US Core Implementation Guide
7.0.0 - STU7
US Core Implementation Guide
7.0.0 - STU7
This page is part of the US Core (v7.0.0: STU7) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions. Page versions: STU6.1 STU6 STU5
| Page standards status: Informative |
The guidance below addresses how a patient or a provider can access a patient’s active, historical, and future (planned) medications list. This use case adopts the use cases defined as part of the Argonaut Project and US Core, specifically within the scope of accessing medication information prescribed in the ONC U.S. Core Data for Interoperability (USCDI). This section provides specific guidance on accessing “all medications” and “all active medications” for a patient using a query on MedicationRequest. Note that a query on MedicationStatement was required in prior versions of this guide. Because of underlying changes in the FHIR Release 4 pharmacy resources, this guide doesn’t require the use of MedicationStatement since an “active” medication list can be obtained using only MedicationRequest.1
The FHIR specification defines five FHIR pharmacy resources concerned with the ordering, dispensing, administering, and recording of medications. This guide documents accessing a patient’s medications using the following three resources:
The following two medication resources are not profiled by US Core, and systems that support US Core are permitted to use them. They are introduced here to provide background and define the relationships between the pharmacy resources. However, as documented in the section below, the US Core Guidance for accessing a patient’s medications does not use them:
The FHIR specification details each resource. The FHIR Medications Module and the Guide to Resources Sections describe the interaction between these resources in general.
This IG focuses on access to a patient’s medications. Therefore, it is essential to understand the relationships between these resources. Figure 1 illustrates the workflow relationship between the medication order and the fulfillment represented by the FHIR medication resources. Note that in the outpatient setting, the patient does the administration.
Several sources may be used to create a MedicationRequest, as is shown in Figure 2 below. The information may be captured directly by a system’s medication order or reported by a provider. A patient or related person may also report the information (or provide some record), including “self-prescribed” orders. For example, the patient is often the only source of information when the patient reports Cannabis or OTC medication use.
This guide supports representing a medication using a code or a reference to a Medication resource. Typically, a code will be for a branded (for example, Crestor 10mg tablet) or a generic (for example, Rosuvastatin 10mg tablet) medication. When using a code, the code SHALL follow the extensible binding rules to Medication Clinical Drug (RxNorm) - i.e., unless RxNorm does not cover the concept, the RxNorm code SHALL be used. USCDI recommends the National Drug Codes (NDC) as an optional medication terminology. They can be supplied as an additional coding element. More information about using codes can be found in the General Guidance and the FHIR Terminology sections. A medication resource is typically used when information not included in the RxNorm code is required. For example, the Medication resource is the only way to represent compounded correctly or extemporaneously prepared medication. When referencing the Medication resource, the resource may be included in the returned bundle, as an external resource, or as a contained resource if it can’t stand alone. These options are shown in Figure 3 below. The server application MAY choose any combination of these methods, but if an external reference to Medication is used, the server SHALL support the _include parameter for searching this element. The client application MUST support all methods. The MedicationRequest examples show these different methods. Additional guidance is provided below and in the US Core Server Capability Statement section.
Definitions
Note that these definitions do not convey compliance - i.e., the list is a statement of what is prescribed (or self-prescribed) and not what is consumed by the patient.
Requirements to access “all medications” and “all active medications” for a patient:
A MedicationRequest resource query:
intent = “order” representing authorized medication orders directly derived from the system’s orders.intent = “plan” representing reported medications
reported[x] element to indicate that the MedicationRequest record was captured as a secondary “reported” record rather than an original primary source-of-truth record. It may also indicate the source of the report.requester element to indicate the Patient or RelatedPerson as the prescriber.encounter element SHOULD be supported. Searching by context (i.e., for a given inpatient encounter) will return all medications ordered during that encounter, including medications administered in hospital and prescribed or discharge medications intended to be taken at home.category and encounter elements MAY be used together to get the intersection of medications for a given encounter (i.e., the context) that were administered during as an inpatient (i.e., the category).Get all medications for a patient by querying MedicationRequest using the patient search parameter and intent search parameter = “order,plan”. See MedicationRequest Quick Start for further details.
GET /MedicationRequest?patient=[id]&intent=order,plan{&_include=MedicationRequest:medication}
Storyboard for this example
This example is based upon the following scenario:
Patient Brian Z uses an App to request all his medications from a single provider, Dr Cayr. This test scenario exercises a mix of routine meds, unusual schedule meds and as-needed meds. All meds are in the outpatient setting only.
Provider A’s (Dr Cayr) medication records for Patient Brian Z
| Item | Date | Script | Source | Notes |
|---|---|---|---|---|
| 1 | 9/12/2016 | testosterone cypionate 100mg/ml inj 1ml intramuscularly every 3 weeks | Reported by Patient | Get at doctor’s office every third Friday. Taking for energy level and drive. |
| 2 | 9/1/2016 | testosterone cypionate 100mg/ml inj 1ml intramuscularly | Reported by Dr Cryn | completed |
| 3 | 1/15/2016 | Zocor (simvastatin) 40mg by mouth once daily | Dr. Cayr Order: BMC | patient med status: taking |
| 4 | 7/1/2015 | Humulin R (insulin regular, human) U100 10U every AM, 5U every PM, 5U at bedtime. | Dr.Cayr Order:BMC | patient med status: taking |
| 5 | 6/12/2015 | simvastatin 30mg by mouth once daily | Dr. Cayr Order: BMC | patient med status: completed |
Request:
Get “all medications” for a patient by querying MedicationRequest using the patient search parameter.
GET [base]/MedicationRequest?patient=test2&intent=order,plan
Response:
A Server returns a search Bundle resource containing all the MedicationRequests for the patient Brian Z
HTTP/1.1 200 OK
[other headers]
{
"resourceType": "Bundle",
"id": "f48e4a18-173b-4c82-8eeb-3e39daa59f",
"meta": {
"lastUpdated": "2022-04-12T00:01:27.106Z"
},
"type": "searchset",
"total": 5,
"link": [
{
"relation": "self",
"url": "http://test.fhir.org/r4/MedicationRequest?_format=application/fhir+json&search-id=a27179f4-7471-44dd-b6f1-73ae7ef001&&patient=test2&intent=order,plan&_sort=_id"
}
],
"entry": [
{
"fullUrl": "http://test.fhir.org/r4/MedicationRequest/269",
"resource": {
"resourceType": "MedicationRequest",
"id": "269",
"meta": {
"versionId": "2",
"lastUpdated": "2022-04-11T23:29:16.906Z",
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest"
],
"tag": [
{
"code": "US_Core_5"
},
{
"code": "US_Core_5_Example"
}
]
},
"status": "active",
"intent": "order",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
"code": "outpatient",
"display": "Outpatient"
}
],
"text": "Outpatient"
}
],
"reportedBoolean": false,
"medicationCodeableConcept": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "104491",
"display": "Simvastatin 20 MG Oral Tablet [Zocor]"
}
],
"text": "Zocor (simvastatin) 20mg Tablet"
},
"subject": {
"reference": "Patient/test2",
"display": "Brian Z"
},
"encounter": {
"reference": "Encounter/outpatien-Example-1"
},
"authoredOn": "2016-01-15",
"requester": {
"reference": "Practitioner/practitioner-drcayr",
"display": "Dr Cayr"
},
"reasonCode": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "13644009",
"display": "Hypercholesterolemia (disorder)"
}
]
}
],
"dosageInstruction": [
{
"sequence": 1,
"text": "40mg by mouth once daily",
"asNeededBoolean": false,
"route": {
"coding": [
{
"system": "http://ncimeta.nci.nih.gov",
"code": "C38288",
"display": "ORAL"
}
]
}
}
],
"dispenseRequest": {
"numberOfRepeatsAllowed": 11,
"quantity": {
"value": 60,
"unit": "tablets",
"system": "http://hl7.org/fhir/v3/orderableDrugForm",
"code": "TAB"
}
}
},
"search": {
"mode": "match"
}
},
{
"fullUrl": "http://test.fhir.org/r4/MedicationRequest/270",
"resource": {
"resourceType": "MedicationRequest",
"id": "270",
"meta": {
"versionId": "1",
"lastUpdated": "2022-04-11T23:33:38.281Z",
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest"
],
"tag": [
{
"code": "US_Core_5"
}
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>meta</b>: </p><p><b>status</b>: active</p><p><b>intent</b>: order</p><p><b>category</b>: Outpatient <span style=\"background: LightGoldenRodYellow \">(Details : {http://terminology.hl7.org/CodeSystem/medicationrequest-category code \"outpatient\" := \"outpatient\", given as \"Outpatient\"})</span></p><p><b>reported</b>: false</p><p><b>medication</b>: Humulin R (insulin regular, human) U100 100units/ml inj solution <span style=\"background: LightGoldenRodYellow \">(Details : {RxNorm code \"311036\" := \"311036\", given as \"Humulin R (insulin regular, human) U100 100units/ml inj solution\"})</span></p><p><b>subject</b>: <a href=\"Patient/test2\">Brian Z</a></p><p><b>encounter</b>: <a href=\"Encounter/outpatient-example-2\">Encounter/outpatient-example-2</a></p><p><b>authoredOn</b>: 7/1/2015</p><p><b>requester</b>: </p><p><b>dosageInstruction</b>: </p></div>"
},
"status": "active",
"intent": "order",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
"code": "outpatient",
"display": "Outpatient"
}
],
"text": "Outpatient"
}
],
"reportedBoolean": false,
"medicationCodeableConcept": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "311036",
"display": "Humulin R (insulin regular, human) U100 100units/ml inj solution"
}
],
"text": "Humulin R (insulin regular, human) U100 100units/ml inj solution"
},
"subject": {
"reference": "Patient/test2",
"display": "Brian Z"
},
"encounter": {
"reference": "Encounter/outpatient-example-2"
},
"authoredOn": "2015-07-01",
"requester": {
"reference": "Practitioner/practitioner-drcayr",
"display": "Dr Cayr"
},
"dosageInstruction": [
{
"sequence": 1,
"text": "10U every AM, 5U every PM, 5U at bedtime",
"asNeededBoolean": false,
"route": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "34206005",
"display": "Subcutaneous route (qualifier value)"
}
]
}
}
],
"dispenseRequest": {
"numberOfRepeatsAllowed": 11,
"quantity": {
"value": 40,
"unit": "ml",
"system": "http://unitsofmeasure.org",
"code": "mL"
}
}
},
"search": {
"mode": "match"
}
},
{
"fullUrl": "http://test.fhir.org/r4/MedicationRequest/271",
"resource": {
"resourceType": "MedicationRequest",
"id": "271",
"meta": {
"versionId": "1",
"lastUpdated": "2022-04-11T23:46:16.248Z",
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest"
],
"tag": [
{
"code": "US_Core_5"
}
]
},
"status": "active",
"intent": "plan",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
"code": "outpatient",
"display": "Outpatient"
}
],
"text": "Outpatient"
}
],
"reportedBoolean": false,
"medicationCodeableConcept": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "835829",
"display": "testosterone cypionate 100 MG/ML Injectable Solution"
}
],
"text": "testosterone cypionate 100mg/ml inj"
},
"subject": {
"reference": "Patient/test2",
"display": "Brian Z"
},
"encounter": {
"reference": "Encounter/outpatient-example-3"
},
"authoredOn": "2016-09-12",
"requester": {
"reference": "Practitioner/practitioner-drcryn",
"display": "Dr Cryn"
},
"reasonCode": [
{
"text": "Taking for energy level and drive."
}
],
"dosageInstruction": [
{
"sequence": 1,
"text": "1ml intramuscularly every 3 weeks"
}
]
},
"search": {
"mode": "match"
}
},
{
"fullUrl": "http://test.fhir.org/r4/MedicationRequest/272",
"resource": {
"resourceType": "MedicationRequest",
"id": "272",
"meta": {
"versionId": "1",
"lastUpdated": "2022-04-11T23:49:12.951Z",
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest"
],
"tag": [
{
"code": "US_Core_5"
}
]
},
"status": "completed",
"intent": "order",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
"code": "outpatient",
"display": "Outpatient"
}
],
"text": "Outpatient"
}
],
"reportedBoolean": false,
"medicationCodeableConcept": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "314231",
"display": "Simvastatin 10 MG Oral Tablet"
}
],
"text": "simvastatin 10mg Tablet"
},
"subject": {
"reference": "Patient/test2",
"display": "Brian Z"
},
"authoredOn": "2015-06-12",
"requester": {
"reference": "Practitioner/practitioner-drcayr",
"display": "Dr Cayr"
},
"reasonCode": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "13644009",
"display": "Hypercholesterolemia (disorder)"
}
]
}
],
"dosageInstruction": [
{
"sequence": 1,
"text": "30mg (3 tablets) by mouth once daily",
"asNeededBoolean": false,
"route": {
"coding": [
{
"system": "http://ncimeta.nci.nih.gov",
"code": "C38288",
"display": "ORAL"
}
]
}
}
],
"dispenseRequest": {
"numberOfRepeatsAllowed": 6,
"quantity": {
"value": 90,
"unit": "tablets",
"system": "http://hl7.org/fhir/v3/orderableDrugForm",
"code": "TAB"
}
}
},
"search": {
"mode": "match"
}
},
{
"fullUrl": "http://test.fhir.org/r4/MedicationRequest/273",
"resource": {
"resourceType": "MedicationRequest",
"id": "273",
"meta": {
"versionId": "1",
"lastUpdated": "2022-04-11T23:57:17.715Z",
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest"
],
"tag": [
{
"code": "US_Core_5"
}
]
},
"status": "completed",
"intent": "plan",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
"code": "outpatient",
"display": "Outpatient"
}
],
"text": "Outpatient"
}
],
"reportedBoolean": false,
"medicationCodeableConcept": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "835829",
"display": "testosterone cypionate 100 MG/ML Injectable Solution"
}
],
"text": "testosterone cypionate 100mg/ml inj"
},
"subject": {
"reference": "Patient/test2",
"display": "Brian Z"
},
"authoredOn": "2016-09-01",
"requester": {
"reference": "Practitioner/practitioner-drcryn",
"display": "Dr Cryn"
},
"reasonCode": [
{
"text": "Taking for energy level and drive."
}
],
"dosageInstruction": [
{
"sequence": 1,
"text": "1ml intramuscularly"
}
]
},
"search": {
"mode": "match"
}
}
]
}
Get all active medications for a patient by querying MedicationRequest using the patient, and intent = “order,plan” status = “active” search parameters. See MedicationRequest Quick Start for further details. Note that the client should also consider MedicationRequests with a status of “unknown” and whether to query those as well.
GET /MedicationRequest?patient=[id]&intent=order,plan&status=active{&_include=MedicationRequest:medication}
Storyboard for this example
This example is based upon the following scenario:
Patient Brian Z uses an App to request all his medications from a single provider, Dr Cayr. This test scenario exercises a mix of routine meds, unusual schedule meds and as-needed meds. All meds are in the outpatient setting only.
Provider A’s (Dr Cayr) medication records for Patient Brian Z. Note that three of these are active, the other two are completed.
| Item | Date | Script | Source | Notes |
|---|---|---|---|---|
| 1 | 9/12/2016 | testosterone cypionate 100mg/ml inj 1ml intramuscularly every 3 weeks | Reported by Patient | Get at doctor’s office every third Friday. Taking for energy level and drive. |
| 2 | 9/1/2016 | testosterone cypionate 100mg/ml inj 1ml intramuscularly | Reported by Dr Cryn | completed |
| 3 | 1/15/2016 | Zocor (simvastatin) 40mg by mouth once daily | Dr. Cayr Order: BMC | patient med status: taking |
| 4 | 7/1/2015 | Humulin R (insulin regular, human) U100 10U every AM, 5U every PM, 5U at bedtime. | Dr.Cayr Order:BMC | patient med status: taking |
| 5 | 6/12/2015 | simvastatin 30mg by mouth once daily | Dr. Cayr Order: BMC | patient med status: completed |
Request:
Get “all active medications” for a patient by querying MedicationRequest using the patient and status= “active” search parameters.
GET [base]/MedicationRequest?patient=test2&intent=order,plan&status=active
Response:
A Server returns a search Bundle resource containing all the MedicationRequests with a status of “active” for the patient Brian Z
HTTP/1.1 200 OK
[other headers]
{
"resourceType": "Bundle",
"id": "1f8a772f-1a54-4ef7-8bf6-7e27325ca4",
"meta": {
"lastUpdated": "2022-04-12T01:01:49.419Z"
},
"type": "searchset",
"total": 3,
"link": [
{
"relation": "self",
"url": "http://test.fhir.org/r4/MedicationRequest?_format=application/fhir+json&search-id=667926e8-efa6-427e-b801-73c66b1789&&patient=test2&intent=order,plan&status=active&_sort=_id"
}
],
"entry": [
{
"fullUrl": "http://test.fhir.org/r4/MedicationRequest/269",
"resource": {
"resourceType": "MedicationRequest",
"id": "269",
"meta": {
"versionId": "3",
"lastUpdated": "2022-04-12T01:01:29.279Z",
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest"
],
"tag": [
{
"code": "US_Core_5"
},
{
"code": "US_Core_5_Example"
}
]
},
"status": "active",
"intent": "order",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
"code": "outpatient",
"display": "Outpatient"
}
],
"text": "Outpatient"
}
],
"reportedBoolean": false,
"medicationCodeableConcept": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "104491",
"display": "Simvastatin 20 MG Oral Tablet [Zocor]"
}
],
"text": "Zocor (simvastatin) 20mg Tablet"
},
"subject": {
"reference": "Patient/test2",
"display": "Brian Z"
},
"encounter": {
"reference": "Encounter/outpatien-Example-1"
},
"authoredOn": "2016-01-15",
"requester": {
"reference": "Practitioner/practitioner-drcayr",
"display": "Dr Cayr"
},
"reasonCode": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "13644009",
"display": "Hypercholesterolemia (disorder)"
}
]
}
],
"dosageInstruction": [
{
"sequence": 1,
"text": "40mg by mouth once daily",
"asNeededBoolean": false,
"route": {
"coding": [
{
"system": "http://ncimeta.nci.nih.gov",
"code": "C38288",
"display": "ORAL"
}
]
}
}
],
"dispenseRequest": {
"numberOfRepeatsAllowed": 11,
"quantity": {
"value": 60,
"unit": "tablets",
"system": "http://hl7.org/fhir/v3/orderableDrugForm",
"code": "TAB"
}
}
},
"search": {
"mode": "match"
}
},
{
"fullUrl": "http://test.fhir.org/r4/MedicationRequest/270",
"resource": {
"resourceType": "MedicationRequest",
"id": "270",
"meta": {
"versionId": "2",
"lastUpdated": "2022-04-12T01:01:29.498Z",
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest"
],
"tag": [
{
"code": "US_Core_5"
}
]
},
"status": "active",
"intent": "order",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
"code": "outpatient",
"display": "Outpatient"
}
],
"text": "Outpatient"
}
],
"reportedBoolean": false,
"medicationCodeableConcept": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "311036",
"display": "Humulin R (insulin regular, human) U100 100units/ml inj solution"
}
],
"text": "Humulin R (insulin regular, human) U100 100units/ml inj solution"
},
"subject": {
"reference": "Patient/test2",
"display": "Brian Z"
},
"encounter": {
"reference": "Encounter/outpatient-example-2"
},
"authoredOn": "2015-07-01",
"requester": {
"reference": "Practitioner/practitioner-drcayr",
"display": "Dr Cayr"
},
"dosageInstruction": [
{
"sequence": 1,
"text": "10U every AM, 5U every PM, 5U at bedtime",
"asNeededBoolean": false,
"route": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "34206005",
"display": "Subcutaneous route (qualifier value)"
}
]
}
}
],
"dispenseRequest": {
"numberOfRepeatsAllowed": 11,
"quantity": {
"value": 40,
"unit": "ml",
"system": "http://unitsofmeasure.org",
"code": "mL"
}
}
},
"search": {
"mode": "match"
}
},
{
"fullUrl": "http://test.fhir.org/r4/MedicationRequest/271",
"resource": {
"resourceType": "MedicationRequest",
"id": "271",
"meta": {
"versionId": "2",
"lastUpdated": "2022-04-12T01:01:29.795Z",
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest"
],
"tag": [
{
"code": "US_Core_5"
}
]
},
"status": "active",
"intent": "plan",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
"code": "outpatient",
"display": "Outpatient"
}
],
"text": "Outpatient"
}
],
"reportedBoolean": false,
"medicationCodeableConcept": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "835829",
"display": "testosterone cypionate 100 MG/ML Injectable Solution"
}
],
"text": "testosterone cypionate 100mg/ml inj"
},
"subject": {
"reference": "Patient/test2",
"display": "Brian Z"
},
"encounter": {
"reference": "Encounter/outpatient-example-3"
},
"authoredOn": "2016-09-12",
"requester": {
"reference": "Practitioner/practitioner-drcryn",
"display": "Dr Cryn"
},
"reasonCode": [
{
"text": "Taking for energy level and drive."
}
],
"dosageInstruction": [
{
"sequence": 1,
"text": "1ml intramuscularly every 3 weeks"
}
]
},
"search": {
"mode": "match"
}
}
]
}
Get “all medications” for an encounter by querying MedicationRequest using the patient, encounter, intent = “order,plan” search parameters. See MedicationRequest Quick Start for further details.
GET /MedicationRequest?patient=[id]&intent=order,plan&encounter=[id]{&_include=MedicationRequest:medication}
Storyboard for this example
This example is based upon the following scenario.
Patient Brain Z has presented with the same condition (pneumonia) as in a previous inpatient encounter. Provider A (Dr Cayr) uses a desktop or mobile application to request all the medications from this previous inpatient encounter (Encounter A).
Medication records for Patient Brian Z during Encounter A
| Item | Date | Script | Source | Notes |
|---|---|---|---|---|
| 1 | 9/10/2016 - 9/12-2016 | Cefatoxime 1gm intravenously every 6 hours | Provider B’s Order | Administered in hospital |
| 2 | 9/10/2016 - 9/12-2016 | Zithromax (azithromycin) 500 MG in 250 ml Normal Saline intravenous infusion over 1hr daily | Provider B’s Order | Administered in hospital |
| 3 | 9/10/2016 - 9/12-2016 | Ketorolac 15 mg intravenously every 6 hours | Provider B’s Order | Administered in hospital |
| 2 | 9/10/2016 - 9/12-2016 | LRS Solution 200 ml/hr intravenously CRI | Provider B’s Order | Administered in hospital |
| 5 | 9/12/2016 | Amoxicillin 500mg by mouth every 6 hours for 10 days | Provider B’s Order | discharge prescription, patient reported did not comply (fill prescription) |
| 6 | 9/12/2016 | Zithromax (azithromycin) 250mg by mouth every 12 hours for 10 days | Provider B’s Order | discharge prescription, patient reported did not comply (fill prescription) |
Request:
Get “all medications” for a patient inpatient encounter by querying MedicationRequest using the patient and encounter search parameters.
GET [base]/MedicationRequest?patient=test2&intent=order,plan&encounter=A
Response:
A Server returns a search Bundle resource containing all the MedicationRequests for the patient Brian Z during inpatient Encounter A:
HTTP/1.1 200 OK
[other headers]
{
"resourceType": "Bundle",
"id": "bb33a47a-cab8-4b4b-ba2e-3b663ffb98",
"meta": {
"lastUpdated": "2022-04-12T01:55:49.093Z"
},
"type": "searchset",
"total": 6,
"link": [
{
"relation": "self",
"url": "http://test.fhir.org/r4/MedicationRequest?_format=application/fhir+json&search-id=3f726452-7d24-4740-86f8-9c4a8f993a&&patient=test2&intent=order,plan&encounter=inpatient-example&_sort=_id"
}
],
"entry": [
{
"fullUrl": "http://test.fhir.org/r4/MedicationRequest/0e2dda71-7122-4840-9252-17c84a0d50",
"resource": {
"resourceType": "MedicationRequest",
"id": "0e2dda71-7122-4840-9252-17c84a0d50",
"meta": {
"versionId": "4",
"lastUpdated": "2022-04-12T01:54:45.483Z",
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest"
],
"tag": [
{
"code": "US_Core_5"
},
{
"code": "Inpatient"
}
]
},
"contained": [
{
"resourceType": "Medication",
"id": "med-1",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication"
]
},
"code": {
"text": "Azithromycin 500mg in 250 ml Normal Saline"
},
"ingredient": [
{
"itemCodeableConcept": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "1668240",
"display": "Zithromax 500 MG Injection"
}
],
"text": "Zithromax (azithromycin) 500 MG Injection"
},
"isActive": true
},
{
"itemCodeableConcept": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "313002",
"display": "Sodium Chloride 0.9% injectable solution"
}
],
"text": "Normal Saline"
},
"isActive": true
}
]
}
],
"status": "active",
"intent": "order",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
"code": "inpatient",
"display": "Inpatient"
}
],
"text": "Inpatient"
}
],
"reportedBoolean": false,
"medicationReference": {
"reference": "#med-1"
},
"subject": {
"reference": "Patient/test2",
"display": "Brian Z"
},
"encounter": {
"reference": "Encounter/inpatient-example",
"display": "Inpatient encounter"
},
"authoredOn": "2016-09-12",
"requester": {
"reference": "Practitioner/example-drb",
"display": "Dr B"
},
"reasonCode": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "233604007",
"display": "Pneumonia (disorder)"
}
]
}
],
"dosageInstruction": [
{
"sequence": 1,
"text": "Azithromycin 500mg in 250 ml Normal Saline intravenously over 1hour every 24 hours",
"timing": {
"repeat": {
"duration": 1,
"durationUnit": "h",
"frequency": 1,
"period": 24,
"periodUnit": "h"
}
},
"asNeededBoolean": false,
"route": {
"coding": [
{
"system": "http://ncimeta.nci.nih.gov",
"code": "C38276",
"display": "INTRAVENOUS"
}
]
},
"method": {
"text": "1 hr infusion"
}
}
]
},
"search": {
"mode": "match"
}
},
{
"fullUrl": "http://test.fhir.org/r4/MedicationRequest/1e51d801-1cdf-4d61-9dc0-8937945a35",
"resource": {
"resourceType": "MedicationRequest",
"id": "1e51d801-1cdf-4d61-9dc0-8937945a35",
"meta": {
"versionId": "4",
"lastUpdated": "2022-04-12T01:54:45.608Z",
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest"
],
"tag": [
{
"code": "US_Core_5"
},
{
"code": "Inpatient"
}
]
},
"status": "active",
"intent": "order",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
"code": "inpatient",
"display": "Inpatient"
}
],
"text": "Inpatient"
}
],
"reportedBoolean": false,
"medicationCodeableConcept": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "212446",
"display": "Zithromax 250 MG Oral Tablet"
}
],
"text": "Zithromax 500 MG Oral Tablet"
},
"subject": {
"reference": "Patient/test2",
"display": "Brian Z"
},
"encounter": {
"reference": "Encounter/inpatient-example",
"display": "Inpatient encounter"
},
"authoredOn": "2016-09-12",
"requester": {
"reference": "Practitioner/example-drb",
"display": "Dr B"
},
"reasonCode": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "233604007",
"display": "Pneumonia (disorder)"
}
]
}
],
"dosageInstruction": [
{
"sequence": 1,
"text": "Zithromax (azithromycin) 250mg by mouth every 12 hours for 10 days",
"additionalInstruction": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "311504000",
"display": "With or after food"
}
]
}
],
"timing": {
"repeat": {
"frequency": 1,
"period": 12,
"periodUnit": "h"
}
},
"route": {
"coding": [
{
"system": "http://ncimeta.nci.nih.gov",
"code": "C38288",
"display": "ORALLY",
"userSelected": false
}
]
}
}
],
"dispenseRequest": {
"validityPeriod": {
"start": "2016-09-12",
"end": "2016-10-12"
},
"quantity": {
"value": 20,
"unit": "TAB",
"system": "http://hl7.org/fhir/v3/orderableDrugForm",
"code": "TAB"
},
"expectedSupplyDuration": {
"value": 10,
"unit": "days",
"system": "http://unitsofmeasure.org",
"code": "d"
}
}
},
"search": {
"mode": "match"
}
},
{
"fullUrl": "http://test.fhir.org/r4/MedicationRequest/4362b3f0-37bc-4463-93b3-c6b8228d91",
"resource": {
"resourceType": "MedicationRequest",
"id": "4362b3f0-37bc-4463-93b3-c6b8228d91",
"meta": {
"versionId": "4",
"lastUpdated": "2022-04-12T01:54:45.671Z",
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest"
],
"tag": [
{
"code": "US_Core_5"
},
{
"code": "Inpatient"
}
]
},
"status": "active",
"intent": "order",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
"code": "inpatient",
"display": "Inpatient"
}
],
"text": "Inpatient"
}
],
"reportedBoolean": false,
"medicationCodeableConcept": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "308191",
"display": "Amoxicillin 500 MG Oral Capsule"
}
],
"text": "Amoxicillin 500 MG"
},
"subject": {
"reference": "Patient/test2",
"display": "Brian Z"
},
"encounter": {
"reference": "Encounter/inpatient-example",
"display": "Inpatient encounter"
},
"authoredOn": "2016-09-12",
"requester": {
"reference": "Practitioner/example-drb",
"display": "Dr B"
},
"reasonCode": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "233604007",
"display": "Pneumonia (disorder)"
}
]
}
],
"dosageInstruction": [
{
"sequence": 1,
"text": "Amoxicillin 500mg by mouth every 6 hours for 10 days",
"additionalInstruction": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "311504000",
"display": "With or after food"
}
]
}
],
"timing": {
"repeat": {
"frequency": 1,
"period": 6,
"periodUnit": "h"
}
},
"route": {
"coding": [
{
"system": "http://ncimeta.nci.nih.gov",
"code": "C38288",
"display": "ORALLY",
"userSelected": false
}
]
}
}
],
"dispenseRequest": {
"validityPeriod": {
"start": "2016-09-12",
"end": "2016-10-12"
},
"numberOfRepeatsAllowed": 0,
"quantity": {
"value": 40,
"unit": "Oral Capsule",
"system": "http://hl7.org/fhir/v3/orderableDrugForm",
"code": "ORCAP"
},
"expectedSupplyDuration": {
"value": 10,
"unit": "days",
"system": "http://unitsofmeasure.org",
"code": "d"
}
}
},
"search": {
"mode": "match"
}
},
{
"fullUrl": "http://test.fhir.org/r4/MedicationRequest/5996de24-bb15-44d5-ad5e-e942090123",
"resource": {
"resourceType": "MedicationRequest",
"id": "5996de24-bb15-44d5-ad5e-e942090123",
"meta": {
"versionId": "4",
"lastUpdated": "2022-04-12T01:54:45.765Z",
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest"
],
"tag": [
{
"code": "US_Core_5"
},
{
"code": "Inpatient"
}
]
},
"status": "active",
"intent": "order",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
"code": "inpatient",
"display": "Inpatient"
}
],
"text": "Inpatient"
}
],
"reportedBoolean": false,
"medicationCodeableConcept": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "860601",
"display": "Calcium Chloride 0.0014 MEQ/ML / Potassium Chloride 0.024 MEQ/ML / Sodium Chloride 0.103 MEQ/ML / Sodium Lactate 0.028 MEQ/ML Injectable Solution"
}
],
"text": "LRS"
},
"subject": {
"reference": "Patient/test2",
"display": "Brian Z"
},
"encounter": {
"reference": "Encounter/inpatient-example",
"display": "Inpatient encounter"
},
"authoredOn": "2016-09-12",
"requester": {
"reference": "Practitioner/example-drb",
"display": "Dr B"
},
"reasonCode": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "233604007",
"display": "Pneumonia (disorder)"
}
]
}
],
"dosageInstruction": [
{
"sequence": 1,
"text": "LRS IV at 250 ml/hr",
"asNeededBoolean": false,
"route": {
"coding": [
{
"system": "http://ncimeta.nci.nih.gov",
"code": "C38276",
"display": "INTRAVENOUS",
"userSelected": false
}
]
},
"method": {
"text": "Constant Rate Infusion"
}
}
]
},
"search": {
"mode": "match"
}
},
{
"fullUrl": "http://test.fhir.org/r4/MedicationRequest/bb95536c-eca6-4f31-af6e-821c3bc9d3",
"resource": {
"resourceType": "MedicationRequest",
"id": "bb95536c-eca6-4f31-af6e-821c3bc9d3",
"meta": {
"versionId": "4",
"lastUpdated": "2022-04-12T01:54:45.811Z",
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest"
],
"tag": [
{
"code": "US_Core_5"
},
{
"code": "Inpatient"
}
]
},
"status": "active",
"intent": "order",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
"code": "inpatient",
"display": "Inpatient"
}
],
"text": "Inpatient"
}
],
"reportedBoolean": false,
"medicationCodeableConcept": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "1656313",
"display": "Cefotaxime 1000 MG Injection"
}
],
"text": "Cefotaxime 1000Mg Powder For Solution For Injection"
},
"subject": {
"reference": "Patient/test2",
"display": "Brian Z"
},
"encounter": {
"reference": "Encounter/inpatient-example",
"display": "Inpatient encounter"
},
"authoredOn": "2016-09-12",
"requester": {
"reference": "Practitioner/example-drcayr",
"display": "Dr Cayr"
},
"reasonCode": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "233604007",
"display": "Pneumonia (disorder)"
}
]
}
],
"dosageInstruction": [
{
"sequence": 1,
"text": "Cefatoxime 1gm intravenously every 6 hours",
"timing": {
"repeat": {
"frequency": 1,
"period": 6,
"periodUnit": "h"
}
},
"asNeededBoolean": false,
"route": {
"coding": [
{
"system": "http://ncimeta.nci.nih.gov",
"code": "C38276",
"display": "INTRAVENOUS",
"userSelected": false
}
]
},
"method": {
"text": "Slow Push"
}
}
]
},
"search": {
"mode": "match"
}
},
{
"fullUrl": "http://test.fhir.org/r4/MedicationRequest/e5fb50da-bff9-414a-a229-68b431c489",
"resource": {
"resourceType": "MedicationRequest",
"id": "e5fb50da-bff9-414a-a229-68b431c489",
"meta": {
"versionId": "4",
"lastUpdated": "2022-04-12T01:54:45.858Z",
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest"
],
"tag": [
{
"code": "US_Core_5"
},
{
"code": "Inpatient"
}
]
},
"status": "active",
"intent": "order",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
"code": "inpatient",
"display": "Inpatient"
}
],
"text": "Inpatient"
}
],
"reportedBoolean": false,
"medicationCodeableConcept": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "860092",
"display": "1 ML Ketorolac Tromethamine 15 MG/ML Injection"
}
],
"text": "Ketorolac Tromethamine 15 MG/ML For Injection"
},
"subject": {
"reference": "Patient/test2",
"display": "Brian Z"
},
"encounter": {
"reference": "Encounter/inpatient-example",
"display": "Inpatient encounter"
},
"authoredOn": "2016-09-12",
"requester": {
"reference": "Practitioner/example-drb",
"display": "Dr B"
},
"reasonCode": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "233604007",
"display": "Pneumonia (disorder)"
}
]
}
],
"dosageInstruction": [
{
"sequence": 1,
"text": "Ketoralac 15mg every six hours",
"timing": {
"repeat": {
"frequency": 1,
"period": 6,
"periodUnit": "h"
}
},
"asNeededBoolean": false,
"route": {
"coding": [
{
"system": "http://ncimeta.nci.nih.gov",
"code": "C38276",
"display": "INTRAVENOUS",
"userSelected": false
}
]
},
"method": {
"text": "Slow Push"
}
}
]
},
"search": {
"mode": "match"
}
}
]
}
See the US Core Server Capability Statement for a complete list of supported RESTful operations and search parameters for this IG.
Medications may be duplicated in a medication list when multiple sources of data are used to generate the list. To provide a list of a patient’s medications, it may be necessary to “de-duplicate” them. The de-duplication activity MAY be supplied by the server, but SHOULD be provided by the client.
This specification does not specify de-duplication best practices; however, systems can consider the following approaches:
MedicationRequest.identifier. The identifier element is an external business identifier systems include to help indicate that the resources are related.Footnotes
Future versions of FHIR are anticipated to include further changes to the medication resources, which may lead to changes in our guidance for fetching patient medications in future versions of this guide. ↩
IG © 2024+ HL7 International / Cross-Group Projects. Package hl7.fhir.us.core#7.0.0 based on FHIR 4.0.1. Generated 2024-05-08
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