# US Core Medication Adherence Extension - US Core Implementation Guide v9.0.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **US Core Medication Adherence Extension**

## Extension: US Core Medication Adherence Extension 

| | | |
| :--- | :--- | :--- |
| *Official URL*:http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence | *Version*:9.0.0 | |
| * Standards status: *[Trial-use](http://hl7.org/fhir/R4/versions.html#std-process) | [Maturity Level](changes-between-versions.md#us-core-maturity-levels): 2 | *Computable Name*:USCoreMedicationAdherenceExtension |
| *Other Identifiers:*OID:2.16.840.1.113883.4.642.40.2.42.37 | | |

The Medication Adherence Extension is used to report whether a medication has been consumed according to instructions as reported by a patient or on behalf of the patient.

**Context of Use**

### Profile Specific Implementation Guidance

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

This Complex Extension is made up of three sub-extensions:

1. A required Medication Adherence Code, which is bound to the [Medication Adherence ValueSet](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1240.8/expansionStructureDefinition-us-core-medication-adherence.html) - a "starter" set of medication compliance SNOMED CT and NullValue codes. Its binding is [extensible](http://hl7.org/fhir/R4/terminologies.html#extensible), and other concepts from SNOMED CT or another code system, including local codes, can be used. The table below illustrates basic scenarios of how an implementer can use them:

| | |
| :--- | :--- |
| The medication is being taken as directed. | 1156699004|Complies with drug therapy (finding) |
| The medication is being taken, but not as directed. For example, the patient occasionally forgets or takes two pills instead of three. | 702565001|Non-compliance of drug therapy (finding) |
| The medication is not being taken. For example, the patient did not pick up a prescription. | 715036001|Does not take medication (finding) |


1. A required date asserting when the information was provided
1. A Must Support information source code with an[example binding](http://hl7.org/fhir/R4/terminologies.html#example)to the**Medication Adherence ValueSet**- a "starter" set of informant role codes.

**Usage info**

**Usages:**

* Use this Extension: [US Core MedicationRequest Profile](StructureDefinition-us-core-medicationrequest.md)
* Examples for this Extension: [MedicationRequest/medicationrequest-coded-oral-axid](MedicationRequest-medicationrequest-coded-oral-axid.md) and [MedicationRequest/self-tylenol](MedicationRequest-self-tylenol.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/resource/hl7.fhir.us.core|current/StructureDefinition/StructureDefinition-us-core-medication-adherence.json)

**Changes since version 8.0.1:**

* The resource metadata has changed (copyright)

### Formal Views of Extension Content

 [Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](StructureDefinition-us-core-medication-adherence.csv), [Excel](StructureDefinition-us-core-medication-adherence.xlsx), [Schematron](StructureDefinition-us-core-medication-adherence.sch) 

#### Terminology Bindings

#### Constraints



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "us-core-medication-adherence",
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 2
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "cgp"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "trial-use",
    "_valueCode" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/core/ImplementationGuide/hl7.fhir.us.core"
      }]
    }
  }],
  "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.40.2.42.37"
  }],
  "version" : "9.0.0",
  "name" : "USCoreMedicationAdherenceExtension",
  "title" : "US Core Medication Adherence Extension",
  "status" : "active",
  "date" : "2023-10-17",
  "publisher" : "HL7 International / Cross-Group Projects",
  "contact" : [{
    "name" : "HL7 International / Cross-Group Projects",
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/cgp"
    },
    {
      "system" : "email",
      "value" : "cgp@lists.HL7.org"
    }]
  }],
  "description" : "The Medication Adherence Extension is used to report whether a medication has been consumed according to instructions as reported by a patient or on behalf of the patient.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US"
    }]
  }],
  "fhirVersion" : "4.0.1",
  "mapping" : [{
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  }],
  "kind" : "complex-type",
  "abstract" : false,
  "context" : [{
    "type" : "element",
    "expression" : "MedicationRequest"
  }],
  "type" : "Extension",
  "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/Extension",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "Extension",
      "path" : "Extension",
      "definition" : "Reported adherence to prescribed medication instructions.",
      "min" : 0,
      "max" : "*"
    },
    {
      "id" : "Extension.extension",
      "path" : "Extension.extension",
      "slicing" : {
        "discriminator" : [{
          "type" : "value",
          "path" : "url"
        }],
        "rules" : "open"
      },
      "min" : 2
    },
    {
      "id" : "Extension.extension:medicationAdherence",
      "path" : "Extension.extension",
      "sliceName" : "medicationAdherence",
      "code" : [{
        "system" : "http://loinc.org",
        "code" : "71799-1",
        "display" : "Adherence to prescribed medication instructions [Reported]"
      }],
      "short" : "Medication adherence code",
      "definition" : "Code stating whether the patient is consuming medications according to instructions.",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "Extension"
      }],
      "mustSupport" : true
    },
    {
      "id" : "Extension.extension:medicationAdherence.url",
      "path" : "Extension.extension.url",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "uri"
      }],
      "fixedUri" : "medicationAdherence"
    },
    {
      "id" : "Extension.extension:medicationAdherence.value[x]",
      "path" : "Extension.extension.value[x]",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "binding" : {
        "strength" : "extensible",
        "description" : "This set of values contains terms representing whether a medication has been consumed according to instructions.",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1240.8"
      }
    },
    {
      "id" : "Extension.extension:dateAsserted",
      "path" : "Extension.extension",
      "sliceName" : "dateAsserted",
      "short" : "When the medication adherence was asserted",
      "definition" : "When the medication adherence was asserted by the information source",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "Extension"
      }],
      "mustSupport" : true
    },
    {
      "id" : "Extension.extension:dateAsserted.url",
      "path" : "Extension.extension.url",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "uri"
      }],
      "fixedUri" : "dateAsserted"
    },
    {
      "id" : "Extension.extension:dateAsserted.value[x]",
      "path" : "Extension.extension.value[x]",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "dateTime"
      }]
    },
    {
      "id" : "Extension.extension:informationSource",
      "path" : "Extension.extension",
      "sliceName" : "informationSource",
      "short" : "Who provided the information about the medication adherence",
      "definition" : "The person or organization that provided the information about the medication adherence",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "Extension"
      }],
      "mustSupport" : true
    },
    {
      "id" : "Extension.extension:informationSource.url",
      "path" : "Extension.extension.url",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "uri"
      }],
      "fixedUri" : "informationSource"
    },
    {
      "id" : "Extension.extension:informationSource.value[x]",
      "path" : "Extension.extension.value[x]",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "binding" : {
        "strength" : "example",
        "description" : "The person or organization that provided the information about the medication adherence",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.11"
      }
    },
    {
      "id" : "Extension.url",
      "path" : "Extension.url",
      "fixedUri" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence"
    },
    {
      "id" : "Extension.value[x]",
      "path" : "Extension.value[x]",
      "min" : 0,
      "max" : "0"
    }]
  }
}

```
