HdBe-InstructionsForUse
| Profile | Description | Status | URL |
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| HdBe-InstructionsForUse.DosageInstructions | Instructions for the use or administration of the medication, e.g. dose and route of administration. In the event of medication use, this is the pattern of use established by the patient or which the patient followed. | draft | https://fhir.healthdata.be/StructureDefinition/HdBe-InstructionsForUse.DosageInstructions |
| Instructions |
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This element mostly represents the DosingInstructions container from CBB InstructionsForUse, but also includes the AdditionalInstructions and RouteOfAdministration concepts, which are normally placed on the same level as this container. As a result, these concepts are duplicated in every repetition of this element, even though these concepts should be present just once according to the CBB. The RepeatPeriodCyclicalSchedule and Description elements of the CBB are not represented in this profile. When a HdBe profile contains a InstructionsForUse.DosageInstructions datatype, the RepeatPeriodCyclicalSchedule and Description elements are separately added to this profile as well. This element does not contain a mapping to the Dosage container from CBB InstructionsForUse. However, the child concepts of Dosage are all mapped. Multiple Dosage instances are represented by another DosingInstructions that contains a similiar SequenceNumber. |
| Dosage | Dosage | Element idDosage DosingInstructions Alternate namesDoseerinstructie DefinitionIndicates how the medication is/was taken or should be taken by the patient. This element mostly represents the DosingInstructions container from CBB InstructionsForUse, but also includes the AdditionalInstructions and RouteOfAdministration concepts, which are normally placed on the same level as this container. As a result, these concepts are duplicated in every repetition of this element, even though these concepts should be present just once according to the CBB. The RepeatPeriodCyclicalSchedule and Description elements of the CBB are not represented in this profile. When a HdBe profile contains a InstructionsForUse.DosageInstructions datatype, the RepeatPeriodCyclicalSchedule and Description elements are separately added to this profile as well. This element does not contain a mapping to the Dosage container from CBB InstructionsForUse. However, the child concepts of Dosage are all mapped. Multiple Dosage instances are represented by another DosingInstructions that contains a similiar SequenceNumber.
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| sequence | Σ | 0..1 | integer | Element idDosage.sequence SequenceNumber Alternate namesVolgnummer DefinitionThis indicates the sequence of the dosing instructions within the medication agreement. 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. 32 bit number; for values larger than this, use decimal
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| text | Σ | 0..1 | string | There are no (further) constraints on this element Element idDosage.text Free text dosage instructions e.g. SIG DefinitionFree text dosage instructions e.g. SIG. 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. Note that FHIR strings SHALL NOT exceed 1MB in size
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| additionalInstruction | Σ | 0..* | CodeableConcept | Element idDosage.additionalInstruction AdditionalInstructions Alternate namesAanvullendeInstructie DefinitionThe additional instructions contain extra information on the use of the current prescription. This includes all instructions for use. The text can come from the original “paper" medication prescription, but can also be generated from the coded information. This concept may contain more information than what is structurally coded in the information below, but may not conflict with it. The instructions may not conflict with other components of the request for administration. The instructions can also refer to an existing protocol. 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. Please note that in contrast to the CBB, this AdditionalInstructions concept is grouped under the DosingInstructions concept. This CBB concept should thus be duplicated when there are multiple DosingInstructions. A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
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| patientInstruction | Σ | 0..1 | string | There are no (further) constraints on this element Element idDosage.patientInstruction Patient or consumer oriented instructions DefinitionInstructions in terms that are understood by the patient or consumer. Note that FHIR strings SHALL NOT exceed 1MB in size
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| timing | Σ | 0..1 | Timing | Element idDosage.timing AdministeringSchedule Alternate namesToedieningsschema DefinitionSpecifications of the times at which the medication is to be administered. This is indicated as follows:
If a certain medication is not to be taken daily, the aforementioned can be combined with daily indications:
The specified administration “infinite” is automatically to be repeated until:
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. 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.
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.timing.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.timing.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.timing.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| event | Σ | 0..* | dateTime | There are no (further) constraints on this element Element idDosage.timing.event When the event occurs DefinitionIdentifies specific times when the event occurs. In a Medication Administration Record, for instance, you need to take a general specification, and turn it into a precise specification.
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| repeat | Σ I | 0..1 | Element | There are no (further) constraints on this element Element idDosage.timing.repeat When the event is to occur DefinitionA set of rules that describe when the event is scheduled. Many timing schedules are determined by regular repetitions.
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.timing.repeat.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.timing.repeat.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| timingExact | I | 0..1 | Extension(boolean) | Element idDosage.timing.repeat.extension:timingExact Whether specified times must be followed as closely as possible Alternate namesextensions, user content DefinitionIf true, indicates that the specified times, frequencies, periods are expected to be adhered to as precisely as possible. If false, indicates that a typical degree of variability based on institutional and/or patient convenience is acceptable. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. http://hl7.org/fhir/StructureDefinition/timing-exact Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.timing.repeat.extension:timingExact.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..0 | Extension | There are no (further) constraints on this element Element idDosage.timing.repeat.extension:timingExact.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| url | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idDosage.timing.repeat.extension:timingExact.url identifies the meaning of the extension DefinitionSource of the definition for the extension code - a logical name or a URL. The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. http://hl7.org/fhir/StructureDefinition/timing-exact
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| value[x] | 1..1 | Element idDosage.timing.repeat.extension:timingExact.value[x] Value of extension DefinitionIndicates that the timing as specified by The times can be chosen freely, but distribution throughout the day is more precise, and the interval between times is important (e.g. in the case of antibiotics) In the case of Baxter packs and intramural care, such a prescription is used to draw up a (location-specific) outline for distribution times (logistics). Notes on the CBB concepts Frequency and Interval:
In summary:
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| valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
| bounds[x] | Σ | 0..1 | Element idDosage.timing.repeat.bounds[x] Length/Range of lengths, or (Start and/or end) limits DefinitionEither a duration for the length of the timing schedule, a range of possible length, or outer bounds for start and/or end limits of the timing schedule. Unordered, Open, by $this(Type) Constraints
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| boundsRange | Range | There are no (further) constraints on this element Data type | ||
| boundsPeriod | Period | There are no (further) constraints on this element Data type | ||
| boundsDuration | Σ | 0..1 | Duration | Element idDosage.timing.repeat.bounds[x]:boundsDuration DoseDuration Alternate namesDoseerduur DefinitionThe intended time duration for these dosing instructions, e.g. 5 days or 8 weeks. In the case of medication for an indefinite period, the dosing duration is left empty in the last dosing instruction.
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| count | Σ | 0..1 | positiveInt | Element idDosage.timing.repeat.count Frequency / minimumValue / nominalValue Alternate namesFrequentie, nominaleWaarde, minimumWaarde DefinitionUsually, frequency comprises both amount and time unit (3 times a day), but it can occur without the time unit (single use). This is represented by this A reasonable distribution over the day is expected, but exact times are not given. This is left to the patient. It is the most common manner of extramural prescription. In the case of Baxter packs and intramural care, such a prescription is used to draw up a (location-specific) outline for distribution times (logistics). Repetitions may be limited by end time or total occurrences. Notes on the CBB concepts Frequency and Interval:
In summary:
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| countMax | Σ | 0..1 | positiveInt | Element idDosage.timing.repeat.countMax Frequency / maximumValue Alternate namesFrequentie, maximumWaarde DefinitionUsually, frequency comprises both amount and time unit (3 times a day), but it can occur without the time unit (single use). This is represented by the A reasonable distribution over the day is expected, but exact times are not given. This is left to the patient. It is the most common manner of extramural prescription. In the case of Baxter packs and intramural care, such a prescription is used to draw up a (location-specific) outline for distribution times (logistics). Notes on the CBB concepts Frequency and Interval:
In summary:
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| duration | Σ | 0..1 | decimal | Element idDosage.timing.repeat.duration DurationOfAdministration Alternate namesToedieningsduur DefinitionThe duration of administration defines the length of time during which the drug is administered and is mainly used in the slow parenteral administration of fluids. The Some activities are not instantaneous and need to be maintained for a period of time. For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).
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| durationMax | Σ | 0..1 | decimal | There are no (further) constraints on this element Element idDosage.timing.repeat.durationMax How long when it happens (Max) DefinitionIf present, indicates that the duration is a range - so to perform the action between [duration] and [durationMax] time length. Some activities are not instantaneous and need to be maintained for a period of time. For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).
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| durationUnit | Σ | 0..1 | codeBinding | Element idDosage.timing.repeat.durationUnit DurationOfAdministration Alternate namesToedieningsduur DefinitionThe units of time, in UCUM units, for the duration of administration of time during which the drug is administered. Note that FHIR strings SHALL NOT exceed 1MB in size A unit of time (units from UCUM).
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| frequency | Σ | 0..1 | positiveInt | Element idDosage.timing.repeat.frequency Frequency / minimumValue / nominalValue / Interval Alternate namesFrequentie, minimumWaarde, nominaleWaarde, Interval DefinitionThe number of times to repeat the action within the specified period. If frequencyMax is present, this element indicates the lower bound of the allowed range of the frequency. If the If the Notes on the CBB concepts Frequency and Interval:
In summary:
If no frequency is stated, the assumption is that the event occurs once per period, but systems SHOULD always be specific about this
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| frequencyMax | Σ | 0..1 | positiveInt | Element idDosage.timing.repeat.frequencyMax Frequency / maximumValue Alternate namesmaximumWaarde, Frequentie DefinitionIf present, indicates that the frequency is a range - so to repeat between [frequency] and [frequencyMax] times within the period or period range. If the If the Notes on the CBB concepts Frequency and Interval:
In summary:
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| period | Σ | 0..1 | decimal | Element idDosage.timing.repeat.period Frequency / Interval Alternate namesFrequentie, Interval DefinitionIndicates the duration of time over which repetitions are to occur; e.g. to express "3 times per day", 3 would be the frequency and "1 day" would be the period. If periodMax is present, this element indicates the lower bound of the allowed range of the period length. If the If the Notes on the CBB concepts Frequency and Interval:
In summary:
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| periodMax | Σ | 0..1 | decimal | There are no (further) constraints on this element Element idDosage.timing.repeat.periodMax Upper limit of period (3-4 hours) DefinitionIf present, indicates that the period is a range from [period] to [periodMax], allowing expressing concepts such as "do this once every 3-5 days. Do not use an IEEE type floating point type, instead use something that works like a true decimal, with inbuilt precision (e.g. Java BigInteger)
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| periodUnit | Σ | 0..1 | codeBinding | Element idDosage.timing.repeat.periodUnit Frequency / Interval Alternate namesFrequentie, Interval DefinitionThe units of time for the period in UCUM units for Frequency and Interval. If the If the Notes on the CBB concepts Frequency and Interval:
In summary:
A unit of time (units from UCUM).
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| dayOfWeek | Σ | 0..* | codeBinding | Element idDosage.timing.repeat.dayOfWeek WeekDay Alternate namesWeekdag DefinitionWeekDay indicates a pattern of doses on fixed week days. If no days are specified, the action is assumed to happen every day as otherwise specified. Use ConceptMap 'WeekDay_to_DaysOfWeek' to translate CBB terminology to profile terminology in ValueSet 'DaysOfWeek.' Permitted Values Constraints
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| timeOfDay | Σ | 0..* | time | Element idDosage.timing.repeat.timeOfDay AdministrationTime Alternate namesToedientijd DefinitionThe time of administration is a specific time of day (on the clock). This time usually isn’t (intended to be) exact. There can be multiple administering times in one day. The ideal time of administration can also be entered as a time of day (morning, afternoon, evening, night-time). The administration time is then to be left empty, and the time of day can be entered in the TimeOfDay concept. If there's a timeOfDay, there cannot be a when, or vice versa.
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| when | Σ | 0..* | codeBinding | Element idDosage.timing.repeat.when TimeOfDay Alternate namesDagdeel DefinitionTime of day: morning, afternoon, evening, night. Timings are frequently determined by occurrences such as waking, eating and sleep. When more than one event is listed, the event is tied to the union of the specified events. Use ConceptMap 'TimeOfDay_to_EventTiming' to translate CBB terminology to profile terminology in ValueSet 'EventTiming.' Permitted Values Constraints
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| offset | Σ | 0..1 | unsignedInt | There are no (further) constraints on this element Element idDosage.timing.repeat.offset Minutes from event (before or after) DefinitionThe number of minutes from the event. If the event code does not indicate whether the minutes is before or after the event, then the offset is assumed to be after the event. 32 bit number; for values larger than this, use decimal
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| code | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idDosage.timing.code BID | TID | QID | AM | PM | QD | QOD | + DefinitionA code for the timing schedule (or just text in code.text). Some codes such as BID are ubiquitous, but many institutions define their own additional codes. If a code is provided, the code is understood to be a complete statement of whatever is specified in the structured timing data, and either the code or the data may be used to interpret the Timing, with the exception that .repeat.bounds still applies over the code (and is not contained in the code). BID etc. are defined as 'at institutionally specified times'. For example, an institution may choose that BID is "always at 7am and 6pm". If it is inappropriate for this choice to be made, the code BID should not be used. Instead, a distinct organization-specific code should be used in place of the HL7-defined BID code and/or a structured representation should be used (in this case, specifying the two event times). Code for a known / defined timing pattern.
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| asNeeded[x] | Σ | 0..1 | Element idDosage.asNeeded[x] Take "as needed" (for x) DefinitionIndicates 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). 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". Unordered, Open, by $this(Type) BindingA 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.
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| asNeededBoolean | boolean | There are no (further) constraints on this element Data type | ||
| asNeededCodeableConcept | Σ | 0..1 | CodeableConceptBinding | Element idDosage.asNeeded[x]:asNeededCodeableConcept Condition Alternate namesCriterium DefinitionThe condition for administering medication can be:
Physiological measurement values or other conditions do not need to be coded. These can be expressed in free text in the Description concept. 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". 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.
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| site | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idDosage.site Body site to administer to DefinitionBody site to administer to. A coded specification of the anatomic site where the medication first enters the body. 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. A coded concept describing the site location the medicine enters into or onto the body.
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| route | Σ | 0..1 | CodeableConceptBinding | Element idDosage.route RouteOfAdministration Alternate namesToedieningsweg DefinitionThe route through which the medication is administered (oral, nasal, intravenous, etc.). A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body. Please note that in contrast to the CBB, this RouteOfAdministration concept is grouped under the DosingInstructions concept. This CBB concept should thus be duplicated when there are multiple DosingInstructions. A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
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| method | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idDosage.method Technique for administering medication DefinitionTechnique for administering medication. 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. Terminologies used often pre-coordinate this term with the route and or form of administration. A coded concept describing the technique by which the medicine is administered.
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| doseAndRate | Σ | 0..* | Element | Element idDosage.doseAndRate Dosage Alternate namesDosering DefinitionInstructions for the administrator to administer the medication (the patient themselves, a nurse or other aid). When taking stock of medication use, the dosage describes the pattern of use established by the patient. Once the dose schedule (distribution of doses over time) and the dose have been determined, then there should be one single instruction for use. Multiple parallel instructions for use can be included in the event of a changing dose within one day and in the event of a variable use frequency. Multiple sequential instructions for use can be included in the event of changing doses within one period and/or in the event of a changing dose schedule. DurationOfAdministration is not mapped to this element but to
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.doseAndRate.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.doseAndRate.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| type | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idDosage.doseAndRate.type The kind of dose or rate specified DefinitionThe kind of dose or rate specified, for example, ordered or calculated. If the type is not populated, assume to be "ordered". 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. The kind of dose or rate specified.
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| dose[x] | Σ | 0..1 | Element idDosage.doseAndRate.dose[x] Dose Alternate namesKeerdosis DefinitionThe dose indicates the amount/unit per administration. The unit can be any unit that can occur with this particular medicine. The amount of therapeutic or other substance given at one administration event. 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. Unordered, Open, by $this(Type) Constraints
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| doseRange | Σ | 0..1 | Range | Element idDosage.doseAndRate.dose[x]:doseRange Amount of medication per dose DefinitionAmount of medication per dose. The amount of therapeutic or other substance given at one administration event. 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.
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.doseAndRate.dose[x]:doseRange.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.doseAndRate.dose[x]:doseRange.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| low | Σ I | 0..1 | SimpleQuantity | Element idDosage.doseAndRate.dose[x]:doseRange.low minimumValue Alternate namesminimumWaarde DefinitionThe minimal value of the range. The boundary is inclusive. If the low element is missing, the low boundary is not known.
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| high | Σ I | 0..1 | SimpleQuantity | Element idDosage.doseAndRate.dose[x]:doseRange.high maximumValue Alternate namesmaximumWaarde DefinitionThe maximum value of the range. The boundary is inclusive. If the high element is missing, the high boundary is not known.
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| doseQuantity | Σ | 0..1 | SimpleQuantity | Element idDosage.doseAndRate.dose[x]:doseQuantity nominalValue Alternate namesnominaleWaarde DefinitionAmount of medication per dose. The nominal value of the quantity. The amount of therapeutic or other substance given at one administration event. 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.
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| rate[x] | Σ | 0..1 | Element idDosage.doseAndRate.rate[x] AdministeringSpeed Alternate namesToedieningssnelheid DefinitionThe administering speed is used in slow administration of liquid. In practice, the measuring unit is almost always ml/hour. Entering an interval (such as 0-10 ml/hour) is also a commonly used option. For example, with an administering speed of 10ml/hour:
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. 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. Unordered, Open, by $this(Type) Constraints
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| rateRatio | Ratio | There are no (further) constraints on this element Data type | ||
| rateRange | Σ | 0..1 | Range | Element idDosage.doseAndRate.rate[x]:rateRange Amount of medication per unit of time DefinitionAmount of medication per unit of time. 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. 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.
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.doseAndRate.rate[x]:rateRange.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.doseAndRate.rate[x]:rateRange.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| low | Σ I | 0..1 | SimpleQuantity | Element idDosage.doseAndRate.rate[x]:rateRange.low minimumValue Alternate namesminimumWaarde DefinitionThe minimal value of the range. The boundary is inclusive. If the low element is missing, the low boundary is not known.
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| high | Σ I | 0..1 | SimpleQuantity | Element idDosage.doseAndRate.rate[x]:rateRange.high maximumValue Alternate namesmaximumWaarde DefinitionThe maximum value of the range. The boundary is inclusive. If the high element is missing, the high boundary is not known.
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| rateQuantity | Σ | 0..1 | SimpleQuantity | Element idDosage.doseAndRate.rate[x]:rateQuantity nominalValue Alternate namesnominaleWaarde DefinitionThe nominal value of the quantity. 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. 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.
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| maxDosePerPeriod | Σ I | 0..1 | Ratio | Element idDosage.maxDosePerPeriod MaximumDose Alternate namesMaximaleDosering DefinitionA maximum dose maximizes (in time) the usage of a drug in an 'as needed' prescription. 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. 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".
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| maxDosePerAdministration | Σ I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idDosage.maxDosePerAdministration Upper limit on medication per administration DefinitionUpper limit on medication per administration. The maximum total quantity of a therapeutic substance that may be administered to a subject per administration. 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.
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| maxDosePerLifetime | Σ I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idDosage.maxDosePerLifetime Upper limit on medication per lifetime of the patient DefinitionUpper limit on medication per lifetime of the patient. The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject. 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.
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| Dosage | Dosage | Element idDosage DosingInstructions Alternate namesDoseerinstructie DefinitionIndicates how the medication is/was taken or should be taken by the patient. This element mostly represents the DosingInstructions container from CBB InstructionsForUse, but also includes the AdditionalInstructions and RouteOfAdministration concepts, which are normally placed on the same level as this container. As a result, these concepts are duplicated in every repetition of this element, even though these concepts should be present just once according to the CBB. The RepeatPeriodCyclicalSchedule and Description elements of the CBB are not represented in this profile. When a HdBe profile contains a InstructionsForUse.DosageInstructions datatype, the RepeatPeriodCyclicalSchedule and Description elements are separately added to this profile as well. This element does not contain a mapping to the Dosage container from CBB InstructionsForUse. However, the child concepts of Dosage are all mapped. Multiple Dosage instances are represented by another DosingInstructions that contains a similiar SequenceNumber.
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| sequence | Σ | 0..1 | integer | Element idDosage.sequence SequenceNumber Alternate namesVolgnummer DefinitionThis indicates the sequence of the dosing instructions within the medication agreement. 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. 32 bit number; for values larger than this, use decimal
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| text | Σ | 0..1 | string | There are no (further) constraints on this element Element idDosage.text Free text dosage instructions e.g. SIG DefinitionFree text dosage instructions e.g. SIG. 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. Note that FHIR strings SHALL NOT exceed 1MB in size
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| additionalInstruction | Σ | 0..* | CodeableConcept | Element idDosage.additionalInstruction AdditionalInstructions Alternate namesAanvullendeInstructie DefinitionThe additional instructions contain extra information on the use of the current prescription. This includes all instructions for use. The text can come from the original “paper" medication prescription, but can also be generated from the coded information. This concept may contain more information than what is structurally coded in the information below, but may not conflict with it. The instructions may not conflict with other components of the request for administration. The instructions can also refer to an existing protocol. 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. Please note that in contrast to the CBB, this AdditionalInstructions concept is grouped under the DosingInstructions concept. This CBB concept should thus be duplicated when there are multiple DosingInstructions. A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
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| patientInstruction | Σ | 0..1 | string | There are no (further) constraints on this element Element idDosage.patientInstruction Patient or consumer oriented instructions DefinitionInstructions in terms that are understood by the patient or consumer. Note that FHIR strings SHALL NOT exceed 1MB in size
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| timing | Σ | 0..1 | Timing | Element idDosage.timing AdministeringSchedule Alternate namesToedieningsschema DefinitionSpecifications of the times at which the medication is to be administered. This is indicated as follows:
If a certain medication is not to be taken daily, the aforementioned can be combined with daily indications:
The specified administration “infinite” is automatically to be repeated until:
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. 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.
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.timing.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.timing.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.timing.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| event | Σ | 0..* | dateTime | There are no (further) constraints on this element Element idDosage.timing.event When the event occurs DefinitionIdentifies specific times when the event occurs. In a Medication Administration Record, for instance, you need to take a general specification, and turn it into a precise specification.
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| repeat | Σ I | 0..1 | Element | There are no (further) constraints on this element Element idDosage.timing.repeat When the event is to occur DefinitionA set of rules that describe when the event is scheduled. Many timing schedules are determined by regular repetitions.
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.timing.repeat.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.timing.repeat.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| timingExact | I | 0..1 | Extension(boolean) | Element idDosage.timing.repeat.extension:timingExact Whether specified times must be followed as closely as possible Alternate namesextensions, user content DefinitionIf true, indicates that the specified times, frequencies, periods are expected to be adhered to as precisely as possible. If false, indicates that a typical degree of variability based on institutional and/or patient convenience is acceptable. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. http://hl7.org/fhir/StructureDefinition/timing-exact Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.timing.repeat.extension:timingExact.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..0 | Extension | There are no (further) constraints on this element Element idDosage.timing.repeat.extension:timingExact.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| url | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idDosage.timing.repeat.extension:timingExact.url identifies the meaning of the extension DefinitionSource of the definition for the extension code - a logical name or a URL. The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. http://hl7.org/fhir/StructureDefinition/timing-exact
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| value[x] | 1..1 | Element idDosage.timing.repeat.extension:timingExact.value[x] Value of extension DefinitionIndicates that the timing as specified by The times can be chosen freely, but distribution throughout the day is more precise, and the interval between times is important (e.g. in the case of antibiotics) In the case of Baxter packs and intramural care, such a prescription is used to draw up a (location-specific) outline for distribution times (logistics). Notes on the CBB concepts Frequency and Interval:
In summary:
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| valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
| bounds[x] | Σ | 0..1 | Element idDosage.timing.repeat.bounds[x] Length/Range of lengths, or (Start and/or end) limits DefinitionEither a duration for the length of the timing schedule, a range of possible length, or outer bounds for start and/or end limits of the timing schedule. Unordered, Open, by $this(Type) Constraints
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| boundsRange | Range | There are no (further) constraints on this element Data type | ||
| boundsPeriod | Period | There are no (further) constraints on this element Data type | ||
| boundsDuration | Σ | 0..1 | Duration | Element idDosage.timing.repeat.bounds[x]:boundsDuration DoseDuration Alternate namesDoseerduur DefinitionThe intended time duration for these dosing instructions, e.g. 5 days or 8 weeks. In the case of medication for an indefinite period, the dosing duration is left empty in the last dosing instruction.
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| count | Σ | 0..1 | positiveInt | Element idDosage.timing.repeat.count Frequency / minimumValue / nominalValue Alternate namesFrequentie, nominaleWaarde, minimumWaarde DefinitionUsually, frequency comprises both amount and time unit (3 times a day), but it can occur without the time unit (single use). This is represented by this A reasonable distribution over the day is expected, but exact times are not given. This is left to the patient. It is the most common manner of extramural prescription. In the case of Baxter packs and intramural care, such a prescription is used to draw up a (location-specific) outline for distribution times (logistics). Repetitions may be limited by end time or total occurrences. Notes on the CBB concepts Frequency and Interval:
In summary:
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| countMax | Σ | 0..1 | positiveInt | Element idDosage.timing.repeat.countMax Frequency / maximumValue Alternate namesFrequentie, maximumWaarde DefinitionUsually, frequency comprises both amount and time unit (3 times a day), but it can occur without the time unit (single use). This is represented by the A reasonable distribution over the day is expected, but exact times are not given. This is left to the patient. It is the most common manner of extramural prescription. In the case of Baxter packs and intramural care, such a prescription is used to draw up a (location-specific) outline for distribution times (logistics). Notes on the CBB concepts Frequency and Interval:
In summary:
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| duration | Σ | 0..1 | decimal | Element idDosage.timing.repeat.duration DurationOfAdministration Alternate namesToedieningsduur DefinitionThe duration of administration defines the length of time during which the drug is administered and is mainly used in the slow parenteral administration of fluids. The Some activities are not instantaneous and need to be maintained for a period of time. For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).
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| durationMax | Σ | 0..1 | decimal | There are no (further) constraints on this element Element idDosage.timing.repeat.durationMax How long when it happens (Max) DefinitionIf present, indicates that the duration is a range - so to perform the action between [duration] and [durationMax] time length. Some activities are not instantaneous and need to be maintained for a period of time. For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).
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| durationUnit | Σ | 0..1 | codeBinding | Element idDosage.timing.repeat.durationUnit DurationOfAdministration Alternate namesToedieningsduur DefinitionThe units of time, in UCUM units, for the duration of administration of time during which the drug is administered. Note that FHIR strings SHALL NOT exceed 1MB in size A unit of time (units from UCUM).
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| frequency | Σ | 0..1 | positiveInt | Element idDosage.timing.repeat.frequency Frequency / minimumValue / nominalValue / Interval Alternate namesFrequentie, minimumWaarde, nominaleWaarde, Interval DefinitionThe number of times to repeat the action within the specified period. If frequencyMax is present, this element indicates the lower bound of the allowed range of the frequency. If the If the Notes on the CBB concepts Frequency and Interval:
In summary:
If no frequency is stated, the assumption is that the event occurs once per period, but systems SHOULD always be specific about this
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| frequencyMax | Σ | 0..1 | positiveInt | Element idDosage.timing.repeat.frequencyMax Frequency / maximumValue Alternate namesmaximumWaarde, Frequentie DefinitionIf present, indicates that the frequency is a range - so to repeat between [frequency] and [frequencyMax] times within the period or period range. If the If the Notes on the CBB concepts Frequency and Interval:
In summary:
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| period | Σ | 0..1 | decimal | Element idDosage.timing.repeat.period Frequency / Interval Alternate namesFrequentie, Interval DefinitionIndicates the duration of time over which repetitions are to occur; e.g. to express "3 times per day", 3 would be the frequency and "1 day" would be the period. If periodMax is present, this element indicates the lower bound of the allowed range of the period length. If the If the Notes on the CBB concepts Frequency and Interval:
In summary:
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| periodMax | Σ | 0..1 | decimal | There are no (further) constraints on this element Element idDosage.timing.repeat.periodMax Upper limit of period (3-4 hours) DefinitionIf present, indicates that the period is a range from [period] to [periodMax], allowing expressing concepts such as "do this once every 3-5 days. Do not use an IEEE type floating point type, instead use something that works like a true decimal, with inbuilt precision (e.g. Java BigInteger)
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| periodUnit | Σ | 0..1 | codeBinding | Element idDosage.timing.repeat.periodUnit Frequency / Interval Alternate namesFrequentie, Interval DefinitionThe units of time for the period in UCUM units for Frequency and Interval. If the If the Notes on the CBB concepts Frequency and Interval:
In summary:
A unit of time (units from UCUM).
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| dayOfWeek | Σ | 0..* | codeBinding | Element idDosage.timing.repeat.dayOfWeek WeekDay Alternate namesWeekdag DefinitionWeekDay indicates a pattern of doses on fixed week days. If no days are specified, the action is assumed to happen every day as otherwise specified. Use ConceptMap 'WeekDay_to_DaysOfWeek' to translate CBB terminology to profile terminology in ValueSet 'DaysOfWeek.' Permitted Values Constraints
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| timeOfDay | Σ | 0..* | time | Element idDosage.timing.repeat.timeOfDay AdministrationTime Alternate namesToedientijd DefinitionThe time of administration is a specific time of day (on the clock). This time usually isn’t (intended to be) exact. There can be multiple administering times in one day. The ideal time of administration can also be entered as a time of day (morning, afternoon, evening, night-time). The administration time is then to be left empty, and the time of day can be entered in the TimeOfDay concept. If there's a timeOfDay, there cannot be a when, or vice versa.
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| when | Σ | 0..* | codeBinding | Element idDosage.timing.repeat.when TimeOfDay Alternate namesDagdeel DefinitionTime of day: morning, afternoon, evening, night. Timings are frequently determined by occurrences such as waking, eating and sleep. When more than one event is listed, the event is tied to the union of the specified events. Use ConceptMap 'TimeOfDay_to_EventTiming' to translate CBB terminology to profile terminology in ValueSet 'EventTiming.' Permitted Values Constraints
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| offset | Σ | 0..1 | unsignedInt | There are no (further) constraints on this element Element idDosage.timing.repeat.offset Minutes from event (before or after) DefinitionThe number of minutes from the event. If the event code does not indicate whether the minutes is before or after the event, then the offset is assumed to be after the event. 32 bit number; for values larger than this, use decimal
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| code | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idDosage.timing.code BID | TID | QID | AM | PM | QD | QOD | + DefinitionA code for the timing schedule (or just text in code.text). Some codes such as BID are ubiquitous, but many institutions define their own additional codes. If a code is provided, the code is understood to be a complete statement of whatever is specified in the structured timing data, and either the code or the data may be used to interpret the Timing, with the exception that .repeat.bounds still applies over the code (and is not contained in the code). BID etc. are defined as 'at institutionally specified times'. For example, an institution may choose that BID is "always at 7am and 6pm". If it is inappropriate for this choice to be made, the code BID should not be used. Instead, a distinct organization-specific code should be used in place of the HL7-defined BID code and/or a structured representation should be used (in this case, specifying the two event times). Code for a known / defined timing pattern.
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| asNeeded[x] | Σ | 0..1 | Element idDosage.asNeeded[x] Take "as needed" (for x) DefinitionIndicates 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). 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". Unordered, Open, by $this(Type) BindingA 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.
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| asNeededBoolean | boolean | There are no (further) constraints on this element Data type | ||
| asNeededCodeableConcept | Σ | 0..1 | CodeableConceptBinding | Element idDosage.asNeeded[x]:asNeededCodeableConcept Condition Alternate namesCriterium DefinitionThe condition for administering medication can be:
Physiological measurement values or other conditions do not need to be coded. These can be expressed in free text in the Description concept. 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". 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.
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| site | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idDosage.site Body site to administer to DefinitionBody site to administer to. A coded specification of the anatomic site where the medication first enters the body. 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. A coded concept describing the site location the medicine enters into or onto the body.
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| route | Σ | 0..1 | CodeableConceptBinding | Element idDosage.route RouteOfAdministration Alternate namesToedieningsweg DefinitionThe route through which the medication is administered (oral, nasal, intravenous, etc.). A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body. Please note that in contrast to the CBB, this RouteOfAdministration concept is grouped under the DosingInstructions concept. This CBB concept should thus be duplicated when there are multiple DosingInstructions. A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
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| method | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idDosage.method Technique for administering medication DefinitionTechnique for administering medication. 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. Terminologies used often pre-coordinate this term with the route and or form of administration. A coded concept describing the technique by which the medicine is administered.
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| doseAndRate | Σ | 0..* | Element | Element idDosage.doseAndRate Dosage Alternate namesDosering DefinitionInstructions for the administrator to administer the medication (the patient themselves, a nurse or other aid). When taking stock of medication use, the dosage describes the pattern of use established by the patient. Once the dose schedule (distribution of doses over time) and the dose have been determined, then there should be one single instruction for use. Multiple parallel instructions for use can be included in the event of a changing dose within one day and in the event of a variable use frequency. Multiple sequential instructions for use can be included in the event of changing doses within one period and/or in the event of a changing dose schedule. DurationOfAdministration is not mapped to this element but to
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.doseAndRate.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.doseAndRate.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| type | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idDosage.doseAndRate.type The kind of dose or rate specified DefinitionThe kind of dose or rate specified, for example, ordered or calculated. If the type is not populated, assume to be "ordered". 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. The kind of dose or rate specified.
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| dose[x] | Σ | 0..1 | Element idDosage.doseAndRate.dose[x] Dose Alternate namesKeerdosis DefinitionThe dose indicates the amount/unit per administration. The unit can be any unit that can occur with this particular medicine. The amount of therapeutic or other substance given at one administration event. 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. Unordered, Open, by $this(Type) Constraints
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| doseRange | Σ | 0..1 | Range | Element idDosage.doseAndRate.dose[x]:doseRange Amount of medication per dose DefinitionAmount of medication per dose. The amount of therapeutic or other substance given at one administration event. 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.
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.doseAndRate.dose[x]:doseRange.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.doseAndRate.dose[x]:doseRange.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| low | Σ I | 0..1 | SimpleQuantity | Element idDosage.doseAndRate.dose[x]:doseRange.low minimumValue Alternate namesminimumWaarde DefinitionThe minimal value of the range. The boundary is inclusive. If the low element is missing, the low boundary is not known.
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| high | Σ I | 0..1 | SimpleQuantity | Element idDosage.doseAndRate.dose[x]:doseRange.high maximumValue Alternate namesmaximumWaarde DefinitionThe maximum value of the range. The boundary is inclusive. If the high element is missing, the high boundary is not known.
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| doseQuantity | Σ | 0..1 | SimpleQuantity | Element idDosage.doseAndRate.dose[x]:doseQuantity nominalValue Alternate namesnominaleWaarde DefinitionAmount of medication per dose. The nominal value of the quantity. The amount of therapeutic or other substance given at one administration event. 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.
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| rate[x] | Σ | 0..1 | Element idDosage.doseAndRate.rate[x] AdministeringSpeed Alternate namesToedieningssnelheid DefinitionThe administering speed is used in slow administration of liquid. In practice, the measuring unit is almost always ml/hour. Entering an interval (such as 0-10 ml/hour) is also a commonly used option. For example, with an administering speed of 10ml/hour:
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. 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. Unordered, Open, by $this(Type) Constraints
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| rateRatio | Ratio | There are no (further) constraints on this element Data type | ||
| rateRange | Σ | 0..1 | Range | Element idDosage.doseAndRate.rate[x]:rateRange Amount of medication per unit of time DefinitionAmount of medication per unit of time. 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. 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.
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.doseAndRate.rate[x]:rateRange.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.doseAndRate.rate[x]:rateRange.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| low | Σ I | 0..1 | SimpleQuantity | Element idDosage.doseAndRate.rate[x]:rateRange.low minimumValue Alternate namesminimumWaarde DefinitionThe minimal value of the range. The boundary is inclusive. If the low element is missing, the low boundary is not known.
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| high | Σ I | 0..1 | SimpleQuantity | Element idDosage.doseAndRate.rate[x]:rateRange.high maximumValue Alternate namesmaximumWaarde DefinitionThe maximum value of the range. The boundary is inclusive. If the high element is missing, the high boundary is not known.
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| rateQuantity | Σ | 0..1 | SimpleQuantity | Element idDosage.doseAndRate.rate[x]:rateQuantity nominalValue Alternate namesnominaleWaarde DefinitionThe nominal value of the quantity. 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. 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.
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| maxDosePerPeriod | Σ I | 0..1 | Ratio | Element idDosage.maxDosePerPeriod MaximumDose Alternate namesMaximaleDosering DefinitionA maximum dose maximizes (in time) the usage of a drug in an 'as needed' prescription. 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. 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".
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| maxDosePerAdministration | Σ I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idDosage.maxDosePerAdministration Upper limit on medication per administration DefinitionUpper limit on medication per administration. The maximum total quantity of a therapeutic substance that may be administered to a subject per administration. 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.
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| maxDosePerLifetime | Σ I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idDosage.maxDosePerLifetime Upper limit on medication per lifetime of the patient DefinitionUpper limit on medication per lifetime of the patient. The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject. 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.
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| Dosage | Dosage | Element idDosage DosingInstructions Alternate namesDoseerinstructie DefinitionIndicates how the medication is/was taken or should be taken by the patient. This element mostly represents the DosingInstructions container from CBB InstructionsForUse, but also includes the AdditionalInstructions and RouteOfAdministration concepts, which are normally placed on the same level as this container. As a result, these concepts are duplicated in every repetition of this element, even though these concepts should be present just once according to the CBB. The RepeatPeriodCyclicalSchedule and Description elements of the CBB are not represented in this profile. When a HdBe profile contains a InstructionsForUse.DosageInstructions datatype, the RepeatPeriodCyclicalSchedule and Description elements are separately added to this profile as well. This element does not contain a mapping to the Dosage container from CBB InstructionsForUse. However, the child concepts of Dosage are all mapped. Multiple Dosage instances are represented by another DosingInstructions that contains a similiar SequenceNumber.
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| sequence | Σ | 0..1 | integer | Element idDosage.sequence SequenceNumber Alternate namesVolgnummer DefinitionThis indicates the sequence of the dosing instructions within the medication agreement. 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. 32 bit number; for values larger than this, use decimal
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| text | Σ | 0..1 | string | There are no (further) constraints on this element Element idDosage.text Free text dosage instructions e.g. SIG DefinitionFree text dosage instructions e.g. SIG. 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. Note that FHIR strings SHALL NOT exceed 1MB in size
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| additionalInstruction | Σ | 0..* | CodeableConcept | Element idDosage.additionalInstruction AdditionalInstructions Alternate namesAanvullendeInstructie DefinitionThe additional instructions contain extra information on the use of the current prescription. This includes all instructions for use. The text can come from the original “paper" medication prescription, but can also be generated from the coded information. This concept may contain more information than what is structurally coded in the information below, but may not conflict with it. The instructions may not conflict with other components of the request for administration. The instructions can also refer to an existing protocol. 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. Please note that in contrast to the CBB, this AdditionalInstructions concept is grouped under the DosingInstructions concept. This CBB concept should thus be duplicated when there are multiple DosingInstructions. A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
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| patientInstruction | Σ | 0..1 | string | There are no (further) constraints on this element Element idDosage.patientInstruction Patient or consumer oriented instructions DefinitionInstructions in terms that are understood by the patient or consumer. Note that FHIR strings SHALL NOT exceed 1MB in size
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| timing | Σ | 0..1 | Timing | Element idDosage.timing AdministeringSchedule Alternate namesToedieningsschema DefinitionSpecifications of the times at which the medication is to be administered. This is indicated as follows:
If a certain medication is not to be taken daily, the aforementioned can be combined with daily indications:
The specified administration “infinite” is automatically to be repeated until:
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. 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.
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.timing.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.timing.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.timing.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| event | Σ | 0..* | dateTime | There are no (further) constraints on this element Element idDosage.timing.event When the event occurs DefinitionIdentifies specific times when the event occurs. In a Medication Administration Record, for instance, you need to take a general specification, and turn it into a precise specification.
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| repeat | Σ I | 0..1 | Element | There are no (further) constraints on this element Element idDosage.timing.repeat When the event is to occur DefinitionA set of rules that describe when the event is scheduled. Many timing schedules are determined by regular repetitions.
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.timing.repeat.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.timing.repeat.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| timingExact | I | 0..1 | Extension(boolean) | Element idDosage.timing.repeat.extension:timingExact Whether specified times must be followed as closely as possible Alternate namesextensions, user content DefinitionIf true, indicates that the specified times, frequencies, periods are expected to be adhered to as precisely as possible. If false, indicates that a typical degree of variability based on institutional and/or patient convenience is acceptable. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. http://hl7.org/fhir/StructureDefinition/timing-exact Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.timing.repeat.extension:timingExact.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..0 | Extension | There are no (further) constraints on this element Element idDosage.timing.repeat.extension:timingExact.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| url | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idDosage.timing.repeat.extension:timingExact.url identifies the meaning of the extension DefinitionSource of the definition for the extension code - a logical name or a URL. The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. http://hl7.org/fhir/StructureDefinition/timing-exact
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| value[x] | 1..1 | Element idDosage.timing.repeat.extension:timingExact.value[x] Value of extension DefinitionIndicates that the timing as specified by The times can be chosen freely, but distribution throughout the day is more precise, and the interval between times is important (e.g. in the case of antibiotics) In the case of Baxter packs and intramural care, such a prescription is used to draw up a (location-specific) outline for distribution times (logistics). Notes on the CBB concepts Frequency and Interval:
In summary:
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| valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
| bounds[x] | Σ | 0..1 | Element idDosage.timing.repeat.bounds[x] Length/Range of lengths, or (Start and/or end) limits DefinitionEither a duration for the length of the timing schedule, a range of possible length, or outer bounds for start and/or end limits of the timing schedule. Unordered, Open, by $this(Type) Constraints
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| boundsRange | Range | There are no (further) constraints on this element Data type | ||
| boundsPeriod | Period | There are no (further) constraints on this element Data type | ||
| boundsDuration | Σ | 0..1 | Duration | Element idDosage.timing.repeat.bounds[x]:boundsDuration DoseDuration Alternate namesDoseerduur DefinitionThe intended time duration for these dosing instructions, e.g. 5 days or 8 weeks. In the case of medication for an indefinite period, the dosing duration is left empty in the last dosing instruction.
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| count | Σ | 0..1 | positiveInt | Element idDosage.timing.repeat.count Frequency / minimumValue / nominalValue Alternate namesFrequentie, nominaleWaarde, minimumWaarde DefinitionUsually, frequency comprises both amount and time unit (3 times a day), but it can occur without the time unit (single use). This is represented by this A reasonable distribution over the day is expected, but exact times are not given. This is left to the patient. It is the most common manner of extramural prescription. In the case of Baxter packs and intramural care, such a prescription is used to draw up a (location-specific) outline for distribution times (logistics). Repetitions may be limited by end time or total occurrences. Notes on the CBB concepts Frequency and Interval:
In summary:
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| countMax | Σ | 0..1 | positiveInt | Element idDosage.timing.repeat.countMax Frequency / maximumValue Alternate namesFrequentie, maximumWaarde DefinitionUsually, frequency comprises both amount and time unit (3 times a day), but it can occur without the time unit (single use). This is represented by the A reasonable distribution over the day is expected, but exact times are not given. This is left to the patient. It is the most common manner of extramural prescription. In the case of Baxter packs and intramural care, such a prescription is used to draw up a (location-specific) outline for distribution times (logistics). Notes on the CBB concepts Frequency and Interval:
In summary:
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| duration | Σ | 0..1 | decimal | Element idDosage.timing.repeat.duration DurationOfAdministration Alternate namesToedieningsduur DefinitionThe duration of administration defines the length of time during which the drug is administered and is mainly used in the slow parenteral administration of fluids. The Some activities are not instantaneous and need to be maintained for a period of time. For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).
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| durationMax | Σ | 0..1 | decimal | There are no (further) constraints on this element Element idDosage.timing.repeat.durationMax How long when it happens (Max) DefinitionIf present, indicates that the duration is a range - so to perform the action between [duration] and [durationMax] time length. Some activities are not instantaneous and need to be maintained for a period of time. For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).
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| durationUnit | Σ | 0..1 | codeBinding | Element idDosage.timing.repeat.durationUnit DurationOfAdministration Alternate namesToedieningsduur DefinitionThe units of time, in UCUM units, for the duration of administration of time during which the drug is administered. Note that FHIR strings SHALL NOT exceed 1MB in size A unit of time (units from UCUM).
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| frequency | Σ | 0..1 | positiveInt | Element idDosage.timing.repeat.frequency Frequency / minimumValue / nominalValue / Interval Alternate namesFrequentie, minimumWaarde, nominaleWaarde, Interval DefinitionThe number of times to repeat the action within the specified period. If frequencyMax is present, this element indicates the lower bound of the allowed range of the frequency. If the If the Notes on the CBB concepts Frequency and Interval:
In summary:
If no frequency is stated, the assumption is that the event occurs once per period, but systems SHOULD always be specific about this
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| frequencyMax | Σ | 0..1 | positiveInt | Element idDosage.timing.repeat.frequencyMax Frequency / maximumValue Alternate namesmaximumWaarde, Frequentie DefinitionIf present, indicates that the frequency is a range - so to repeat between [frequency] and [frequencyMax] times within the period or period range. If the If the Notes on the CBB concepts Frequency and Interval:
In summary:
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| period | Σ | 0..1 | decimal | Element idDosage.timing.repeat.period Frequency / Interval Alternate namesFrequentie, Interval DefinitionIndicates the duration of time over which repetitions are to occur; e.g. to express "3 times per day", 3 would be the frequency and "1 day" would be the period. If periodMax is present, this element indicates the lower bound of the allowed range of the period length. If the If the Notes on the CBB concepts Frequency and Interval:
In summary:
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| periodMax | Σ | 0..1 | decimal | There are no (further) constraints on this element Element idDosage.timing.repeat.periodMax Upper limit of period (3-4 hours) DefinitionIf present, indicates that the period is a range from [period] to [periodMax], allowing expressing concepts such as "do this once every 3-5 days. Do not use an IEEE type floating point type, instead use something that works like a true decimal, with inbuilt precision (e.g. Java BigInteger)
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| periodUnit | Σ | 0..1 | codeBinding | Element idDosage.timing.repeat.periodUnit Frequency / Interval Alternate namesFrequentie, Interval DefinitionThe units of time for the period in UCUM units for Frequency and Interval. If the If the Notes on the CBB concepts Frequency and Interval:
In summary:
A unit of time (units from UCUM).
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| dayOfWeek | Σ | 0..* | codeBinding | Element idDosage.timing.repeat.dayOfWeek WeekDay Alternate namesWeekdag DefinitionWeekDay indicates a pattern of doses on fixed week days. If no days are specified, the action is assumed to happen every day as otherwise specified. Use ConceptMap 'WeekDay_to_DaysOfWeek' to translate CBB terminology to profile terminology in ValueSet 'DaysOfWeek.' Permitted Values Constraints
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| timeOfDay | Σ | 0..* | time | Element idDosage.timing.repeat.timeOfDay AdministrationTime Alternate namesToedientijd DefinitionThe time of administration is a specific time of day (on the clock). This time usually isn’t (intended to be) exact. There can be multiple administering times in one day. The ideal time of administration can also be entered as a time of day (morning, afternoon, evening, night-time). The administration time is then to be left empty, and the time of day can be entered in the TimeOfDay concept. If there's a timeOfDay, there cannot be a when, or vice versa.
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| when | Σ | 0..* | codeBinding | Element idDosage.timing.repeat.when TimeOfDay Alternate namesDagdeel DefinitionTime of day: morning, afternoon, evening, night. Timings are frequently determined by occurrences such as waking, eating and sleep. When more than one event is listed, the event is tied to the union of the specified events. Use ConceptMap 'TimeOfDay_to_EventTiming' to translate CBB terminology to profile terminology in ValueSet 'EventTiming.' Permitted Values Constraints
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| offset | Σ | 0..1 | unsignedInt | There are no (further) constraints on this element Element idDosage.timing.repeat.offset Minutes from event (before or after) DefinitionThe number of minutes from the event. If the event code does not indicate whether the minutes is before or after the event, then the offset is assumed to be after the event. 32 bit number; for values larger than this, use decimal
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| code | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idDosage.timing.code BID | TID | QID | AM | PM | QD | QOD | + DefinitionA code for the timing schedule (or just text in code.text). Some codes such as BID are ubiquitous, but many institutions define their own additional codes. If a code is provided, the code is understood to be a complete statement of whatever is specified in the structured timing data, and either the code or the data may be used to interpret the Timing, with the exception that .repeat.bounds still applies over the code (and is not contained in the code). BID etc. are defined as 'at institutionally specified times'. For example, an institution may choose that BID is "always at 7am and 6pm". If it is inappropriate for this choice to be made, the code BID should not be used. Instead, a distinct organization-specific code should be used in place of the HL7-defined BID code and/or a structured representation should be used (in this case, specifying the two event times). Code for a known / defined timing pattern.
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| asNeeded[x] | Σ | 0..1 | Element idDosage.asNeeded[x] Take "as needed" (for x) DefinitionIndicates 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). 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". Unordered, Open, by $this(Type) BindingA 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.
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| asNeededBoolean | boolean | There are no (further) constraints on this element Data type | ||
| asNeededCodeableConcept | Σ | 0..1 | CodeableConceptBinding | Element idDosage.asNeeded[x]:asNeededCodeableConcept Condition Alternate namesCriterium DefinitionThe condition for administering medication can be:
Physiological measurement values or other conditions do not need to be coded. These can be expressed in free text in the Description concept. 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". 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.
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| site | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idDosage.site Body site to administer to DefinitionBody site to administer to. A coded specification of the anatomic site where the medication first enters the body. 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. A coded concept describing the site location the medicine enters into or onto the body.
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| route | Σ | 0..1 | CodeableConceptBinding | Element idDosage.route RouteOfAdministration Alternate namesToedieningsweg DefinitionThe route through which the medication is administered (oral, nasal, intravenous, etc.). A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body. Please note that in contrast to the CBB, this RouteOfAdministration concept is grouped under the DosingInstructions concept. This CBB concept should thus be duplicated when there are multiple DosingInstructions. A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
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| method | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idDosage.method Technique for administering medication DefinitionTechnique for administering medication. 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. Terminologies used often pre-coordinate this term with the route and or form of administration. A coded concept describing the technique by which the medicine is administered.
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| doseAndRate | Σ | 0..* | Element | Element idDosage.doseAndRate Dosage Alternate namesDosering DefinitionInstructions for the administrator to administer the medication (the patient themselves, a nurse or other aid). When taking stock of medication use, the dosage describes the pattern of use established by the patient. Once the dose schedule (distribution of doses over time) and the dose have been determined, then there should be one single instruction for use. Multiple parallel instructions for use can be included in the event of a changing dose within one day and in the event of a variable use frequency. Multiple sequential instructions for use can be included in the event of changing doses within one period and/or in the event of a changing dose schedule. DurationOfAdministration is not mapped to this element but to
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.doseAndRate.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.doseAndRate.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| type | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idDosage.doseAndRate.type The kind of dose or rate specified DefinitionThe kind of dose or rate specified, for example, ordered or calculated. If the type is not populated, assume to be "ordered". 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. The kind of dose or rate specified.
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| dose[x] | Σ | 0..1 | Element idDosage.doseAndRate.dose[x] Dose Alternate namesKeerdosis DefinitionThe dose indicates the amount/unit per administration. The unit can be any unit that can occur with this particular medicine. The amount of therapeutic or other substance given at one administration event. 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. Unordered, Open, by $this(Type) Constraints
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| doseRange | Σ | 0..1 | Range | Element idDosage.doseAndRate.dose[x]:doseRange Amount of medication per dose DefinitionAmount of medication per dose. The amount of therapeutic or other substance given at one administration event. 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.
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.doseAndRate.dose[x]:doseRange.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.doseAndRate.dose[x]:doseRange.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| low | Σ I | 0..1 | SimpleQuantity | Element idDosage.doseAndRate.dose[x]:doseRange.low minimumValue Alternate namesminimumWaarde DefinitionThe minimal value of the range. The boundary is inclusive. If the low element is missing, the low boundary is not known.
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| high | Σ I | 0..1 | SimpleQuantity | Element idDosage.doseAndRate.dose[x]:doseRange.high maximumValue Alternate namesmaximumWaarde DefinitionThe maximum value of the range. The boundary is inclusive. If the high element is missing, the high boundary is not known.
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| doseQuantity | Σ | 0..1 | SimpleQuantity | Element idDosage.doseAndRate.dose[x]:doseQuantity nominalValue Alternate namesnominaleWaarde DefinitionAmount of medication per dose. The nominal value of the quantity. The amount of therapeutic or other substance given at one administration event. 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.
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| rate[x] | Σ | 0..1 | Element idDosage.doseAndRate.rate[x] AdministeringSpeed Alternate namesToedieningssnelheid DefinitionThe administering speed is used in slow administration of liquid. In practice, the measuring unit is almost always ml/hour. Entering an interval (such as 0-10 ml/hour) is also a commonly used option. For example, with an administering speed of 10ml/hour:
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. 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. Unordered, Open, by $this(Type) Constraints
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| rateRatio | Ratio | There are no (further) constraints on this element Data type | ||
| rateRange | Σ | 0..1 | Range | Element idDosage.doseAndRate.rate[x]:rateRange Amount of medication per unit of time DefinitionAmount of medication per unit of time. 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. 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.
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| id | 0..1 | string | There are no (further) constraints on this element Element idDosage.doseAndRate.rate[x]:rateRange.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idDosage.doseAndRate.rate[x]:rateRange.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| low | Σ I | 0..1 | SimpleQuantity | Element idDosage.doseAndRate.rate[x]:rateRange.low minimumValue Alternate namesminimumWaarde DefinitionThe minimal value of the range. The boundary is inclusive. If the low element is missing, the low boundary is not known.
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| high | Σ I | 0..1 | SimpleQuantity | Element idDosage.doseAndRate.rate[x]:rateRange.high maximumValue Alternate namesmaximumWaarde DefinitionThe maximum value of the range. The boundary is inclusive. If the high element is missing, the high boundary is not known.
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| rateQuantity | Σ | 0..1 | SimpleQuantity | Element idDosage.doseAndRate.rate[x]:rateQuantity nominalValue Alternate namesnominaleWaarde DefinitionThe nominal value of the quantity. 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. 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.
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| maxDosePerPeriod | Σ I | 0..1 | Ratio | Element idDosage.maxDosePerPeriod MaximumDose Alternate namesMaximaleDosering DefinitionA maximum dose maximizes (in time) the usage of a drug in an 'as needed' prescription. 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. 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".
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| maxDosePerAdministration | Σ I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idDosage.maxDosePerAdministration Upper limit on medication per administration DefinitionUpper limit on medication per administration. The maximum total quantity of a therapeutic substance that may be administered to a subject per administration. 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.
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| maxDosePerLifetime | Σ I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idDosage.maxDosePerLifetime Upper limit on medication per lifetime of the patient DefinitionUpper limit on medication per lifetime of the patient. The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject. 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.
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Mapping FHIR profile to CBB
| Path | map | CBB | comment |
|---|---|---|---|
| Dosage | InstructionsForUse.DosingInstructions | HdBe-InstructionsForUse | |
| Dosage.sequence | InstructionsForUse.DosingInstructions.SequenceNumber | HdBe-InstructionsForUse | |
| Dosage.additionalInstruction | InstructionsForUse.AdditionalInstructions | HdBe-InstructionsForUse | |
| Dosage.timing | InstructionsForUse.DosingInstructions.Dosage.AdministeringSchedule | HdBe-InstructionsForUse | |
| Dosage.timing.repeat.extension:timingExact.value[x] | InstructionsForUse.DosingInstructions.Dosage.AdministeringSchedule.Interval | HdBe-InstructionsForUse | implicit, main mapping is on .frequency, .period and .periodMax |
| Dosage.timing.repeat.bounds[x]:boundsDuration | InstructionsForUse.DosingInstructions.DoseDuration | HdBe-InstructionsForUse | |
| Dosage.timing.repeat.count | InstructionsForUse.DosingInstructions.Dosage.AdministeringSchedule.Frequency | HdBe-InstructionsForUse | single use only |
| Dosage.timing.repeat.countMax | InstructionsForUse.DosingInstructions.Dosage.AdministeringSchedule.Frequency | HdBe-InstructionsForUse | |
| Dosage.timing.repeat.duration | InstructionsForUse.DosingInstructions.Dosage.DurationOfAdministration | HdBe-InstructionsForUse | |
| Dosage.timing.repeat.durationUnit | InstructionsForUse.DosingInstructions.Dosage.DurationOfAdministration | HdBe-InstructionsForUse | |
| Dosage.timing.repeat.frequency | InstructionsForUse.DosingInstructions.Dosage.AdministeringSchedule.Frequency | HdBe-InstructionsForUse | |
| Dosage.timing.repeat.frequency | InstructionsForUse.DosingInstructions.Dosage.AdministeringSchedule.Interval | HdBe-InstructionsForUse | |
| Dosage.timing.repeat.frequencyMax | InstructionsForUse.DosingInstructions.Dosage.AdministeringSchedule.Frequency | HdBe-InstructionsForUse | |
| Dosage.timing.repeat.period | InstructionsForUse.DosingInstructions.Dosage.AdministeringSchedule.Frequency | HdBe-InstructionsForUse | |
| Dosage.timing.repeat.period | InstructionsForUse.DosingInstructions.Dosage.AdministeringSchedule.Interval | HdBe-InstructionsForUse | |
| Dosage.timing.repeat.periodUnit | InstructionsForUse.DosingInstructions.Dosage.AdministeringSchedule.Frequency | HdBe-InstructionsForUse | |
| Dosage.timing.repeat.periodUnit | InstructionsForUse.DosingInstructions.Dosage.AdministeringSchedule.Interval | HdBe-InstructionsForUse | |
| Dosage.timing.repeat.dayOfWeek | InstructionsForUse.DosingInstructions.Dosage.AdministeringSchedule.WeekDay | HdBe-InstructionsForUse | |
| Dosage.timing.repeat.timeOfDay | InstructionsForUse.DosingInstructions.Dosage.AdministeringSchedule.AdministrationTime | HdBe-InstructionsForUse | |
| Dosage.timing.repeat.when | InstructionsForUse.DosingInstructions.Dosage.AdministeringSchedule.TimeOfDay | HdBe-InstructionsForUse | |
| Dosage.asNeeded[x]:asNeededCodeableConcept | InstructionsForUse.DosingInstructions.Dosage.AsNeeded.Condition | HdBe-InstructionsForUse | |
| Dosage.route | InstructionsForUse.RouteOfAdministration | HdBe-InstructionsForUse | |
| Dosage.doseAndRate | InstructionsForUse.DosingInstructions.Dosage | HdBe-InstructionsForUse | |
| Dosage.doseAndRate.dose[x] | InstructionsForUse.DosingInstructions.Dosage.Dose | HdBe-InstructionsForUse | |
| Dosage.doseAndRate.rate[x] | InstructionsForUse.DosingInstructions.Dosage.AdministeringSpeed | HdBe-InstructionsForUse | |
| Dosage.maxDosePerPeriod | InstructionsForUse.DosingInstructions.Dosage.AsNeeded.MaximumDose | HdBe-InstructionsForUse | |
| Dosage.timing.repeat.count | Range.NominalValue | HdBe-Range | |
| Dosage.timing.repeat.count | Range.MinimumValue | HdBe-Range | |
| Dosage.timing.repeat.countMax | Range.MaximumValue | HdBe-Range | |
| Dosage.timing.repeat.frequency | Range.MinimumValue | HdBe-Range | |
| Dosage.timing.repeat.frequency | Range.NominalValue | HdBe-Range | |
| Dosage.timing.repeat.frequencyMax | Range.MaximumValue | HdBe-Range | |
| Dosage.doseAndRate.dose[x]:doseRange.low | Range.MinimumValue | HdBe-Range | |
| Dosage.doseAndRate.dose[x]:doseRange.high | Range.MaximumValue | HdBe-Range | |
| Dosage.doseAndRate.dose[x]:doseQuantity | Range.NominalValue | HdBe-Range | |
| Dosage.doseAndRate.rate[x]:rateRange.low | Range.MinimumValue | HdBe-Range | |
| Dosage.doseAndRate.rate[x]:rateRange.high | Range.MaximumValue | HdBe-Range | |
| Dosage.doseAndRate.rate[x]:rateQuantity | Range.NominalValue | HdBe-Range |
HdBe-InstructionsForUse is a datatype profile and can therefore not have an example of its own. Rather, an example is provided within the example of the HdBe-profile(s) that use this datatype profile.
zib InstructionsForUse difference
| Concept | Category | Description |
|---|---|---|
additionalInstruction |
textual | Removed text regarding the G-standard. |
dosage |
Removed dosage.maxDosePerPeriod denominator and numerator because of the Dutch G-standard | |
asNeeded[x]:asNeededCodeableConcept |
terminology | TO-DO: Replace Dutch valueSet with Belgium or international codes (zib ticket #1781). |
asNeeded[x]:asNeededCodeableConcept |
textual | Removed text regarding the specific Dutch codes. |
route |
terminology | Replaced Dutch valueSet with the SNOMED hierarchy containing descendents of 284009009 (Route of administration value) (zib ticket #1781). Renamed ValueSet name RouteOfAdministration to RouteOfMedicationAdministration as there is an identically named valueSet (in HdBe-DrugUse) and to reuse it both here and in MedicationAdministration. |
Terminology Bindings
| Path | Name | Strength | URL | ConceptMap |
|---|---|---|---|---|
| Dosage.timing.repeat.dayOfWeek | days-of-week|4.0.1 | required | http://hl7.org/fhir/ValueSet/days-of-week|4.0.1 | |
| Dosage.timing.repeat.when | event-timing | required | http://hl7.org/fhir/ValueSet/event-timing | |
| Dosage.asNeeded[x] | AsNeededCriterium | required | https://fhir.healthdata.be/ValueSet/AsNeededCriterium | No bound ConceptMap |
| Dosage.route | RouteOfMedicationAdministration | required | https://fhir.healthdata.be/ValueSet/RouteOfMedicationAdministration | No bound ConceptMap |