condition": [
"mst-1"
],
"constraint": [
{
"key": "mst-1",
"name": "Not given reason",
"severity": "error",
"human": "Reason not given is only permitted if wasNotGiven is true",
"xpath": "not(exists(f:reasonNotGiven) and f:wasNotGiven/@value='false')"
}
],
"binding": {
"name": "MedicationAdministrationNegationReason",
"strength": "example",
"description": "A set of codes indicating the reason why the MedicationAdministration is negated.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/vs/reason-medication-not-given-codes"
}
},
"mapping": [
{
"identity": "v2",
"map": "RXA-9-Administration Notes:RXA-20-Completion Status='NA'"
},
{
"identity": "rim",
"map": "SubstanceAdministration->Reason->Observation->Value"
}
]
},
{
"path": "MedicationStatement.reasonForUse[x]",
"short": "A reason for why the medication is being/was taken.",
"definition": "A reason for why the medication is being/was taken.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
},
{
"code": "Reference",
"profile": "http://hl7.org/fhir/StructureDefinition/condition-qicore-qicore-condition"
}
],
"constraint": [
{
"key": "mst-2",
"name": "Reason for use",
"severity": "error",
"human": "Reason for use is only permitted if wasNotGiven is false",
"xpath": "not(exists(f:reasonForUse[x]) and f:wasNotGiven/@value='true')"
}
]
},
{
"path": "MedicationStatement.effective[x]",
"short": "Over what period was medication consumed?",
"definition": "The interval of time during which it is being asserted that the patient was taking the medication (or was not taking, when the 'wasNotGiven' attribute is true).",
"comments": "If the medication is still being taken at the time the statement is recorded, the \"end\" date will be omitted.",
"min": 0,
"max": "1",
"type": [
{
"code": "dateTime"
},
{
"code": "Period"
}
],
"mustSupport": true,
"mapping": [
{
"identity": "v2",
"map": "RXA-3-Date/Time Start of Administration / RXA-4-Date/Time End of Administration"
},
{
"identity": "rim",
"map": "SubstanceAdministration.effectiveTime"
},
{
"identity": "qdm",
"map": "start and stop datetime"
}
]
},
{
"path": "MedicationStatement.note",
"short": "Further information about the statement",
"definition": "Provides extra information about the medication statement that is not conveyed by the other attributes.",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
},
{
"path": "MedicationStatement.medication",
"short": "What medication was taken?",
"definition": "Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.",
"comments": "Note: do not use Medication.name to describe the medication this statement concerns. When the only available information is a text description of the medication, Medication.code.text should be used.",
"min": 0,
"max": "1",
"type": [
{
"code": "Reference",
"profile": "http://hl7.org/fhir/StructureDefinition/medication-qicore-qicore-medication"
}
],
"mustSupport": true,
"mapping": [
{
"identity": "v2",
"map": "RXA-5-Administered Code"
},
{
"identity": "rim",
"map": "SubstanceAdministration>Component>SubstanceAdministrationRequest.consumable"
},
{
"identity": "qdm",
"map": "primary code"
}
]
},
{
"path": "MedicationStatement.dosage",
"short": "Details of how medication was taken",
"definition": "Indicates how the medication is/was used by the patient.",
"min": 0,
"max": "*",
"mapping": [
{
"identity": "rim",
"map": "SubstanceAdministration>Component>SubstanceAdministrationRequest"
}
]
},
{
"path": "MedicationStatement.dosage.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "unique id for the element within a resource (for internal references).",
"min": 0,
"max": "1",
"type": [
{
"code": "id"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"path": "MedicationStatement.dosage.extension",
"short": "Additional Content defined by implementations",
"definition": "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.",
"comments": "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.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"type": [
{
"code": "Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"path": "MedicationStatement.dosage.modifierExtension",
"short": "Extensions that cannot be ignored",
"definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"comments": "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.",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"path": "MedicationStatement.dosage.text",
"short": "Dosage Instructions",
"definition": "Free text dosage instructions can be used for cases where the instructions are too complex to code. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication.",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
},
{
"path": "MedicationStatement.dosage.schedule",
"short": "When/how often was medication taken?",
"definition": "The timing schedule for giving the medication to the patient. The Schedule 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\".",
"min": 0,
"max": "1",
"type": [
{
"code": "Timing"
}
],
"mustSupport": true,
"mapping": [
{
"identity": "v2",
"map": "RAS:TQ1"
},
{
"identity": "rim",
"map": ".effectiveTime"
},
{
"identity": "qdm",
"map": "frequency"
}
]
},
{
"path": "MedicationStatement.dosage.asNeeded[x]",
"short": "Take \"as needed\" f(or x)",
"definition": "If set to true or if specified as a CodeableConcept, indicates that the medication is only taken when needed within the specified schedule rather than at every scheduled dose. If a CodeableConcept is present, it indicates the pre-condition for taking the Medication.",
"min": 0,
"max": "1",
"type": [
{
"code": "boolean"
},
{
"code": "CodeableConcept"
}
],
"binding": {
"name": "MedicationAsNeededReason",
"strength": "required",
"description": "A coded concept identifying the pre-condition that should hold prior to consuming a medication dose. For example \"pain\", \"30 minutes prior to sexual intercourse\", \"on flare-up\", etc."
},
"mapping": [
{
"identity": "rim",
"map": "boolean: .outboundRelationship[typeCode=PRCN].negationInd (inversed - so negationInd = true means asNeeded=false\r\rCodeableConcept: .outboundRelationship[typCode=PRCN].target[classCode=OBS, moodCode=EVN, isCriterionInd=true, code=\"Assertion\"].value"
}
]
},
{
"path": "MedicationStatement.dosage.site",
"short": "Where on body was medication administered?",
"definition": "A coded specification of the anatomic site where the medication first enters the body.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"name": "MedicationAdministrationSite",
"strength": "example",
"description": "A coded concept describing the site location the medicine enters into or onto the body",
"valueSetReference": {
"reference": "http://hl7.org/fhir/vs/approach-site-codes"
}
},
"mapping": [
{
"identity": "v2",
"map": "RXR-2-Administration Site"
},
{
"identity": "rim",
"map": ".approachSiteCode"
}
]
},
{
"path": "MedicationStatement.dosage.route",
"short": "How did the medication enter the body?",
"definition": "A code specifying the route or physiological path of administration of a therapeutic agent into or onto a subject.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"mustSupport": true,
"binding": {
"name": "RouteOfAdministration",
"strength": "example",
"description": "A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/vs/route-codes"
}
},
"mapping": [
{
"identity": "v2",
"map": "RXR-1-Route"
},
{
"identity": "rim",
"map": ".routeCode"
},
{
"identity": "qdm",
"map": "route"
}
]
},
{
"path": "MedicationStatement.dosage.method",
"short": "Technique used to administer medication",
"definition": "A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. Examples: Slow Push; Deep IV.\r\rTerminologies used often pre-coordinate this term with the route and or form of administration.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"name": "MedicationAdministrationMethod",
"strength": "example",
"description": "A coded concept describing the technique by which the medicine is administered",
"valueSetReference": {
"reference": "http://hl7.org/fhir/vs/administration-method-codes"
}
},
"mapping": [
{
"identity": "v2",
"map": "RXR-4-Administration Method"
},
{
"identity": "rim",
"map": ".methodCode"
}
]
},
{
"path": "MedicationStatement.dosage.quantity",
"short": "Amount administered in one dose",
"definition": "The amount of therapeutic or other substance given at one administration event.",
"min": 0,
"max": "1",
"type": [
{
"code": "Quantity"
}
],
"mustSupport": true,
"mapping": [
{
"identity": "v2",
"map": "RXA-6-Administered Amount / RXA-7.1-Administered Units.code / RXA-7.3-Administered Units.name of coding system"
},
{
"identity": "rim",
"map": ".doseQuantity"
},
{
"identity": "qdm",
"map": "dose"
}
]
},
{
"path": "MedicationStatement.dosage.rate",
"short": "Dose quantity per unit of time",
"definition": "Identifies the speed with which the substance is introduced into the subject. Typically the rate for an infusion. 200ml in 2 hours.",
"min": 0,
"max": "1",
"type": [
{
"code": "Ratio"
}
],
"mapping": [
{
"identity": "v2",
"map": "RXA-12-Administered Per (Time Unit)"
},
{
"identity": "rim",
"map": ".rateQuantity"
}
]
},
{
"path": "MedicationStatement.dosage.maxDosePerPeriod",
"short": "Maximum dose that was consumed per unit of time",
"definition": "The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. E.g. 1000mg in 24 hours.",
"min": 0,
"max": "1",
"type": [
{
"code": "Ratio"
}
],
"mapping": [
{
"identity": "v2",
"map": "RXE-4-Give Amount - Maximum / RXE-5-Give Units"
},
{
"identity": "rim",
"map": ".maxDoseQuantity"
}
]
}
]
},
"differential": {
"element": [
{
"path": "MedicationStatement",
"name": "QICore-MedicationStatement",
"min": 1,
"max": "1",
"type": [
{
"code": "MedicationStatement"
}
],
"mapping": [
{
"identity": "qdm",
"map": "Medication, Active"
}
]
},
{
"path": "MedicationStatement.patient",
"type": [
{
"code": "Reference",
"profile": "http://hl7.org/fhir/StructureDefinition/patient-qicore-qicore-patient"
}
],
"mustSupport": true
},
{
"path": "MedicationStatement.informationSource",
"type": [
{
"code": "Reference",
"profile": "http://hl7.org/fhir/StructureDefinition/patient-qicore-qicore-patient"
},
{
"code": "Reference",
"profile": "http://hl7.org/fhir/StructureDefinition/practitioner-qicore-qicore-practitioner"
},
{
"code": "Reference",
"profile": "http://hl7.org/fhir/StructureDefinition/relatedperson-qicore-qicore-relatedperson"
}
]
},
{
"path": "MedicationStatement.dateAsserted",
"mustSupport": true
},
{
"path": "MedicationStatement.status",
"mustSupport": true
},
{
"path": "MedicationStatement.wasNotGiven",
"mustSupport": true,
"mapping": [
{
"identity": "qdm",
"map": "negation rationale"
}
]
},
{
"path": "MedicationStatement.reasonForUse[x]",
"type": [
{
"code": "CodeableConcept"
},
{
"code": "Reference",
"profile": "http://hl7.org/fhir/StructureDefinition/condition-qicore-qicore-condition"
}
]
},
{
"path": "MedicationStatement.effective[x]",
"mustSupport": true,
"mapping": [
{
"identity": "qdm",
"map": "start and stop datetime"
}
]
},
{
"path": "MedicationStatement.medication",
"type": [
{
"code": "Reference",
"profile": "http://hl7.org/fhir/StructureDefinition/medication-qicore-qicore-medication"
}
],
"mustSupport": true,
"mapping": [
{
"identity": "qdm",
"map": "primary code"
}
]
},
{
"path": "MedicationStatement.dosage"
},
{
"path": "MedicationStatement.dosage.schedule",
"mustSupport": true,
"mapping": [
{
"identity": "qdm",
"map": "frequency"
}
]
},
{
"path": "MedicationStatement.dosage.route",
"mustSupport": true,
"mapping": [
{
"identity": "qdm",
"map": "route"
}
]
},
{
"path": "MedicationStatement.dosage.quantity",
"mustSupport": true,
"mapping": [
{
"identity": "qdm",
"map": "dose"
}
]
}
]
}
}
© HL7.org 2011+. FHIR DSTU (v0.5.0-5149) generated on Fri, Apr 3, 2015 14:33+1100.
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