MedicationRequest (CA-Core)

There are no (further) constraints on this element

Element id

MedicationRequest.category

Short description

Type of medication usage

Definition

Indicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).

Comments

The category can be used to include where the medication is expected to be consumed or other types of requests.

Data type

medicationRequest Category Codes (example)

Binding

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.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
script10.6: Message/Body/NewRx/MedicationPrescribed/Directions or Message/Body/NewRx/MedicationPrescribed/StructuredSIG
w5: FiveWs.class
rim: .inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication usage"].value

priority

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.priority

Short description

routine | urgent | asap | stat

Definition

Indicates how quickly the Medication Request should be addressed with respect to other requests.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data type

Binding

Identifies the level of importance to be assigned to actioning the request.

RequestPriority (required)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
workflow: Request.priority
w5: FiveWs.grade
rim: .priorityCode

doNotPerform

Σ ?!

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.doNotPerform

Short description

True if request is prohibiting action

Definition

If true indicates that the provider is asking for the medication request not to occur.

Comments

If do not perform is not specified, the request is a positive request e.g. "do perform".

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
rim: SubstanceAdministration.actionNegationInd

reported[x]

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.reported[x]

Short description

Reported rather than primary record

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.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
rim: .participation[typeCode=INF].role

reportedBoolean

There are no (further) constraints on this element

Data type

SNOMEDCTMedicationCodes (example)

reportedReference

Reference(Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)

There are no (further) constraints on this element

Data type

Reference(Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)

medication[x]

SO Σ

1..1

Element id

MedicationRequest.medication[x]

Short description

Medication to be taken

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.

Comments

The decision whether to use medicationCodeableConcept versus medicationReference is highly context dependent. Therefore, Ca Core+ defers that decision to downstream, use case specific implementation guides.

Slicing

Unordered, Open, by $this(Type)

Binding

A coded concept identifying substance or product that can be ordered.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
workflow: Request.code
script10.6: Message/Body/NewRx/MedicationPrescribed Medication.code.coding.code = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCode Medication.code.coding.system = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCodeQualifier Medication.code.coding.display = Message/Body/NewRx/MedicationPrescribed/DrugDescription
w5: FiveWs.what[x]
v2: RXE-2-Give Code / RXO-1-Requested Give Code / RXC-2-Component Code
rim: consumable.administrableMedication

Obligations

Code	Actor
SHALL:populate-if-known	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/producer
SHALL:no-error	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/consumer

medicationReference

0..1

Element id

MedicationRequest.medication[x]:medicationReference

Short description

Medication to be taken

Definition

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.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
workflow: Request.code
script10.6: Message/Body/NewRx/MedicationPrescribed Medication.code.coding.code = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCode Medication.code.coding.system = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCodeQualifier Medication.code.coding.display = Message/Body/NewRx/MedicationPrescribed/DrugDescription
w5: FiveWs.what[x]
v2: RXE-2-Give Code / RXO-1-Requested Give Code / RXC-2-Component Code
rim: consumable.administrableMedication

medicationCodeableConcept

0..1

Element id

MedicationRequest.medication[x]:medicationCodeableConcept

Short description

Concept - reference to a terminology or just text

Definition

A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.

Comments

The preferred binding on this element is to use Canadian Clinical Drug Data Set (CCDD).

Data type

PrescriptionMedicinalProduct (preferred)

Binding

A coded concept identifying substance or product that can be ordered.

Additional bindings

LicensedNaturalHealthProducts (candidate)
ValueSet for licensed natural health products
WhoAtcUvIps (candidate)
per pCHDCF: Can be used for the international use case where a medication is not available in Canada and therefore does not appear in the recommended pan-Canadian value sets. ATC is the recommended supporting classification for reporting and analysis
PharmaceuticalBiologicProductAndSubstanceCode (candidate)
per PCHDCF: The alternate value set can be used for the international use case where the medication is not available in Canada and therefore does not appear in the recommended pan-Canadian value sets
DINvs (candidate)
A Drug Identification Number (DIN) is a computer-generated eight digit number assigned by Health Canada to a drug product prior to being marketed in Canada. It uniquely identifies all drug products sold in a dosage form in Canada

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
workflow: Request.code
script10.6: Message/Body/NewRx/MedicationPrescribed Medication.code.coding.code = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCode Medication.code.coding.system = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCodeQualifier Medication.code.coding.display = Message/Body/NewRx/MedicationPrescribed/DrugDescription
w5: FiveWs.what[x]
v2: RXE-2-Give Code / RXO-1-Requested Give Code / RXC-2-Component Code
rim: consumable.administrableMedication
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
CACDI: Medication

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.medication[x]:medicationCodeableConcept.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.medication[x]:medicationCodeableConcept.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

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.

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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()

Mappings

rim: n/a
rim: N/A

coding

0..*

CodingCACore

There are no (further) constraints on this element

Element id

MedicationRequest.medication[x]:medicationCodeableConcept.coding

Short description

A reference to a code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Codes may be defined very casually in enumerations or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information.

Data type

CodingCACore

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim: CV
orim: fhir:Coding rdfs:subClassOf dt:CDCoding
v2: C*E.1-8, C*E.10-22
rim: union(., ./translation)
orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.medication[x]:medicationCodeableConcept.coding.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.medication[x]:medicationCodeableConcept.coding.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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()

Mappings

rim: n/a
rim: N/A

system

0..1

Element id

MedicationRequest.medication[x]:medicationCodeableConcept.coding.system

Short description

Identity of the terminology system

Definition

The identification of the code system that defines the meaning of the symbol in the code.

Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: C*E.3
rim: ./codeSystem
orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
CACDI: Drug Code System URI

version

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.medication[x]:medicationCodeableConcept.coding.version

Short description

Version of the system - if relevant

Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: C*E.7
rim: ./codeSystemVersion
orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.medication[x]:medicationCodeableConcept.coding.code

Short description

Symbol in syntax defined by the system

Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Requirements

Need to refer to a particular code in the system.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: C*E.1
rim: ./code
orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

0..1

Element id

MedicationRequest.medication[x]:medicationCodeableConcept.coding.display

Short description

Representation defined by the system

Definition

A representation of the meaning of the code in the system, following the rules of the system.

Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: C*E.2 - but note this is not well followed
rim: CV.displayName
orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
CACDI: Drug English Description
CACDI: Drug French Description

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.medication[x]:medicationCodeableConcept.coding.display.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.medication[x]:medicationCodeableConcept.coding.display.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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()

Mappings

rim: n/a
rim: N/A

translation

0..*

Extension(Complex)

There are no (further) constraints on this element

Element id

MedicationRequest.medication[x]:medicationCodeableConcept.coding.display.extension:translation

Short description

Language Translation (Localization)

Alternate names

extensions, user content

Definition

Language translation from base language of resource to another language, used to provide translations for strings, including markdown. Generally, the type of the translation extension SHOULD match that of the element being extended.

Comments

Data type

Extension(Complex)

Extension URL

Translation

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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()

Mappings

rim: n/a
rim: N/A
rim: ST.translation

value

0..1

System.String

There are no (further) constraints on this element

Element id

MedicationRequest.medication[x]:medicationCodeableConcept.coding.display.value

Short description

Primitive value for string

Definition

Primitive value for string

Data type

System.String

Maximum string length

1048576

userSelected

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.medication[x]:medicationCodeableConcept.coding.userSelected

Short description

If this coding was chosen directly by the user

Definition

Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: Sometimes implied by being first
rim: CD.codingRationale
orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]

text

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.medication[x]:medicationCodeableConcept.text

Short description

Plain text representation of the concept

Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Very often the text is the same as a displayName of one of the codings.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: C*E.9. But note many systems use C*E.2 for this
rim: ./originalText[mediaType/code="text/plain"]/data
orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

subject

Σ C

1..1

Element id

MedicationRequest.subject

Short description

Who or group medication request is for

Definition

A link to a resource representing the person or set of individuals to whom the medication will be given.

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.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Request.subject
script10.6: Message/Body/NewRx/Patient (need detail to link to specific patient … Patient.Identification in SCRIPT)
w5: FiveWs.subject[x]
v2: PID-3-Patient ID List
rim: .participation[typeCode=AUT].role
w5: FiveWs.subject

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.subject.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.subject.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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()

Mappings

rim: n/a
rim: N/A

reference

Σ C

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.subject.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1, ref-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
rim: N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element id

MedicationRequest.subject.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

Comments

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Data type

Binding

Aa resource (or, for logical models, the URI of the logical model).

ResourceType (extensible)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
rim: N/A

identifier

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.subject.identifier

Short description

Logical reference, when literal reference is not known

Definition

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

Comments

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd: Identifier
rim: .identifier

display

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.subject.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
rim: N/A

encounter

0..1

Reference(Encounter)

There are no (further) constraints on this element

Element id

MedicationRequest.encounter

Short description

Encounter created as part of encounter/admission/stay

Definition

The Encounter during which this [x] was created or to which the creation of this record is tightly associated.

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.

Data type

Reference(Encounter)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Request.context
script10.6: no mapping
w5: FiveWs.context
v2: PV1-19-Visit Number
rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]

supportingInformation

0..*

Reference(Resource)

There are no (further) constraints on this element

Element id

MedicationRequest.supportingInformation

Short description

Information to support ordering of the medication

Definition

Include additional information (for example, patient height and weight) that supports the ordering of the medication.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Data type

Reference(Resource)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Request.supportingInfo
w5: FiveWs.context
rim: .outboundRelationship[typeCode=PERT].target[A_SupportingClinicalStatement CMET minimal with many different choices of classCodes(ORG, ENC, PROC, SPLY, SBADM, OBS) and each of the act class codes draws from one or more of the following moodCodes (EVN, DEF, INT PRMS, RQO, PRP, APT, ARQ, GOL)]

authoredOn

0..1

dateTime

There are no (further) constraints on this element

Element id

MedicationRequest.authoredOn

Short description

When request was initially authored

Definition

The date (and perhaps time) when the prescription was initially written or authored on.

Data type

dateTime

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
workflow: Request.authoredOn
script10.6: Message/Body/NewRx/MedicationPrescribed/WrittenDate
w5: FiveWs.recorded
v2: RXE-32-Original Order Date/Time / ORC-9-Date/Time of Transaction
rim: author.time

requester

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.requester

Short description

Who/What requested the Request

Definition

The individual, organization, or device that initiated the request and has responsibility for its activation.

Comments

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Request.requester
w5: FiveWs.author
rim: .participation[typeCode=AUT].role

performer

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.performer

Short description

Intended performer of administration

Definition

The specified desired performer of the medication treatment (e.g. the performer of the medication administration).

Comments

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Request.performer
w5: FiveWs.actor
rim: .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]

performerType

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.performerType

Short description

Desired kind of performer of the medication administration

Definition

Indicates the type of performer of the administration of the medication.

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.

Data type

ProcedurePerformerRoleCodes (example)

Binding

Identifies the type of individual that is desired to administer the medication.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
workflow: Request.performerType
rim: .participation[typeCode=PRF].role[scoper.determinerCode=KIND].code

recorder

0..1

Reference(Practitioner | PractitionerRole)

There are no (further) constraints on this element

Element id

MedicationRequest.recorder

Short description

Person who entered the request

Definition

The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order.

Comments

Data type

Reference(Practitioner | PractitionerRole)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5: FiveWs.who
rim: .participation[typeCode=TRANS].role[classCode=ASSIGNED].code (HealthcareProviderType)

reasonCode

0..*

Element id

MedicationRequest.reasonCode

Short description

Concept - reference to a terminology or just text

Definition

A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Data type

MedicationReasonCode (preferred)

Binding

A coded concept indicating why the medication was ordered.

Additional bindings

PrescriptionIndicationForUse (candidate)
Commonly used reason for which a medication is being ordered reference set (foundation metadata concept)
HealthConditionCode (candidate)
A value set for health-related conditions which can be diagnoses, the results of a clinical observation or assessment of judgment

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
workflow: Request.reasonCode
script10.6: Message/Body/NewRx/MedicationPrescribed/Diagnosis/Primary/Value
w5: FiveWs.why[x]
v2: ORC-16-Order Control Code Reason /RXE-27-Give Indication/RXO-20-Indication / RXD-21-Indication / RXG-22-Indication / RXA-19-Indication
rim: reason.observation.reasonCode
CACDI: Medication Reason

Obligations

Code	Actor
MAY:populate-if-known	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/producer
SHALL:no-error	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/consumer

reasonReference

O C

0..*

Reference(Condition | Observation)

Element id

MedicationRequest.reasonReference

Short description

Condition or observation that supports why the prescription is being written

Definition

Condition or observation that supports why the medication was ordered.

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.

Data type

Reference(Condition | Observation)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Request.reasonReference
script10.6: no mapping
w5: FiveWs.why[x]
rim: reason.observation[code=ASSERTION].value
CACDI: Medication Reason

Obligations

Code	Actor
MAY:populate-if-known	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/producer
SHALL:no-error	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/consumer

instantiatesCanonical

0..*

canonical

There are no (further) constraints on this element

Element id

MedicationRequest.instantiatesCanonical

Short description

Instantiates FHIR protocol or definition

Definition

The URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest.

Comments

see Canonical References

Data type

canonical

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
workflow: Request.instantiates
rim: .outboundRelationship[typeCode=DEFN].target

instantiatesUri

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.instantiatesUri

Short description

Instantiates external protocol or definition

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.

Comments

see http://en.wikipedia.org/wiki/Uniform_resource_identifier

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
rim: .outboundRelationship[typeCode=DEFN].target

basedOn

Σ C

0..*

Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | ServiceRequest)

There are no (further) constraints on this element

Element id

MedicationRequest.basedOn

Short description

What request fulfills

Definition

A plan or request that is fulfilled in whole or in part by this medication request.

Comments

Data type

Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | ServiceRequest)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Request.basedOn
rim: .outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]

groupIdentifier

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.groupIdentifier

Short description

Composite request this is part of

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.

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.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd: Identifier
workflow: Request.groupIdentifier
rim: .outboundRelationship(typeCode=COMP].target[classCode=SBADM, moodCode=INT].id

courseOfTherapyType

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.courseOfTherapyType

Short description

Overall pattern of medication administration

Definition

The description of the overall patte3rn of the administration of the medication to the patient.

Comments

This attribute should not be confused with the protocol of the medication.

Data type

medicationRequest Course of Therapy Codes (example)

Binding

Identifies the overall pattern of medication administratio.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
rim: Act.code where classCode = LIST and moodCode = EVN

insurance

0..*

Reference(ClaimResponse | Coverage)

There are no (further) constraints on this element

Element id

MedicationRequest.insurance

Short description

Associated insurance coverage

Definition

Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service.

Comments

Data type

Reference(ClaimResponse | Coverage)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Request.insurance
rim: .outboundRelationship[typeCode=COVBY].target

note

0..*

Annotation

There are no (further) constraints on this element

Element id

MedicationRequest.note

Short description

Information about the prescription

Definition

Extra information about the prescription that could not be conveyed by the other attributes.

Comments

For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).

Data type

Annotation

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: N/A
rim: Act
workflow: Request.note
script10.6: Message/Body/NewRx/MedicationPrescribed/Note
rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=OBS,moodCode=EVN,code="annotation"].value

dosageInstruction

0..*

Dosage

Element id

MedicationRequest.dosageInstruction

Short description

How the medication should be taken

Definition

Indicates how the medication is to be used by the patient.

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.

Data type

Dosage

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
rim: .outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT]
workflow: Request.occurrence[x]
rim: see dosageInstruction mapping

Obligations

Code	Actor
MAY:populate-if-known	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/producer
SHALL:no-error	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/consumer

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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()

Mappings

rim: n/a
rim: N/A

modifierExtension

Σ ?! C

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.modifierExtension

Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

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).

Requirements

Comments

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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()

Mappings

rim: n/a
rim: N/A

sequence

0..1

integer

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.sequence

Short description

The order of the dosage instructions

Definition

Indicates the order in which the dosage instructions should be applied or interpreted.

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.

Comments

32 bit number; for values larger than this, use decimal

Data type

integer

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: TQ1-1
rim: .text

text

O Σ

0..1

Element id

MedicationRequest.dosageInstruction.text

Short description

Free text dosage instructions e.g. SIG

Definition

Free text dosage instructions e.g. SIG.

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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: RXO-6; RXE-21
rim: .text

Obligations

Code	Actor
MAY:populate-if-known	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/producer
SHALL:no-error	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/consumer

additionalInstruction

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.additionalInstruction

Short description

Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"

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").

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.

Data type

SNOMEDCTAdditionalDosageInstructions (example)

Binding

A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
v2: RXO-7
rim: .text

patientInstruction

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.patientInstruction

Short description

Patient or consumer oriented instructions

Definition

Instructions in terms that are understood by the patient or consumer.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data type

SNOMEDCTMedicationAsNeededReasonCodes (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: RXO-7
rim: .text

timing

0..1

Timing

Element id

MedicationRequest.dosageInstruction.timing

Short description

When medication should be administered

Definition

When medication should be administered.

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.

Data type

Timing

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: N/A
rim: QSET<TS> (GTS)
rim: .effectiveTime
CACDI: Medication Timing

asNeeded[x]

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.asNeeded[x]

Short description

Take "as needed" (for 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).

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".

Binding

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.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: TQ1-9
rim: .outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept

asNeededBoolean

There are no (further) constraints on this element

Data type

asNeededCodeableConcept

There are no (further) constraints on this element

Data type

site

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.site

Short description

Body site to administer to

Definition

Body site to administer to.

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.

Data type

SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example)

Binding

A coded concept describing the site location the medicine enters into or onto the body.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
v2: RXR-2
rim: .approachSiteCode

route

0..1

Element id

MedicationRequest.dosageInstruction.route

Short description

Concept - reference to a terminology or just text

Definition

A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.

Requirements

A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

Comments

Data type

RouteOfAdministration (preferred)

Binding

A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

Additional bindings

PrescriptionRouteOfAdministration (candidate)
Route of administration for the prescription from the PrescribeIT value set. Implementers should anticipate that data collected and or exchanged in the context of ePrescribing may contain concepts from this valueSet. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
v2: RXR-1
rim: .routeCode
CACDI: Medication Route of Administration

method

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.method

Short description

Technique for administering medication

Definition

Technique for administering medication.

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.

Data type

SNOMEDCTAdministrationMethodCodes (example)

Binding

A coded concept describing the technique by which the medicine is administered.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
v2: RXR-4
rim: .doseQuantity

doseAndRate

0..*

Element

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate

Short description

Amount of medication administered

Definition

The amount of medication administered.

Data type

Element

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: TQ1-2

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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()

Mappings

rim: n/a
rim: N/A

type

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.type

Short description

The kind of dose or rate specified

Definition

The kind of dose or rate specified, for example, ordered or calculated.

Requirements

If the type is not populated, assume to be "ordered".

Comments

Data type

Binding

The kind of dose or rate specified.

DoseAndRateType (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
v2: RXO-21; RXE-23

dose[x]

0..1

Element id

MedicationRequest.dosageInstruction.doseAndRate.dose[x]

Short description

Amount of medication per dose

Definition

Amount of medication per dose.

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.

Slicing

Unordered, Open, by $this(Type)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: RXO-2, RXE-3
rim: .doseQuantity

doseRange

There are no (further) constraints on this element

Data type

doseQuantity

Σ C

0..1

Element id

MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity

Short description

A fixed quantity (no comparator)

Definition

The comparator is not used on a SimpleQuantity

Requirements

The amount of therapeutic or other substance given at one administration event.

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
qty-3: If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists()
sqty-1: The comparator is not used on a SimpleQuantity
comparator.empty()

Mappings

rim: n/a
v2: RXO-2, RXE-3
rim: .doseQuantity
v2: SN (see also Range) or CQ
rim: PQ, IVL<PQ>, MO, CO, depending on the values

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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()

Mappings

rim: n/a
rim: N/A

value

0..1

decimal

Element id

MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.value

Short description

Numerical value (with implicit precision)

Definition

The value of the measured amount. The value includes an implicit precision in the presentation of the value.

Requirements

Precision is handled implicitly in almost all cases of measurement.

Comments

The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

Data type

decimal

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: SN.2 / CQ - N/A
rim: PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value
CACDI: Medication Dose Value

comparator

Σ ?!

0..0

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.comparator

Short description

< | <= | >= | > - how to understand the value

Definition

Not allowed to be used in this context

Requirements

Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Meaning when missing

If there is no comparator, then there is no modification of the value

Data type

Binding

How the Quantity should be understood and represented.

QuantityComparator (required)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: SN.1 / CQ.1
rim: IVL properties

unit

0..1

Element id

MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.unit

Short description

Unit representation

Definition

A human-readable form of the unit.

Requirements

There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: (see OBX.6 etc.) / CQ.2
rim: PQ.unit
CACDI: Medication Dose Unit of Measure

system

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.system

Short description

System that defines coded unit form

Definition

The identification of the system that provides the coded form of the unit.

Requirements

Need to know the system that defines the coded form of the unit.

Comments

see http://en.wikipedia.org/wiki/Uniform_resource_identifier

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1, qty-3

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: (see OBX.6 etc.) / CQ.2
rim: CO.codeSystem, PQ.translation.codeSystem

code

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.code

Short description

Coded form of the unit

Definition

A computer processable form of the unit in some unit representation system.

Requirements

Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

Comments

The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: (see OBX.6 etc.) / CQ.2
rim: PQ.code, MO.currency, PQ.translation.code

rate[x]

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.rate[x]

Short description

Amount of medication per unit of time

Definition

Amount of medication per unit of time.

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.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: RXE22, RXE23, RXE-24
rim: .rateQuantity

rateQuantity

There are no (further) constraints on this element

Data type

rateRange

There are no (further) constraints on this element

Data type

rateRatio

There are no (further) constraints on this element

Data type

maxDosePerPeriod

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.maxDosePerPeriod

Short description

Upper limit on medication per unit of time

Definition

Upper limit on medication per unit of time.

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".

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
rat-1: Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present
(numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists())

Mappings

rim: n/a
v2: N/A
rim: RTO
v2: RXO-23, RXE-19
rim: .maxDoseQuantity

maxDosePerAdministration

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.maxDosePerAdministration

Short description

Upper limit on medication per administration

Definition

Upper limit on medication per administration.

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.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
qty-3: If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists()
sqty-1: The comparator is not used on a SimpleQuantity
comparator.empty()

Mappings

rim: n/a
v2: SN (see also Range) or CQ
rim: PQ, IVL<PQ>, MO, CO, depending on the values
rim: not supported

maxDosePerLifetime

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.maxDosePerLifetime

Short description

Upper limit on medication per lifetime of the patient

Definition

Upper limit on medication per lifetime of the patient.

Requirements

The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
qty-3: If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists()
sqty-1: The comparator is not used on a SimpleQuantity
comparator.empty()

Mappings

rim: n/a
v2: SN (see also Range) or CQ
rim: PQ, IVL<PQ>, MO, CO, depending on the values
rim: not supported

dispenseRequest

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest

Short description

Medication supply authorization

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.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
script10.6: Message/Body/NewRx/MedicationPrescribed/ExpirationDate
rim: component.supplyEvent

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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()

Mappings

rim: n/a
rim: N/A

modifierExtension

Σ ?! C

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.modifierExtension

Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Comments

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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()

Mappings

rim: n/a
rim: N/A

initialFill

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.initialFill

Short description

First fill details

Definition

Indicates the quantity or duration for the first dispense of the medication.

Comments

If populating this element, either the quantity or the duration must be included.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
rim: SubstanceAdministration -> ActRelationship[sequenceNumber = '1'] -> Supply

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.initialFill.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.initialFill.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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()

Mappings

rim: n/a
rim: N/A

modifierExtension

Σ ?! C

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.initialFill.modifierExtension

Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Comments

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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()

Mappings

rim: n/a
rim: N/A

quantity

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.initialFill.quantity

Short description

First fill quantity

Definition

The amount or quantity to provide as part of the first dispense.

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
qty-3: If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists()
sqty-1: The comparator is not used on a SimpleQuantity
comparator.empty()

Mappings

rim: n/a
v2: SN (see also Range) or CQ
rim: PQ, IVL<PQ>, MO, CO, depending on the values
rim: Supply.quantity[moodCode=RQO]

duration

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.initialFill.duration

Short description

First fill duration

Definition

The length of time that the first dispense is expected to last.

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
qty-3: If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists()
drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM.
code.exists() implies ((system = %ucum) and value.exists())

Mappings

rim: n/a
v2: SN (see also Range) or CQ
rim: PQ, IVL<PQ>, MO, CO, depending on the values
rim: PQ, IVL<PQ> depending on the values
rim: Supply.effectivetime[moodCode=RQO]

dispenseInterval

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.dispenseInterval

Short description

Minimum period of time between dispenses

Definition

The minimum period of time that must occur between dispenses of the medication.

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
qty-3: If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists()
drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM.
code.exists() implies ((system = %ucum) and value.exists())

Mappings

rim: n/a
v2: SN (see also Range) or CQ
rim: PQ, IVL<PQ>, MO, CO, depending on the values
rim: PQ, IVL<PQ> depending on the values
rim: Supply.effectivetime[moodCode=RQO]

validityPeriod

0..1

Period

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.validityPeriod

Short description

Time period supply is authorized for

Definition

This indicates the validity period of a prescription (stale dating the Prescription).

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.

Data type

Period

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
per-1: If present, start SHALL have a lower value than end
start.hasValue().not() or end.hasValue().not() or (start <= end)

Mappings

rim: n/a
v2: DR
rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
script10.6: Message/Body/NewRx/MedicationPrescribed/Refills
rim: effectiveTime

numberOfRepeatsAllowed

0..1

unsignedInt

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.numberOfRepeatsAllowed

Short description

Number of refills authorized

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.

Comments

If displaying "number of authorized fills", add 1 to this number.

Data type

unsignedInt

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
script10.6: Message/Body/NewRx/MedicationPrescribed/Quantity
v2: RXE-12-Number of Refills
rim: repeatNumber

quantity

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.quantity

Short description

Amount of medication to supply per dispense

Definition

The amount that is to be dispensed for one fill.

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
qty-3: If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists()
sqty-1: The comparator is not used on a SimpleQuantity
comparator.empty()

Mappings

rim: n/a
v2: SN (see also Range) or CQ
rim: PQ, IVL<PQ>, MO, CO, depending on the values
script10.6: Message/Body/NewRx/MedicationPrescribed/DaysSupply
v2: RXD-4-Actual Dispense Amount / RXD-5.1-Actual Dispense Units.code / RXD-5.3-Actual Dispense Units.name of coding system
rim: quantity

expectedSupplyDuration

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.expectedSupplyDuration

Short description

Number of days supply per dispense

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.

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.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
qty-3: If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists()
drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM.
code.exists() implies ((system = %ucum) and value.exists())

Mappings

rim: n/a
v2: SN (see also Range) or CQ
rim: PQ, IVL<PQ>, MO, CO, depending on the values
rim: PQ, IVL<PQ> depending on the values
script10.6: Message/Body/NewRx/MedicationPrescribed/Substitutions
rim: expectedUseTime

performer

0..1

Reference(Organization)

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer

Short description

Intended dispenser

Definition

Indicates the intended dispensing Organization specified by the prescriber.

Comments

Data type

Reference(Organization)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5: FiveWs.who
rim: .outboundRelationship[typeCode=COMP].target[classCode=SPLY, moodCode=RQO] .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]

substitution

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.substitution

Short description

Any restrictions on medication 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.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
script10.6: specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions
rim: subjectOf.substitutionPersmission

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.substitution.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.substitution.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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()

Mappings

rim: n/a
rim: N/A

modifierExtension

Σ ?! C

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.substitution.modifierExtension

Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Comments

Data type

ActSubstanceAdminSubstitutionCode (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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()

Mappings

rim: n/a
rim: N/A

allowed[x]

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.substitution.allowed[x]

Short description

Whether substitution is allowed or not

Definition

True if the prescriber allows a different drug to be dispensed from what was prescribed.

Comments

This element is labeled as a modifier because whether substitution is allow or not, it cannot be ignored.

Binding

Identifies the type of substitution allowed.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
script10.6: specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions
v2: RXO-9-Allow Substitutions / RXE-9-Substitution Status
rim: code

allowedBoolean

There are no (further) constraints on this element

Data type

allowedCodeableConcept

There are no (further) constraints on this element

Data type

reason

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.substitution.reason

Short description

Why should (not) substitution be made

Definition

Indicates the reason for the substitution, or why substitution must or must not be performed.

Comments

Data type

SubstanceAdminSubstitutionReason (example)

Binding

A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
script10.6: not mapped
v2: RXE-9 Substition status
rim: reasonCode

priorPrescription

0..1

Reference(MedicationRequest)

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription

Short description

An order/prescription that is being replaced

Definition

A link to a resource representing an earlier order related order or prescription.

Comments

Data type

Reference(MedicationRequest)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Request.replaces
script10.6: not mapped
rim: .outboundRelationship[typeCode=?RPLC or ?SUCC]/target[classCode=SBADM,moodCode=RQO]

detectedIssue

0..*

Reference(DetectedIssue)

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue

Short description

Clinical Issue with action

Alternate names

Contraindication, Drug Utilization Review (DUR), Alert

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.

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.

Data type

Reference(DetectedIssue)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=ALRT,moodCode=EVN].value

eventHistory

0..*

Reference(Provenance)

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory

Short description

A list of events of interest in the lifecycle

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.

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.).

Data type

Reference(Provenance)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Request.relevantHistory
rim: .inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]

MedicationRequestCACore (MedicationRequest)

MedicationRequest

extension

There are no (further) constraints on this element

Element id

MedicationRequest.extension

Slicing

Unordered, Open, by url(Value)

RenderedDosageInstruction

0..1

Extension(string)

There are no (further) constraints on this element

Element id

MedicationRequest.extension:RenderedDosageInstruction

Short description

Extension for representing rendered dosage instruction.

Definition

Comments

Data type

Extension(string)

Extension URL

MedicationRenderedDosage

medication[x]

There are no (further) constraints on this element

Element id

MedicationRequest.medication[x]

Comments

Slicing

Unordered, Open, by $this(Type)

Obligations

Code	Actor
SHALL:populate-if-known	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/producer
SHALL:no-error	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/consumer

medicationReference

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.medication[x]:medicationReference

Data type

medicationCodeableConcept

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.medication[x]:medicationCodeableConcept

Comments

The preferred binding on this element is to use Canadian Clinical Drug Data Set (CCDD).

Data type

PrescriptionMedicinalProduct (preferred)

Binding

Additional bindings

LicensedNaturalHealthProducts (candidate)
ValueSet for licensed natural health products
WhoAtcUvIps (candidate)
per pCHDCF: Can be used for the international use case where a medication is not available in Canada and therefore does not appear in the recommended pan-Canadian value sets. ATC is the recommended supporting classification for reporting and analysis
PharmaceuticalBiologicProductAndSubstanceCode (candidate)
per PCHDCF: The alternate value set can be used for the international use case where the medication is not available in Canada and therefore does not appear in the recommended pan-Canadian value sets
DINvs (candidate)
A Drug Identification Number (DIN) is a computer-generated eight digit number assigned by Health Canada to a drug product prior to being marketed in Canada. It uniquely identifies all drug products sold in a dosage form in Canada

Mappings

CACDI: Medication

coding

system

There are no (further) constraints on this element

Element id

MedicationRequest.medication[x]:medicationCodeableConcept.coding.system

Mappings

CACDI: Drug Code System URI

display

There are no (further) constraints on this element

Element id

MedicationRequest.medication[x]:medicationCodeableConcept.coding.display

Mappings

CACDI: Drug English Description
CACDI: Drug French Description

subject

There are no (further) constraints on this element

Element id

MedicationRequest.subject

Data type

reference

1..

There are no (further) constraints on this element

Element id

MedicationRequest.subject.reference

reasonCode

There are no (further) constraints on this element

Element id

MedicationRequest.reasonCode

Data type

MedicationReasonCode (preferred)

Binding

Additional bindings

PrescriptionIndicationForUse (candidate)
Commonly used reason for which a medication is being ordered reference set (foundation metadata concept)
HealthConditionCode (candidate)
A value set for health-related conditions which can be diagnoses, the results of a clinical observation or assessment of judgment

Mappings

CACDI: Medication Reason

Obligations

Code	Actor
MAY:populate-if-known	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/producer
SHALL:no-error	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/consumer

reasonReference

There are no (further) constraints on this element

Element id

MedicationRequest.reasonReference

Mappings

CACDI: Medication Reason

Obligations

Code	Actor
MAY:populate-if-known	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/producer
SHALL:no-error	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/consumer

dosageInstruction

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction

Obligations

Code	Actor
MAY:populate-if-known	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/producer
SHALL:no-error	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/consumer

text

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.text

Obligations

Code	Actor
MAY:populate-if-known	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/producer
SHALL:no-error	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/consumer

timing

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing

Mappings

CACDI: Medication Timing

route

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.route

Data type

RouteOfAdministration (preferred)

Binding

Additional bindings

PrescriptionRouteOfAdministration (candidate)
Route of administration for the prescription from the PrescribeIT value set. Implementers should anticipate that data collected and or exchanged in the context of ePrescribing may contain concepts from this valueSet. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology.

Mappings

CACDI: Medication Route of Administration

doseAndRate

dose[x]

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.dose[x]

Slicing

Unordered, Open, by $this(Type)

doseQuantity

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity

Data type