Specialty Medication Enrollment
0.1.0 - STU1 Ballot

Publication Build: This will be filled in by the publication tooling

## Resource Profile: SpecialtyRxPrescription - Detailed Descriptions

Definitions for the specialty-rx-medicationrequest resource profile.

1. MedicationRequest
Definition | The US Core Medication Request (Order) Profile is based upon the core FHIR MedicationRequest Resource and created to meet the 2015 Edition Common Clinical Data Set 'Medications' requirements.
Control | 0..*
Alternate Names | Prescription, Order
Invariants | Defined on this element dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty()) dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (: contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (: text.`div`.exists())
2. MedicationRequest.id
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Control | 0..1
Type | string
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
3. MedicationRequest.meta
Definition | 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.
Control | 0..1
Type | Meta
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
4. MedicationRequest.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Control | 0..1
Type | uri
Is Modifier | true
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
5. MedicationRequest.language
Definition | The base language in which the resource is written.
Control | 0..1
Binding | The codes SHOULD be taken from CommonLanguages Max Binding: AllLanguages A human language.
Type | code
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. 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).
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
6. MedicationRequest.text
Definition | 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.
Control | 0..1
Type | Narrative
Alternate Names | narrative, html, xhtml, display
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
7. MedicationRequest.contained
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Control | 0..*
Type | Resource
Alternate Names | inline resources, anonymous resources, contained resources
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
8. MedicationRequest.extension
Definition | May be used to represent additional information that is not part of the basic definition of the resource. 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
9. MedicationRequest.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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).
Control | 0..*
Type | Extension
Is Modifier | true
Requirements | 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.
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
10. MedicationRequest.identifier
Definition | 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.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
Comments | This is a business identifier, not a resource identifier.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
11. MedicationRequest.status
Definition | A code specifying the current state of the order. Generally, this will be active or completed state.
Control | 1..1
Binding | The codes SHALL be taken from medicationrequest Status A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.
Type | code
Is Modifier | true
Must Support | true
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
12. MedicationRequest.statusReason
Definition | Captures the reason for the current state of the MedicationRequest.
Control | 0..1
Binding | For example codes, see medicationRequest Status Reason Codes Identifies the reasons for a given status.
Type | CodeableConcept
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
13. MedicationRequest.intent
Definition | Whether the request is a proposal, plan, or an original order.
Control | 1..1
Binding | The codes SHALL be taken from medicationRequest Intent The kind of medication order.
Type | code
Is Modifier | true
Must Support | true
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
14. MedicationRequest.category
Definition | Indicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).
Control | 0..*
Binding | For example codes, see medicationRequest Category Codes 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.
Type | CodeableConcept
Comments | The category can be used to include where the medication is expected to be consumed or other types of requests.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
15. MedicationRequest.priority
Definition | Indicates how quickly the Medication Request should be addressed with respect to other requests.
Control | 0..1
Binding | The codes SHALL be taken from RequestPriority Identifies the level of importance to be assigned to actioning the request.
Type | code
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
16. MedicationRequest.doNotPerform
Definition | If true indicates that the provider is asking for the medication request not to occur.
Control | 0..1
Type | boolean
Is Modifier | true
Comments | If do not perform is not specified, the request is a positive request e.g. "do perform".
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
17. MedicationRequest.reported[x]
Definition | 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.
Control | 0..1
Type | Choice of: boolean, Reference(USCorePatientProfile | USCorePractitionerProfile | PractitionerRole | USCoreOrganizationProfile | RelatedPerson)
[x] Note | See Choice of Data Types for further information about how to use [x]
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
18. MedicationRequest.medication[x]
Definition | 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.
Control | 1..1
Binding | The codes SHALL be taken from US Core Medication Codes (RxNorm); other codes may be used where these codes are not suitable Prescribable medications
Type | Choice of: CodeableConcept, Reference(USCoreMedicationProfile)
[x] Note | See Choice of Data Types for further information about how to use [x]
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
19. MedicationRequest.subject
Definition | A link to a resource representing the person or set of individuals to whom the medication will be given.
Control | 1..1
Type | Reference(USCorePatientProfile)
Must Support | true
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
20. MedicationRequest.encounter
Definition | The Encounter during which this [x] was created or to which the creation of this record is tightly associated.
Control | 0..1
Type | Reference(Encounter)
Must Support | true
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
21. MedicationRequest.supportingInformation
Definition | Include additional information (for example, patient height and weight) that supports the ordering of the medication.
Control | 0..*
Type | Reference(Resource)
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
22. MedicationRequest.authoredOn
Definition | The date (and perhaps time) when the prescription was initially written or authored on.
Control | 1..1
Type | dateTime
Must Support | true
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
23. MedicationRequest.requester
Definition | The individual, organization, or device that initiated the request and has responsibility for its activation.
Control | 1..1
Type | Reference(USCorePractitionerProfile | PractitionerRole | USCoreOrganizationProfile | USCorePatientProfile | USCoreImplantableDeviceProfile | RelatedPerson)
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
24. MedicationRequest.performer
Definition | The specified desired performer of the medication treatment (e.g. the performer of the medication administration).
Control | 0..1
Type | Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam)
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
25. MedicationRequest.performerType
Definition | Indicates the type of performer of the administration of the medication.
Control | 0..1
Binding | For example codes, see ProcedurePerformerRoleCodes Identifies the type of individual that is desired to administer the medication.
Type | CodeableConcept
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
26. MedicationRequest.recorder
Definition | The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order.
Control | 0..1
Type | Reference(Practitioner | PractitionerRole)
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
27. MedicationRequest.reasonCode
Definition | The reason or the indication for ordering or not ordering the medication.
Control | 0..*
Binding | For example codes, see Condition/Problem/DiagnosisCodes A coded concept indicating why the medication was ordered.
Type | CodeableConcept
Comments | This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
28. MedicationRequest.reasonReference
Definition | Condition or observation that supports why the medication was ordered.
Control | 0..*
Type | Reference(Condition | Observation)
Comments | This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
29. MedicationRequest.instantiatesCanonical
Definition | The URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest.
Control | 0..*
Type | canonical
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
30. MedicationRequest.instantiatesUri
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.
Control | 0..*
Type | uri
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
31. MedicationRequest.basedOn
Definition | A plan or request that is fulfilled in whole or in part by this medication request.
Control | 0..*
Type | Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation)
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
32. MedicationRequest.groupIdentifier
Definition | 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.
Control | 0..1
Type | Identifier
Requirements | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
33. MedicationRequest.courseOfTherapyType
Definition | The description of the overall patte3rn of the administration of the medication to the patient.
Control | 0..1
Binding | For example codes, see medicationRequest Course of Therapy Codes Identifies the overall pattern of medication administratio.
Type | CodeableConcept
Comments | This attribute should not be confused with the protocol of the medication.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
34. MedicationRequest.insurance
Definition | Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service.
Control | 0..*
Type | Reference(Coverage | ClaimResponse)
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
35. MedicationRequest.note
Definition | Extra information about the prescription that could not be conveyed by the other attributes.
Control | 0..*
Type | Annotation
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
36. MedicationRequest.dosageInstruction
Definition | Indicates how the medication is to be used by the patient.
Control | 1..*
Type | Dosage
Must Support | true
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
37. MedicationRequest.dosageInstruction.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
38. MedicationRequest.dosageInstruction.extension
Definition | 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
Slicing | This element introduces a set of slices on MedicationRequest.dosageInstruction.extension. The slices are unordered and Open, and can be differentiated using the following discriminators: value @ url
39. MedicationRequest.dosageInstruction.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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).
Control | 0..*
Type | Extension
Is Modifier | true
Requirements | 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.
Alternate Names | extensions, user content, modifiers
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
40. MedicationRequest.dosageInstruction.sequence
Definition | Indicates the order in which the dosage instructions should be applied or interpreted.
Control | 0..1
Type | integer
Requirements | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
41. MedicationRequest.dosageInstruction.text
Definition | Free text dosage instructions e.g. SIG.
Control | 0..1
Type | string
Must Support | true
Requirements | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
42. MedicationRequest.dosageInstruction.additionalInstruction
Definition | 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").
Control | 0..*
Binding | For example codes, see SNOMEDCTAdditionalDosageInstructions A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
Type | CodeableConcept
Requirements | 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.
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
43. MedicationRequest.dosageInstruction.patientInstruction
Definition | Instructions in terms that are understood by the patient or consumer.
Control | 0..1
Type | string
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
44. MedicationRequest.dosageInstruction.timing
Definition | When medication should be administered.
Control | 0..1
Type | Timing
Requirements | 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.
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
45. MedicationRequest.dosageInstruction.asNeeded[x]
Definition | 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).
Control | 0..1
Binding | For example codes, see SNOMEDCTMedicationAsNeededReasonCodes 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.
Type | Choice of: boolean, CodeableConcept
[x] Note | See Choice of Data Types for further information about how to use [x]
Comments | 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".
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
46. MedicationRequest.dosageInstruction.site
Definition | Body site to administer to.
Control | 0..1
Binding | For example codes, see SNOMEDCTAnatomicalStructureForAdministrationSiteCodes A coded concept describing the site location the medicine enters into or onto the body.
Type | CodeableConcept
Requirements | A coded specification of the anatomic site where the medication first enters the body.
Comments | If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
47. MedicationRequest.dosageInstruction.route
Definition | How drug should enter body.
Control | 0..1
Binding | For example codes, see SNOMEDCTRouteCodes A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
Type | CodeableConcept
Requirements | A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
48. MedicationRequest.dosageInstruction.method
Definition | Technique for administering medication.
Control | 0..1
Binding | For example codes, see SNOMEDCTAdministrationMethodCodes A coded concept describing the technique by which the medicine is administered.
Type | CodeableConcept
Requirements | 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.
Comments | Terminologies used often pre-coordinate this term with the route and or form of administration.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
49. MedicationRequest.dosageInstruction.doseAndRate
Definition | The amount of medication administered.
Control | 0..*
Type | Element
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
50. MedicationRequest.dosageInstruction.doseAndRate.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
51. MedicationRequest.dosageInstruction.doseAndRate.extension
Definition | 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
Slicing | This element introduces a set of slices on MedicationRequest.dosageInstruction.doseAndRate.extension. The slices are unordered and Open, and can be differentiated using the following discriminators: value @ url
52. MedicationRequest.dosageInstruction.doseAndRate.type
Definition | The kind of dose or rate specified, for example, ordered or calculated.
Control | 0..1
Binding | For example codes, see DoseAndRateType The kind of dose or rate specified.
Type | CodeableConcept
Requirements | If the type is not populated, assume to be "ordered".
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
53. MedicationRequest.dosageInstruction.doseAndRate.dose[x]
Definition | Amount of medication per dose.
Control | 0..1
Type | Choice of: Range, Quantity(SimpleQuantity)
[x] Note | See Choice of Data Types for further information about how to use [x]
Requirements | The amount of therapeutic or other substance given at one administration event.
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
54. MedicationRequest.dosageInstruction.doseAndRate.rate[x]
Definition | Amount of medication per unit of time.
Control | 0..1
Type | Choice of: Ratio, Range, Quantity(SimpleQuantity)
[x] Note | See Choice of Data Types for further information about how to use [x]
Requirements | 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.
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
55. MedicationRequest.dosageInstruction.maxDosePerPeriod
Definition | Upper limit on medication per unit of time.
Control | 0..1
Type | Ratio
Requirements | 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.
Comments | 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".
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
56. MedicationRequest.dosageInstruction.maxDosePerAdministration
Definition | Upper limit on medication per administration.
Control | 0..1
Type | Quantity(SimpleQuantity)
Requirements | The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
57. MedicationRequest.dosageInstruction.maxDosePerLifetime
Definition | Upper limit on medication per lifetime of the patient.
Control | 0..1
Type | Quantity(SimpleQuantity)
Requirements | The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
58. MedicationRequest.dispenseRequest
Definition | 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.
Control | 0..1
Type | BackboneElement
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
59. MedicationRequest.dispenseRequest.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
60. MedicationRequest.dispenseRequest.extension
Definition | 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
61. MedicationRequest.dispenseRequest.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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).
Control | 0..*
Type | Extension
Is Modifier | true
Requirements | 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.
Alternate Names | extensions, user content, modifiers
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
62. MedicationRequest.dispenseRequest.initialFill
Definition | Indicates the quantity or duration for the first dispense of the medication.
Control | 0..1
Type | BackboneElement
Comments | If populating this element, either the quantity or the duration must be included.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
63. MedicationRequest.dispenseRequest.initialFill.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
64. MedicationRequest.dispenseRequest.initialFill.extension
Definition | 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
65. MedicationRequest.dispenseRequest.initialFill.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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).
Control | 0..*
Type | Extension
Is Modifier | true
Requirements | 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.
Alternate Names | extensions, user content, modifiers
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
66. MedicationRequest.dispenseRequest.initialFill.quantity
Definition | The amount or quantity to provide as part of the first dispense.
Control | 1..1
Type | Quantity(SimpleQuantity)
Must Support | true
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
67. MedicationRequest.dispenseRequest.initialFill.duration
Definition | The length of time that the first dispense is expected to last.
Control | 0..1
Type | Duration
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
68. MedicationRequest.dispenseRequest.dispenseInterval
Definition | The minimum period of time that must occur between dispenses of the medication.
Control | 0..1
Type | Duration
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
69. MedicationRequest.dispenseRequest.validityPeriod
Definition | This indicates the validity period of a prescription (stale dating the Prescription).
Control | 0..1
Type | Period
Requirements | Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
70. MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
Definition | 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.
Control | 1..1
Type | unsignedInt
Must Support | true
Comments | If displaying "number of authorized fills", add 1 to this number.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
71. MedicationRequest.dispenseRequest.quantity
Definition | The amount that is to be dispensed for one fill.
Control | 0..1
Type | Quantity(SimpleQuantity)
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
72. MedicationRequest.dispenseRequest.expectedSupplyDuration
Definition | 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.
Control | 0..1
Type | Duration
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
73. MedicationRequest.dispenseRequest.performer
Definition | Indicates the intended dispensing Organization specified by the prescriber.
Control | 0..1
Type | Reference(Organization)
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
74. MedicationRequest.substitution
Definition | 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.
Control | 0..1
Type | BackboneElement
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
75. MedicationRequest.substitution.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
76. MedicationRequest.substitution.extension
Definition | 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
77. MedicationRequest.substitution.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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).
Control | 0..*
Type | Extension
Is Modifier | true
Requirements | 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.
Alternate Names | extensions, user content, modifiers
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
78. MedicationRequest.substitution.allowed[x]
Definition | True if the prescriber allows a different drug to be dispensed from what was prescribed.
Control | 1..1
Binding | For example codes, see ActSubstanceAdminSubstitutionCode Identifies the type of substitution allowed.
Type | Choice of: boolean, CodeableConcept
[x] Note | See Choice of Data Types for further information about how to use [x]
Comments | This element is labeled as a modifier because whether substitution is allow or not, it cannot be ignored.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
79. MedicationRequest.substitution.reason
Definition | Indicates the reason for the substitution, or why substitution must or must not be performed.
Control | 0..1
Binding | For example codes, see SubstanceAdminSubstitutionReason A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
Type | CodeableConcept
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
80. MedicationRequest.priorPrescription
Definition | A link to a resource representing an earlier order related order or prescription.
Control | 0..1
Type | Reference(MedicationRequest)
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
81. MedicationRequest.detectedIssue
Definition | 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.
Control | 0..*
Type | Reference(DetectedIssue)
Alternate Names | Contraindication, Drug Utilization Review (DUR), Alert
Comments | 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.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
82. MedicationRequest.eventHistory
Definition | 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.
Control | 0..*
Type | Reference(Provenance)
Comments | 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.).
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))