Generated Narrative: StructureDefinition medicationRequest-obl-eu-hdr Name Flags Card. Type Description & Constraints MedicationRequest 0..* MedicationRequestEuHdr Ordering of medication for patient or group #xD; status O 1..1 code Current state of the order Obligations Actor SHALL:handle HDRConsumer SHOULD:able-to-populate HDRCreator #xD; medication[x] O 1..1 CodeableConcept, Reference(Medication (HDR)) Medication to be taken Obligations Actor SHALL:handle HDRConsumer SHOULD:able-to-populate HDRCreator #xD; subject O 1..1 Reference(Patient (EU core)) Who or group medication request is for Obligations Actor SHALL:handle HDRConsumer SHALL:able-to-populate HDRCreator #xD; authoredOn O 1..1 dateTime When request was initially authored Obligations Actor SHALL:handle HDRConsumer SHALL:able-to-populate HDRCreator #xD; requester O 1..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device) Who/What requested the Request Obligations Actor SHALL:handle HDRConsumer SHALL:able-to-populate HDRCreator #xD; reasonCode O 0..* CodeableConcept Reason or indication for this prescription Obligations Actor SHALL:handle HDRConsumer MAY:able-to-populate HDRCreator #xD; reasonReference O 0..* Reference(Condition | Observation) Condition or observation that supports this prescription Obligations Actor SHALL:handle HDRConsumer MAY:able-to-populate HDRCreator #xD; groupIdentifier O 0..1 Identifier Prescription this is part of. Not needed if a presciption includes only one prescribed item. Obligations Actor SHALL:handle HDRConsumer MAY:able-to-populate HDRCreator #xD; dosageInstruction O 0..* Dosage How the medication should be taken. Obligations Actor SHALL:handle HDRConsumer MAY:able-to-populate HDRCreator #xD; text O 0..1 string Free text dosage instructions Obligations Actor SHALL:handle HDRConsumer SHOULD:able-to-populate HDRCreator #xD; timing O 0..1 Timing Administration schedule Obligations Actor SHALL:handle HDRConsumer SHOULD:able-to-populate HDRCreator #xD; doseAndRate #xD; Slices for dose[x] Content/Rules for all slices #xD; dose[x]:doseQuantity O 0..1 SimpleQuantity Amount of medication per dose Obligations Actor SHALL:handle HDRConsumer SHOULD:able-to-populate HDRCreator #xD; dispenseRequest O 0..1 BackboneElement Medication supply authorization Obligations Actor SHALL:handle HDRConsumer SHALL:able-to-populate HDRCreator #xD; quantity O 0..1 SimpleQuantity(4.0.1) Amount of medication to supply per dispense Obligations Actor SHALL:handle HDRConsumer SHALL:able-to-populate HDRCreator #xD; substitution #xD; Slices for allowed[x] 1..1 boolean, CodeableConcept Whether substitution is allowed or not Slice: Unordered, Open by type:$this #xD; allowed[x]:allowedCodeableConcept O 0..1 CodeableConcept Whether substitution is allowed or not Obligations Actor SHALL:handle HDRConsumer SHALL:able-to-populate HDRCreator #xD; Documentation for this format
This profile defines obligations for the MedicationRequest resource for the purpose of this guide, adapted from the MPD work.
Copyright HL7 Europe. Licensed under Creative Commons public domain (CC0 1.0).
Ordering of medication for patient or group
An order or request for both supply of the medication and the instructions for administration of the medication to a patient. The resource is called "MedicationRequest" rather than "MedicationPrescription" or "MedicationOrder" to generalize the use across inpatient and outpatient settings, including care plans, etc., and to harmonize with workflow patterns.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
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.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
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.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
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).
Text summary of the resource, for human interpretation
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.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
Period over which the medication should be taken.
Period over which the medication should be taken. Where there are multiple dosageInstruction lines (for example, tapering doses), this is the earliest date and the latest end date of the dosageInstructions.
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Identifiers associated with this medication request that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.
It is the prescription ID if the presciption includes only one prescribed item
ORC-2-Placer Order Number / ORC-3-Filler Order Number
A code specifying the current state of the order. Generally, this will be active or completed state.
This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.
Captures the reason for the current state of the MedicationRequest.
This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the MedicationRequest was created at all is captured in reasonCode, not here.
Identifies the reasons for a given status.
.inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde
proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
Whether the request is a proposal, plan, or an original order.
It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only. An instance-order is an instantiation of a request or order and may be used to populate Medication Administration Record. This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.
This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request
.moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)
Indicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).
The category can be used to include where the medication is expected to be consumed or other types of requests.
A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.
Message/Body/NewRx/MedicationPrescribed/Directions or Message/Body/NewRx/MedicationPrescribed/StructuredSIG
.inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication usage"].value
Indicates how quickly the Medication Request should be addressed with respect to other requests.
Identifies the level of importance to be assigned to actioning the request.
If true indicates that the provider is asking for the medication request not to occur.
If do not perform is not specified, the request is a positive request e.g. "do perform".
This element is labeled as a modifier because this element negates the request to occur (ie, this is a request for the medication not to be ordered or prescribed, etc)
Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the report.
Identifies the medication being requested. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medications.
If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the Medication resource is recommended. For example, if you require form or lot number or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource.
A coded concept identifying substance or product that can be ordered.
Message/Body/NewRx/MedicationPrescribed Medication.code.coding.code = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCode Medication.code.coding.system = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCodeQualifier Medication.code.coding.display = Message/Body/NewRx/MedicationPrescribed/DrugDescription
RXE-2-Give Code / RXO-1-Requested Give Code / RXC-2-Component Code
A link to a resource representing the person or set of individuals to whom the medication will be given.
The subject on a medication request is mandatory. For the secondary use case where the actual subject is not provided, there still must be an anonymized subject specified.
Message/Body/NewRx/Patient (need detail to link to specific patient … Patient.Identification in SCRIPT)
Encounter created as part of encounter/admission/stay
The Encounter during which this [x] was created or to which the creation of this record is tightly associated.
This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter." If there is a need to link to episodes of care they will be handled with an extension.
.inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]
Information to support ordering of the medication
Include additional information (for example, patient height and weight) that supports the ordering of the medication.
.outboundRelationship[typeCode=PERT].target[A_SupportingClinicalStatement CMET minimal with many different choices of classCodes(ORG, ENC, PROC, SPLY, SBADM, OBS) and each of the act class codes draws from one or more of the following moodCodes (EVN, DEF, INT PRMS, RQO, PRP, APT, ARQ, GOL)]
The date (and perhaps time) when the prescription was initially written or authored on.
RXE-32-Original Order Date/Time / ORC-9-Date/Time of Transaction
The individual, organization, or device that initiated the request and has responsibility for its activation.
The specified desired performer of the medication treatment (e.g. the performer of the medication administration).
Desired kind of performer of the medication administration
Indicates the type of performer of the administration of the medication.
If specified without indicating a performer, this indicates that the performer must be of the specified type. If specified with a performer then it indicates the requirements of the performer if the designated performer is not available.
Identifies the type of individual that is desired to administer the medication.
The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order.
.participation[typeCode=TRANS].role[classCode=ASSIGNED].code (HealthcareProviderType)
Reason or indication for this prescription
The reason or the indication for ordering or not ordering the medication.
This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference.
A coded concept indicating why the medication was ordered.
ORC-16-Order Control Code Reason /RXE-27-Give Indication/RXO-20-Indication / RXD-21-Indication / RXG-22-Indication / RXA-19-Indication
Condition or observation that supports this prescription
Condition or observation that supports why the medication was ordered.
This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode.
Instantiates FHIR protocol or definition
The URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest.
Instantiates external protocol or definition
The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this MedicationRequest.
A plan or request that is fulfilled in whole or in part by this medication request.
.outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]
Prescription this is part of. Not needed if a presciption includes only one prescribed item.
A shared identifier common to all requests that were authorized more or less simultaneously by a single author, representing the identifier of the requisition or prescription.
Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.
.outboundRelationship(typeCode=COMP].target[classCode=SBADM, moodCode=INT].id
Overall pattern of medication administration
The description of the overall patte3rn of the administration of the medication to the patient.
This attribute should not be confused with the protocol of the medication.
Identifies the overall pattern of medication administratio.
Act.code where classCode = LIST and moodCode = EVN
Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service.
Extra information about the prescription that could not be conveyed by the other attributes.
Indicates how the medication is to be used by the patient.
There are examples where a medication request may include the option of an oral dose or an Intravenous or Intramuscular dose. For example, "Ondansetron 8mg orally or IV twice a day as needed for nausea" or "Compazine® (prochlorperazine) 5-10mg PO or 25mg PR bid prn nausea or vomiting". In these cases, two medication requests would be created that could be grouped together. The decision on which dose and route of administration to use is based on the patient's condition at the time the dose is needed.
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Additional content defined by implementations
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.
Extensions that cannot be ignored even if unrecognized
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).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Indicates the order in which the dosage instructions should be applied or interpreted.
If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.
Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. Additional information about administration or preparation of the medication should be included as text.
Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").
Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.
Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.
A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
Patient or consumer oriented instructions
Instructions in terms that are understood by the patient or consumer.
This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.
The timing schedule for giving the medication to the patient. This data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.
Identifies specific times when the event occurs.
In a Medication Administration Record, for instance, you need to take a general specification, and turn it into a precise specification.
A set of rules that describe when the event is scheduled.
Many timing schedules are determined by regular repetitions.
if there's a duration, there needs to be duration units
duration.empty() or durationUnit.exists()
not(exists(f:duration)) or exists(f:durationUnit)
if there's a period, there needs to be period units
not(exists(f:period)) or exists(f:periodUnit)
f:duration/@value >= 0 or not(f:duration/@value)
f:period/@value >= 0 or not(f:period/@value)
If there's a periodMax, there must be a period
not(exists(f:periodMax)) or exists(f:period)
If there's a durationMax, there must be a duration
durationMax.empty() or duration.exists()
not(exists(f:durationMax)) or exists(f:duration)
If there's a countMax, there must be a count
not(exists(f:countMax)) or exists(f:count)
If there's an offset, there must be a when (and not C, CM, CD, CV)
offset.empty() or (when.exists() and ((when in ('C' | 'CM' | 'CD' | 'CV')).not()))
If there's a timeOfDay, there cannot be a when, or vice versa
not(exists(f:timeOfDay)) or not(exists(f:when))
Length/Range of lengths, or (Start and/or end) limits
Either a duration for the length of the timing schedule, a range of possible length, or outer bounds for start and/or end limits of the timing schedule.
A total count of the desired number of repetitions across the duration of the entire timing specification. If countMax is present, this element indicates the lower bound of the allowed range of count values.
If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.
Repetitions may be limited by end time or total occurrences.
If present, indicates that the count is a range - so to perform the action between [count] and [countMax] times.
How long this thing happens for when it happens. If durationMax is present, this element indicates the lower bound of the allowed range of the duration.
For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).
Some activities are not instantaneous and need to be maintained for a period of time.
If present, indicates that the duration is a range - so to perform the action between [duration] and [durationMax] time length.
s | min | h | d | wk | mo | a - unit of time (UCUM)
The units of time for the duration, in UCUM units.
The number of times to repeat the action within the specified period. If frequencyMax is present, this element indicates the lower bound of the allowed range of the frequency.
If no frequency is stated, the assumption is that the event occurs once per period, but systems SHOULD always be specific about this
Event occurs up to frequencyMax times per period
If present, indicates that the frequency is a range - so to repeat between [frequency] and [frequencyMax] times within the period or period range.
Duration of time over which repetitions are to occur
Indicates the duration of time over which repetitions are to occur; e.g. to express "3 times per day", 3 would be the frequency and "1 day" would be the period. If periodMax is present, this element indicates the lower bound of the allowed range of the period length.
If present, indicates that the period is a range from [period] to [periodMax], allowing expressing concepts such as "do this once every 3-5 days.
The units of time for the period in UCUM units.
If one or more days of week is provided, then the action happens only on the specified day(s).
If no days are specified, the action is assumed to happen every day as otherwise specified. The elements frequency and period cannot be used as well as dayOfWeek.
Specified time of day for action to take place.
When time of day is specified, it is inferred that the action happens every day (as filtered by dayofWeek) on the specified times. The elements when, frequency and period cannot be used as well as timeOfDay.
An approximate time period during the day, potentially linked to an event of daily living that indicates when the action should occur.
When more than one event is listed, the event is tied to the union of the specified events.
Timings are frequently determined by occurrences such as waking, eating and sleep.
Real world event relating to the schedule.
The number of minutes from the event. If the event code does not indicate whether the minutes is before or after the event, then the offset is assumed to be after the event.
A code for the timing schedule (or just text in code.text). Some codes such as BID are ubiquitous, but many institutions define their own additional codes. If a code is provided, the code is understood to be a complete statement of whatever is specified in the structured timing data, and either the code or the data may be used to interpret the Timing, with the exception that .repeat.bounds still applies over the code (and is not contained in the code).
BID etc. are defined as 'at institutionally specified times'. For example, an institution may choose that BID is "always at 7am and 6pm". If it is inappropriate for this choice to be made, the code BID should not be used. Instead, a distinct organization-specific code should be used in place of the HL7-defined BID code and/or a structured representation should be used (in this case, specifying the two event times).
Code for a known / defined timing pattern.
Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).
Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".
A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
.outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept
If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [bodySite](http://hl7.org/fhir/R4/extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both.
A coded specification of the anatomic site where the medication first enters the body.
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 a patient's body.
A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
Terminologies used often pre-coordinate this term with the route and or form of administration.
A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.
A coded concept describing the technique by which the medicine is administered.
The kind of dose or rate specified, for example, ordered or calculated.
If the type is not populated, assume to be "ordered".
Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.
The amount of therapeutic or other substance given at one administration event.
It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate. It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammer where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.
Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.
Upper limit on medication per unit of time
Upper limit on medication per unit of time.
This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".
The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.
Upper limit on medication per administration
Upper limit on medication per administration.
This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.
The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.
Upper limit on medication per lifetime of the patient
Upper limit on medication per lifetime of the patient.
The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.
Indicates the specific details for the dispense or medication supply part of a medication request (also known as a Medication Prescription or Medication Order). Note that this information is not always sent with the order. There may be in some settings (e.g. hospitals) institutional or system support for completing the dispense details in the pharmacy department.
Overall amount of product prescribed, independent from the number of repeats.
When Medication resource implies a pack size, prescribedQuantity should convey number of packages. When the Medication does not imply an amount, overall amount could be in tablets or millilitres.
Indicates the quantity or duration for the first dispense of the medication.
If populating this element, either the quantity or the duration must be included.
SubstanceAdministration -> ActRelationship[sequenceNumber = '1'] -> Supply
The amount or quantity to provide as part of the first dispense.
The length of time that the first dispense is expected to last.
Minimum period of time between dispenses
The minimum period of time that must occur between dispenses of the medication.
This indicates the validity period of a prescription (stale dating the Prescription).
It reflects the prescribers' perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations.
Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.
An integer indicating the number of times, in addition to the original dispense, (aka refills or repeats) that the patient can receive the prescribed medication. Usage Notes: This integer does not include the original order dispense. This means that if an order indicates dispense 30 tablets plus "3 repeats", then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets. A prescriber may explicitly say that zero refills are permitted after the initial dispense.
If displaying "number of authorized fills", add 1 to this number.
Amount of medication to supply per dispense
The amount that is to be dispensed for one fill.
RXD-4-Actual Dispense Amount / RXD-5.1-Actual Dispense Units.code / RXD-5.3-Actual Dispense Units.name of coding system
Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last.
In some situations, this attribute may be used instead of quantity to identify the amount supplied by how long it is expected to last, rather than the physical quantity issued, e.g. 90 days supply of medication (based on an ordered dosage). When possible, it is always better to specify quantity, as this tends to be more precise. expectedSupplyDuration will always be an estimate that can be influenced by external factors.
Indicates the intended dispensing Organization specified by the prescriber.
.outboundRelationship[typeCode=COMP].target[classCode=SPLY, moodCode=RQO] .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]
Any restrictions on medication substitution
Indicates whether or not substitution can or should be part of the dispense. In some cases, substitution must happen, in other cases substitution must not happen. This block explains the prescriber's intent. If nothing is specified substitution may be done.
specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions
True if the prescriber allows a different drug to be dispensed from what was prescribed.
This element is labeled as a modifier because whether substitution is allow or not, it cannot be ignored.
Identifies the type of substitution allowed.
RXO-9-Allow Substitutions / RXE-9-Substitution Status
Indicates the reason for the substitution, or why substitution must or must not be performed.
A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
An order/prescription that is being replaced
A link to a resource representing an earlier order related order or prescription.
.outboundRelationship[typeCode=?RPLC or ?SUCC]/target[classCode=SBADM,moodCode=RQO]
Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etc.
This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.
A list of events of interest in the lifecycle
Links to Provenance records for past versions of this resource or fulfilling request or event resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resource.
This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).
.inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]