US Core Implementation Guide
9.0.0 - STU 9 US

US Core Implementation Guide - Downloaded Version 9.0.0 See the Directory of published versions

## Resource Profile: US Core Medication Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication | Version: 9.0.0
Standards status: Trial-use | Maturity Level: 5 | Computable Name: USCoreMedicationProfile
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.42.38

The US Core Medication Profile inherits from the FHIR Medication resource; refer to it for scope and usage definitions. This profile sets minimum expectations for the Medication resource to record, search, and fetch medications associated with a patient. When referencing a medication, the MedicationRequest resource can use a code or refer to this profile. It specifies which core elements, extensions, vocabularies, and value sets SHALL be present and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.

Example Usage Scenarios:

Queries on Medication resources are expected to be within the context of a MedicationRequest resource query. The following are example usage scenarios for the US Core Medication profile:

- Read Medication resources referenced in MedicationRequest resources.

### Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each Medication Must Have:

1. A medication code

### Profile Specific Implementation Guidance

This section provides detailed implementation guidance for the US Core Profile to support implementation and certification.

- RXNorm concepts are defined as an extensible binding. USCDI recommends the National Drug Codes (NDC) as an optional terminology. They MAY be supplied as an additional coding element.§
- Since the binding is extensible when a code is unavailable, servers MAY use text.§
- When the medication is compounded and is a list of ingredients, the code is still present and may contain only the text.

Usages:

- Refer to this Profile: US Core MedicationDispense Profile and US Core MedicationRequest Profile
- Examples for this Profile: Medication/uscore-med1 and Medication/uscore-med2
- CapabilityStatements using this Profile: US Core Client CapabilityStatement and US Core Server CapabilityStatement

You can also check for usages in the FHIR IG Statistics

Changes since version 8.0.1:

- The resource metadata has changed (copyright)

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Medication |  | 0..* | Medication | Definition of a Medication
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
code | S Σ | 1..1 | CodeableConcept | Codes that identify this medication Binding: Medication Clinical Drug (extensible)
status | ?!Σ | 0..1 | code | active | inactive | entered-in-error Binding: Medication Status Codes (required): A coded concept defining if the medication is in active use.
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Medication.code | Base | extensible | Medication Clinical Drug | ⏿20240606 | tx.fhir.org
Medication.status | Base | required | Medication status codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Medication | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Medication | 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()`
dom-4 | error | Medication | 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()`
dom-5 | error | Medication | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Medication | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from Medication

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Medication |  | 0..* | Medication | Definition of a Medication
code | S | 1..1 | CodeableConcept | Codes that identify this medication Binding: Medication Clinical Drug (extensible)
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Medication.code | Base | extensible | Medication Clinical Drug | ⏿20240606 | tx.fhir.org

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Medication |  | 0..* | Medication | Definition of a Medication
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifier for this medication
code | S Σ | 1..1 | CodeableConcept | Codes that identify this medication Binding: Medication Clinical Drug (extensible)
status | ?!Σ | 0..1 | code | active | inactive | entered-in-error Binding: Medication Status Codes (required): A coded concept defining if the medication is in active use.
manufacturer | Σ | 0..1 | Reference(Organization) | Manufacturer of the item
form |  | 0..1 | CodeableConcept | powder | tablets | capsule + Binding: SNOMEDCTFormCodes (example): A coded concept defining the form of a medication.
amount | Σ | 0..1 | Ratio | Amount of drug in package
ingredient |  | 0..* | BackboneElement | Active or inactive ingredient
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
item[x] |  | 1..1 |  | The actual ingredient or content
itemCodeableConcept |  |  | CodeableConcept |
itemReference |  |  | Reference(Substance | Medication) |
isActive |  | 0..1 | boolean | Active ingredient indicator
strength |  | 0..1 | Ratio | Quantity of ingredient present
batch |  | 0..1 | BackboneElement | Details about packaged medications
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
lotNumber |  | 0..1 | string | Identifier assigned to batch
expirationDate |  | 0..1 | dateTime | When batch will expire
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Medication.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Medication.code | Base | extensible | Medication Clinical Drug | ⏿20240606 | tx.fhir.org
Medication.status | Base | required | Medication status codes | 📍4.0.1 | FHIR Std.
Medication.form | Base | example | SNOMED CT Form Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Medication | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Medication | 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()`
dom-4 | error | Medication | 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()`
dom-5 | error | Medication | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Medication | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from Medication

Summary

Mandatory: 1 element
Must-Support: 1 element

Maturity: 5

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Medication |  | 0..* | Medication | Definition of a Medication
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
code | S Σ | 1..1 | CodeableConcept | Codes that identify this medication Binding: Medication Clinical Drug (extensible)
status | ?!Σ | 0..1 | code | active | inactive | entered-in-error Binding: Medication Status Codes (required): A coded concept defining if the medication is in active use.
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Medication.code | Base | extensible | Medication Clinical Drug | ⏿20240606 | tx.fhir.org
Medication.status | Base | required | Medication status codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Medication | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Medication | 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()`
dom-4 | error | Medication | 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()`
dom-5 | error | Medication | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Medication | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Differential View

This structure is derived from Medication

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Medication |  | 0..* | Medication | Definition of a Medication
code | S | 1..1 | CodeableConcept | Codes that identify this medication Binding: Medication Clinical Drug (extensible)
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Medication.code | Base | extensible | Medication Clinical Drug | ⏿20240606 | tx.fhir.org

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Medication |  | 0..* | Medication | Definition of a Medication
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifier for this medication
code | S Σ | 1..1 | CodeableConcept | Codes that identify this medication Binding: Medication Clinical Drug (extensible)
status | ?!Σ | 0..1 | code | active | inactive | entered-in-error Binding: Medication Status Codes (required): A coded concept defining if the medication is in active use.
manufacturer | Σ | 0..1 | Reference(Organization) | Manufacturer of the item
form |  | 0..1 | CodeableConcept | powder | tablets | capsule + Binding: SNOMEDCTFormCodes (example): A coded concept defining the form of a medication.
amount | Σ | 0..1 | Ratio | Amount of drug in package
ingredient |  | 0..* | BackboneElement | Active or inactive ingredient
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
item[x] |  | 1..1 |  | The actual ingredient or content
itemCodeableConcept |  |  | CodeableConcept |
itemReference |  |  | Reference(Substance | Medication) |
isActive |  | 0..1 | boolean | Active ingredient indicator
strength |  | 0..1 | Ratio | Quantity of ingredient present
batch |  | 0..1 | BackboneElement | Details about packaged medications
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
lotNumber |  | 0..1 | string | Identifier assigned to batch
expirationDate |  | 0..1 | dateTime | When batch will expire
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Medication.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Medication.code | Base | extensible | Medication Clinical Drug | ⏿20240606 | tx.fhir.org
Medication.status | Base | required | Medication status codes | 📍4.0.1 | FHIR Std.
Medication.form | Base | example | SNOMED CT Form Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Medication | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Medication | 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()`
dom-4 | error | Medication | 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()`
dom-5 | error | Medication | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Medication | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from Medication

Summary

Mandatory: 1 element
Must-Support: 1 element

Maturity: 5

Other representations of profile: CSV, Excel, Schematron

### Notes:

Quick Start

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

- See the Scopes Format section for a description of the SMART scopes syntax.
- See the Search Syntax section for a description of the US Core search syntax.
- See the General Requirements section for additional rules and expectations when a Server requires status parameters.
- See the General Guidance section for additional guidance on searching for multiple patients.

#### US Core Scopes

Servers providing access to data MAY support these US Core SMART Scopes:

- resource level scopes: `<patient|user|system>/Medication.rs` §

No required search criteria for us-core-medication profile.