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{
  "resourceType": "StructureDefinition",
  "id": "zib-MedicationAgreement",
  "url": "http://nictiz.nl/fhir/StructureDefinition/zib-MedicationAgreement",
  "version": "2.2.6",
  "name": "Zib MedicationAgreement",
  "title": "HCIM MedicationAgreement",
  "status": "active",
  "publisher": "Nictiz",
  "contact": [
    {
      "name": "Nictiz",
      "telecom": [
        {
          "system": "email",
          "value": "info@nictiz.nl",
          "use": "work"
        }
      ]
    }
  ],
  "description": "This profile is based on the Dutch Health and Care Information models (Dutch: Zorginformatiebouwsteen or ZIB) MedicationAgreement version 1.0.1, year 2017. A medication agreement is a prescriber’s proposal for a patient to use medication. An agreement to discontinue the use of medication is also a medication agreement.",
  "purpose": "The goal of the medication agreement is to provide insight into the agreements reached between the prescriber and the patient on the use of medication.",
  "copyright": "CC0",
  "fhirVersion": "3.0.2",
  "mapping": [
    {
      "identity": "hcim-medicationagreement-v1.0-2017EN",
      "uri": "https://zibs.nl/wiki/MedicationAgreement-v1.0(2017EN)",
      "name": "HCIM MedicationAgreement-v1.0(2017EN)"
    },
    {
      "identity": "Medication-Process-v09",
      "uri": "https://decor.nictiz.nl/medicatieproces/mp-html-20181220T121121/ds-2.16.840.1.113883.2.4.3.11.60.20.77.1.3-2016-06-01T000000.html",
      "name": "Medication Process v09",
      "comment": "Language of Medication Process is Dutch."
    },
    {
      "identity": "hcim-instructionsforuse-v1.0-2017EN",
      "uri": "https://zibs.nl/wiki/InstructionsForUse-v1.0(2017EN)",
      "name": "HCIM InstructionsForUse-v1.0(2017EN)"
    },
    {
      "identity": "hcim-basicelements-v1.0-2017EN",
      "uri": "https://zibs.nl/wiki/BasicElements-v1.0(2017EN)",
      "name": "HCIM BasicElements-v1.0(2017EN)"
    }
  ],
  "kind": "resource",
  "abstract": false,
  "type": "MedicationRequest",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/MedicationRequest",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "MedicationRequest",
        "path": "MedicationRequest",
        "short": "MedicationAgreement",
        "definition": "A medication agreement is a prescriber’s proposal for a patient to use medication. An agreement to discontinue the use of medication is also a medication agreement.",
        "alias": [
          "Medicatieafspraak"
        ],
        "mapping": [
          {
            "identity": "hcim-medicationagreement-v1.0-2017EN",
            "map": "NL-CM:9.6.9580",
            "comment": "MedicationAgreement"
          }
        ]
      },
      {
        "id": "MedicationRequest.extension",
        "path": "MedicationRequest.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "open"
        }
      },
      {
        "id": "MedicationRequest.extension:periodOfUse",
        "path": "MedicationRequest.extension",
        "sliceName": "periodOfUse",
        "short": "PeriodOfUse",
        "definition": "Start date: This is the time at which the agreement was to take effect (or took effect or will take effect). This is the time at which the instructions for use in this agreement start. In the case of an agreement to discontinue use, this is the start date of the original medication agreement. The end date indicates from when the medication is to be discontinued. \r\n\r\nEnd date: The time at which the period of use ends (or ended or will end). In the case of an agreement to discontinue use, this is the time at which the medication is to be discontinued. To avoid confusion between 'to' and 'up to', the submission of time is always mandatory for the end date.\r\n\r\nWith medication for an indefinite period only a start date is indicated.",
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": "http://nictiz.nl/fhir/StructureDefinition/zib-Medication-PeriodOfUse"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-medicationagreement-v1.0-2017EN",
            "map": "NL-CM:9.6.19936",
            "comment": "PeriodOfUse"
          }
        ]
      },
      {
        "id": "MedicationRequest.extension:usageDuration",
        "path": "MedicationRequest.extension",
        "sliceName": "usageDuration",
        "short": "Duration",
        "definition": "Duration: The intended duration of use. E.g. 5 days or 8 weeks. It is not allowed to indicate the duration in months, because different months have a variable duration in days.",
        "alias": [
          "Duur"
        ],
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": "http://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-Duration"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-medicationagreement-v1.0-2017EN",
            "map": "NL-CM:9.6.19936",
            "comment": "PeriodOfUse"
          }
        ]
      },
      {
        "id": "MedicationRequest.extension:additionalInformation",
        "path": "MedicationRequest.extension",
        "sliceName": "additionalInformation",
        "short": "MedicationAgreementAdditionalInformation",
        "definition": "Additional information includes details on the structure of the agreement made that are relevant for pharmacovigilance and fulfillment by the pharmacist. This can be used e.g. to indicate that there was a conscious decision to deviate from the norm or that the agreement is to be structured in a certain way.",
        "comment": "When choosing a medicine, you can deviate from what is expected or from what the standard is. For example, when the hospital uses a different formulary than the community pharmacy. For reasons of efficiency, for example, one gastric acid inhibitor has been chosen in the hospital: pantoprazole.\r\nUpon admission, a patient with omeprazole is converted to pantoprazole for the duration of the stay. When discharged, the patient goes back to omeprazole.\r\nIt is clear that something can go wrong here and that the patient takes both omeprazole and pantoprazole when there is no intervention. In the hospital's medication agreement for pantoprazole a remark can be made about the deviation so that it is clear that pantoprazole is the substitute for omeprazole or that it should be used in addition to omeprazole.\r\nAnother example are the half strengths. The hospital sometimes stocks tablets with half the strength of the normal trade preparation (own production). Where the patient enters the hospital on 25 mg chlortalidone, half a tablet once a day, he receives 12.5 mg intramural chlortalidone, one tablet once a day. Then the nursing does not have to break tablets in this case. Here there is a risk that the patient will use the 25 mg again at home, but then a whole tablet at a time in stead of half a tablet. By means of an explanation in the medication agreement (Additional information) of the last chlortalidone 25 mg, it can be indicated whether this has been a intended increase.",
        "alias": [
          "MedicatieafspraakAanvullendeInformatie"
        ],
        "type": [
          {
            "code": "Extension",
            "profile": "http://nictiz.nl/fhir/StructureDefinition/zib-Medication-AdditionalInformation"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-medicationagreement-v1.0-2017EN",
            "map": "NL-CM:9.6.23283",
            "comment": "MedicationAgreementAdditionalInformation"
          }
        ]
      },
      {
        "id": "MedicationRequest.extension:additionalInformation.valueCodeableConcept:valueCodeableConcept",
        "path": "MedicationRequest.extension.valueCodeableConcept",
        "sliceName": "valueCodeableConcept",
        "example": [
          {
            "label": "Example of MedicationAgreementAdditionalInformation",
            "valueCodeableConcept": {
              "coding": [
                {
                  "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.20.77.5.2.3.2050",
                  "code": "1",
                  "display": "Bewust hoge dosering"
                }
              ]
            }
          }
        ],
        "binding": {
          "strength": "extensible",
          "description": "MedicatieafspraakAanvullendeInformatieCodelijst",
          "valueSetReference": {
            "reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.6.3--20171231000000",
            "display": "MedicatieafspraakAanvullendeInformatieCodelijst"
          }
        }
      },
      {
        "id": "MedicationRequest.extension:medicationTreatment",
        "path": "MedicationRequest.extension",
        "sliceName": "medicationTreatment",
        "short": "Medication Treatment",
        "definition": "This extension is to describe which overarching medication treatment this information is part of. This is done by the use of an identifier of that medication treatment.",
        "comment": "No HCIM concept is available for this element. Therefore a mapping to the relevant element Medication Process data element is provided.",
        "alias": [
          "Medicamenteuze behandeling"
        ],
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": "http://nictiz.nl/fhir/StructureDefinition/zib-Medication-MedicationTreatment"
          }
        ],
        "mapping": [
          {
            "identity": "Medication-Process-v09",
            "map": "mp-dataelement900-22092",
            "comment": "Medicamenteuze behandeling"
          }
        ]
      },
      {
        "id": "MedicationRequest.extension:nl-core-episodeofcare",
        "path": "MedicationRequest.extension",
        "sliceName": "nl-core-episodeofcare",
        "comment": "It is recommended to use the nl-core-episodeofcare extension to reference nl-core-episodeofcare (EpisodeOfCare) instances rather than the `context` element, as this approach will be enforced in FHIR R4.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "Extension",
            "profile": "http://nictiz.nl/fhir/StructureDefinition/extension-context-nl-core-episodeofcare"
          }
        ]
      },
      {
        "id": "MedicationRequest.modifierExtension",
        "path": "MedicationRequest.modifierExtension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "open"
        }
      },
      {
        "id": "MedicationRequest.modifierExtension:stopType",
        "path": "MedicationRequest.modifierExtension",
        "sliceName": "stopType",
        "label": "MedicatieafspraakStopType",
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": "http://nictiz.nl/fhir/StructureDefinition/zib-Medication-StopType"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-medicationagreement-v1.0-2017EN",
            "map": "NL-CM:9.6.19954",
            "comment": "MedicationAgreementStopType"
          }
        ]
      },
      {
        "id": "MedicationRequest.modifierExtension:stopType.valueCodeableConcept:valueCodeableConcept",
        "path": "MedicationRequest.modifierExtension.valueCodeableConcept",
        "sliceName": "valueCodeableConcept",
        "binding": {
          "strength": "required"
        }
      },
      {
        "id": "MedicationRequest.modifierExtension:repeatPeriodCyclicalSchedule",
        "path": "MedicationRequest.modifierExtension",
        "sliceName": "repeatPeriodCyclicalSchedule",
        "label": "HerhaalperiodeCyclischSchema",
        "short": "RepeatPeriodCyclicalSchedule",
        "definition": "The repeated period in a cyclical schedule (of one or more dosing instructions). A cyclic schedule is noted in days, the corresponding dosing duration is also in days.\r\n\r\nExamples of a cyclical schedule: contraceptive pill (21 days, 1 pill 1x a day, then skip for 7 days, repeat), repeat period here is 28 days.\r\nRepeatPeriodCyclicalSchedule",
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": "http://nictiz.nl/fhir/StructureDefinition/zib-Medication-RepeatPeriodCyclicalSchedule"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-instructionsforuse-v1.0-2017EN",
            "map": "NL-CM:9.12.22505",
            "comment": "RepeatPeriodCyclicalSchedule"
          }
        ]
      },
      {
        "id": "MedicationRequest.identifier",
        "path": "MedicationRequest.identifier",
        "mapping": [
          {
            "identity": "hcim-basicelements-v1.0-2017EN",
            "map": "NL-CM:0.0.6",
            "comment": "IdentificationNumber"
          }
        ]
      },
      {
        "id": "MedicationRequest.intent",
        "path": "MedicationRequest.intent",
        "fixedCode": "order"
      },
      {
        "id": "MedicationRequest.category",
        "path": "MedicationRequest.category",
        "min": 1
      },
      {
        "id": "MedicationRequest.category.coding",
        "path": "MedicationRequest.category.coding",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "code"
            }
          ],
          "rules": "open"
        }
      },
      {
        "id": "MedicationRequest.category.coding:medicationAgreementCode",
        "path": "MedicationRequest.category.coding",
        "sliceName": "medicationAgreementCode",
        "short": "MedicationAgreementCode",
        "definition": "Category code used for indexing/retrieval of the ZIB MedicationAgreeement. The snomed code is stated in the Medication Process v09."
      },
      {
        "id": "MedicationRequest.category.coding:medicationAgreementCode.system",
        "path": "MedicationRequest.category.coding.system",
        "fixedUri": "http://snomed.info/sct"
      },
      {
        "id": "MedicationRequest.category.coding:medicationAgreementCode.code",
        "path": "MedicationRequest.category.coding.code",
        "fixedCode": "16076005"
      },
      {
        "id": "MedicationRequest.category.coding:medicationAgreementCode.display",
        "path": "MedicationRequest.category.coding.display",
        "defaultValueString": "Prescription (procedure)"
      },
      {
        "id": "MedicationRequest.medication[x]:medicationReference",
        "path": "MedicationRequest.medicationReference",
        "sliceName": "medicationReference",
        "short": "AgreedMedicine",
        "definition": "The medicine agreed upon to be used.",
        "comment": "-",
        "alias": [
          "Afgesprokengeneesmiddel"
        ],
        "type": [
          {
            "code": "Reference",
            "targetProfile": "http://nictiz.nl/fhir/StructureDefinition/zib-Product"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-medicationagreement-v1.0-2017EN",
            "map": "NL-CM:9.6.19925",
            "comment": "AgreedMedicine"
          }
        ]
      },
      {
        "id": "MedicationRequest.subject",
        "path": "MedicationRequest.subject",
        "type": [
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-patient"
          },
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/Group"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-basicelements-v1.0-2017EN",
            "map": "NL-CM:0.0.11",
            "comment": "Subject"
          }
        ]
      },
      {
        "id": "MedicationRequest.context",
        "path": "MedicationRequest.context",
        "comment": "It is recommended to use the nl-core-episodeofcare extension to reference nl-core-episodeofcare (EpisodeOfCare) instances rather than the `context` element, as this approach will be enforced in FHIR R4.",
        "type": [
          {
            "code": "Reference",
            "targetProfile": "http://nictiz.nl/fhir/StructureDefinition/zib-Encounter"
          },
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-episodeofcare"
          }
        ]
      },
      {
        "id": "MedicationRequest.authoredOn",
        "path": "MedicationRequest.authoredOn",
        "short": "MedicationAgreementDateTime",
        "definition": "The time at which the agreement was made. \r\n \r\nAppointment date + time are required (order of the appointments must be clear in cases with multiple appointments on one day)",
        "alias": [
          "Afspraakdatum"
        ],
        "min": 1,
        "mapping": [
          {
            "identity": "hcim-medicationagreement-v1.0-2017EN",
            "map": "NL-CM:9.6.19757",
            "comment": "MedicationAgreementDateTime"
          }
        ]
      },
      {
        "id": "MedicationRequest.requester",
        "path": "MedicationRequest.requester",
        "short": "Prescriber",
        "definition": "The health professional that entered the medication agreement with the patient.",
        "comment": "Note that in FHIR STU3, there is an agent Reference type PractitionerRole missing. PractitionerRole, contrary to Practitioner, allows for specialism and organization. This issue has been fixed in FHIR R4. For FHIR STU3, you can use the practitionerrole-reference extension on requester.agent.",
        "alias": [
          "Voorschrijver"
        ],
        "mapping": [
          {
            "identity": "hcim-medicationagreement-v1.0-2017EN",
            "map": "NL-CM:9.6.1030",
            "comment": "Prescriber"
          },
          {
            "identity": "hcim-basicelements-v1.0-2017EN",
            "map": "NL-CM:0.0.7",
            "comment": "Author"
          }
        ]
      },
      {
        "id": "MedicationRequest.requester.agent",
        "path": "MedicationRequest.requester.agent",
        "comment": "The health professional's speciality, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile.",
        "type": [
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner"
          },
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-organization"
          },
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-patient"
          },
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-relatedperson"
          },
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/Device"
          }
        ]
      },
      {
        "id": "MedicationRequest.requester.agent.extension",
        "path": "MedicationRequest.requester.agent.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "open"
        }
      },
      {
        "id": "MedicationRequest.requester.agent.extension:practitionerRole",
        "path": "MedicationRequest.requester.agent.extension",
        "sliceName": "practitionerRole",
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": "http://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference"
          }
        ]
      },
      {
        "id": "MedicationRequest.requester.onBehalfOf",
        "path": "MedicationRequest.requester.onBehalfOf",
        "type": [
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-organization"
          }
        ]
      },
      {
        "id": "MedicationRequest.recorder",
        "path": "MedicationRequest.recorder",
        "type": [
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner"
          }
        ]
      },
      {
        "id": "MedicationRequest.recorder.extension",
        "path": "MedicationRequest.recorder.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "open"
        }
      },
      {
        "id": "MedicationRequest.recorder.extension:practitionerRole",
        "path": "MedicationRequest.recorder.extension",
        "sliceName": "practitionerRole",
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": "http://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference"
          }
        ]
      },
      {
        "id": "MedicationRequest.reasonCode",
        "path": "MedicationRequest.reasonCode",
        "short": "ReasonMedicationAgreement",
        "definition": "Reason for this agreement. This can be the reason to start, change or stop the medication treatment.",
        "alias": [
          "RedenMedicatieafspraak"
        ],
        "binding": {
          "strength": "extensible",
          "description": "RedenWijzigenOfStakenCodelijst",
          "valueSetReference": {
            "reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.6.2--20171231000000",
            "display": "RedenWijzigenOfStakenCodelijst"
          }
        },
        "mapping": [
          {
            "identity": "hcim-medicationagreement-v1.0-2017EN",
            "map": "NL-CM:9.6.22094",
            "comment": "RedenMedicatieafspraak"
          }
        ]
      },
      {
        "id": "MedicationRequest.reasonReference",
        "path": "MedicationRequest.reasonReference",
        "short": "PrescriptionReason",
        "definition": "The medical reason for the prescription or for use of the medication. This can be used to enter a medical indication which was the direct cause for prescription or for use of the medication in question. \r\n\r\nIt can concern every type of problem (or condition) of the patient, almost all diagnoses, complaints or symptoms. \r\n\r\nPlease note: The BST401T file of the G standard contains a “special reference” to indicate that “exchange of the reason for prescription is essential”.",
        "alias": [
          "RedenVanVoorschrijven"
        ],
        "type": [
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/Observation"
          },
          {
            "code": "Reference",
            "targetProfile": "http://nictiz.nl/fhir/StructureDefinition/zib-Problem"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-medicationagreement-v1.0-2017EN",
            "map": "NL-CM:9.6.23133",
            "comment": "PrescriptionReason. Mapping for zib-Problem"
          }
        ]
      },
      {
        "id": "MedicationRequest.note",
        "path": "MedicationRequest.note",
        "short": "Comment",
        "definition": "Explanation for the medication agreement. \r\n \r\nThis explanation can contain e.g. information on why a prescriber makes a medication agreement that deviates from the norm.",
        "alias": [
          "Toelichting"
        ],
        "mapping": [
          {
            "identity": "hcim-medicationagreement-v1.0-2017EN",
            "map": "NL-CM:9.6.22273",
            "comment": "Comment"
          }
        ]
      },
      {
        "id": "MedicationRequest.dosageInstruction",
        "path": "MedicationRequest.dosageInstruction",
        "definition": "Instructions for the use of the medication, e.g. dose and route of administration",
        "type": [
          {
            "code": "Dosage",
            "profile": "http://nictiz.nl/fhir/StructureDefinition/zib-InstructionsForUse"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-medicationagreement-v1.0-2017EN",
            "map": "NL-CM:9.6.23240",
            "comment": "InstructionsForUse"
          },
          {
            "identity": "hcim-basicelements-v1.0-2017EN",
            "map": "NL-CM:0.0.14",
            "comment": "DateTime"
          }
        ]
      }
    ]
  }
}

name : Zib MedicationAgreement

{

}