Medication Request

Concept

A medication request is a prescriber’s proposal for a patient to use medication. A request to discontinue the use of medication is also a medication request.

Purpose

The goal of the medication request is to provide insight into the agreements reached between the prescriber and the patient on the use of medication.

Profiles

zib-MedicationAgreement

The FHIR resource MedicationRequest is defined as MedicationAgreement by the Dutch Health and Care Information models or HCIM/ZIB (Dutch: Zorginformatiebouwsteen or ZIB) MedicationAgreement

The MedicationRequest resource in NCare is exchanged according to the FHIR HCIM MedicationAgreement profile

MedicationRequest	I		MedicationRequest	Element id MedicationRequest Short description MedicationAgreement Alternate names Prescription, Order, Medicatieafspraak Definition A medication agreement is a prescriber’s proposal for a patient to use medication. An agreement to discontinue the use of medication is also a medication agreement. Data type MedicationRequest Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative `contained.text.empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource `contained.where(('#'+id in %resource.descendants().reference).not()).empty()` Mappings rim: Entity. Role, or Act workflow: ..Request script10.6: Message/Body/NewRx rim: CombinedMedicationRequest w5: clinical.medication hcim-medicationagreement-v1.0-2017EN: NL-CM:9.6.9580
id	Σ	0..1	id	There are no (further) constraints on this element Element id MedicationRequest.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type id Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id MedicationRequest.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a rim: N/A
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id MedicationRequest.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Comments Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a
language		0..1	codeBinding	There are no (further) constraints on this element Element id MedicationRequest.language Short description Language of the resource content Definition The base language in which the resource is written. Comments Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). Data type code Binding A human language. ?? (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a
text	I	0..1	Narrative	There are no (further) constraints on this element Element id MedicationRequest.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Comments Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a rim: N/A rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id MedicationRequest.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Data type Resource Mappings rim: Entity. Role, or Act rim: N/A
extension	I	0..*	Extension	Element id MedicationRequest.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
periodOfUse	I	0..1	Extension	Element id MedicationRequest.extension:periodOfUse Short description PeriodOfUse Alternate names extensions, user content, Gebruiksperiode Definition Start date: This is the time at which the agreement was to take effect (or took effect or will take effect). This is the time at which the instructions for use in this agreement start. In the case of an agreement to discontinue use, this is the start date of the original medication agreement. The end date indicates from when the medication is to be discontinued. End date: The time at which the period of use ends (or ended or will end). In the case of an agreement to discontinue use, this is the time at which the medication is to be discontinued. To avoid confusion between 'to' and 'up to', the submission of time is always mandatory for the end date. With medication for an indefinite period only a start date is indicated. Comments According to the HCIM TimeInterval, a time interval is defined by either a start and end time, a start time and duration, or a duration and end time. As this HCIM is expressed by the periodOfUse and usageDuration extensions in this profile, this means that precisely two elements out of `.valuePeriod.start`, `.valuePeriod.end` (both in the periodOfUse extension) and `.valueDuration` (in the usageDuration extension) should be present in order to correctly represent the time interval in which the agreement is used (and in particular not all three elements). Data type Extension Extension URL http://nictiz.nl/fhir/StructureDefinition/zib-Medication-PeriodOfUse Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A hcim-medicationagreement-v1.0-2017EN: NL-CM:9.6.19936
usageDuration	I	0..1	Extension	Element id MedicationRequest.extension:usageDuration Short description Duration Alternate names extensions, user content, Duur Definition Duration: The intended duration of use. E.g. 5 days or 8 weeks. It is not allowed to indicate the duration in months, because different months have a variable duration in days. Comments According to the HCIM TimeInterval, a time interval is defined by either a start and end time, a start time and duration, or a duration and end time. As this HCIM is expressed by the periodOfUse and usageDuration extensions in this profile, this means that precisely two elements out of `.valuePeriod.start`, `.valuePeriod.end` (both in the periodOfUse extension) and `.valueDuration` (in the usageDuration extension) should be present in order to correctly represent the time interval in which the agreement is used (and in particular not all three elements). Data type Extension Extension URL http://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-Duration Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A hcim-medicationagreement-v1.0-2017EN: NL-CM:9.6.19936
additionalInformation	I	0..*	Extension	Element id MedicationRequest.extension:additionalInformation Short description MedicationAgreementAdditionalInformation Alternate names extensions, user content, MedicatieafspraakAanvullendeInformatie Definition Additional information includes details on the structure of the agreement made that are relevant for pharmacovigilance and fulfillment by the pharmacist. This can be used e.g. to indicate that there was a conscious decision to deviate from the norm or that the agreement is to be structured in a certain way. Comments When choosing a medicine, you can deviate from what is expected or from what the standard is. For example, when the hospital uses a different formulary than the community pharmacy. For reasons of efficiency, for example, one gastric acid inhibitor has been chosen in the hospital: pantoprazole. Upon admission, a patient with omeprazole is converted to pantoprazole for the duration of the stay. When discharged, the patient goes back to omeprazole. It is clear that something can go wrong here and that the patient takes both omeprazole and pantoprazole when there is no intervention. In the hospital's medication agreement for pantoprazole a remark can be made about the deviation so that it is clear that pantoprazole is the substitute for omeprazole or that it should be used in addition to omeprazole. Another example are the half strengths. The hospital sometimes stocks tablets with half the strength of the normal trade preparation (own production). Where the patient enters the hospital on 25 mg chlortalidone, half a tablet once a day, he receives 12.5 mg intramural chlortalidone, one tablet once a day. Then the nursing does not have to break tablets in this case. Here there is a risk that the patient will use the 25 mg again at home, but then a whole tablet at a time in stead of half a tablet. By means of an explanation in the medication agreement (Additional information) of the last chlortalidone 25 mg, it can be indicated whether this has been a intended increase. Data type Extension Extension URL http://nictiz.nl/fhir/StructureDefinition/zib-Medication-AdditionalInformation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A hcim-medicationagreement-v1.0-2017EN: NL-CM:9.6.23283
id		0..1	string	There are no (further) constraints on this element Element id MedicationRequest.extension:additionalInformation.id Short description xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Comments Note that FHIR strings may not exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationRequest.extension:additionalInformation.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id MedicationRequest.extension:additionalInformation.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments 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. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed value http://nictiz.nl/fhir/StructureDefinition/zib-Medication-AdditionalInformation Mappings rim: n/a rim: N/A
valueCodeableConcept		0..1	CodeableConceptBinding	Element id MedicationRequest.extension:additionalInformation.valueCodeableConcept:valueCodeableConcept Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Data type CodeableConcept Binding MedicatieafspraakAanvullendeInformatieCodelijst ?? (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples Example of MedicationAgreementAdditionalInformation { "coding": [ { "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.20.77.5.2.3.2050", "code": "1", "display": "Bewust hoge dosering" } ] } Mappings rim: n/a rim: N/A
medicationTreatment	I	0..1	Extension	Element id MedicationRequest.extension:medicationTreatment Short description Medication Treatment Alternate names extensions, user content, Medicamenteuze behandeling Definition This extension is to describe which overarching medication treatment this information is part of. This is done by the use of an identifier of that medication treatment. Comments No HCIM concept is available for this element. Therefore a mapping to the relevant Medication Process data element is provided. Data type Extension Extension URL http://nictiz.nl/fhir/StructureDefinition/zib-Medication-MedicationTreatment Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A Medication-Process-v09: mp-dataelement900-22092
nl-core-episodeofcare	I	0..*	Extension	Element id MedicationRequest.extension:nl-core-episodeofcare Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments It is recommended to use the nl-core-episodeofcare extension to reference nl-core-episodeofcare (EpisodeOfCare) instances rather than the `context` element, as this approach will be enforced in FHIR R4. Data type Extension Extension URL http://nictiz.nl/fhir/StructureDefinition/extension-context-nl-core-episodeofcare Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	?! I	0..*	Extension	Element id MedicationRequest.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
stopType	?! I	0..1	Extension	Element id MedicationRequest.modifierExtension:stopType Short description StopType Alternate names extensions, user content Definition The manner in which (and indicator that) this medication is discontinued (temporarily or permanently). Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Extension URL http://nictiz.nl/fhir/StructureDefinition/zib-Medication-StopType Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A hcim-medicationagreement-v1.0-2017EN: NL-CM:9.6.19954
id		0..1	string	There are no (further) constraints on this element Element id MedicationRequest.modifierExtension:stopType.id Short description xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Comments Note that FHIR strings may not exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationRequest.modifierExtension:stopType.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id MedicationRequest.modifierExtension:stopType.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments 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. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed value http://nictiz.nl/fhir/StructureDefinition/zib-Medication-StopType Mappings rim: n/a rim: N/A
valueCodeableConcept		0..1	CodeableConceptBinding	Element id MedicationRequest.modifierExtension:stopType.valueCodeableConcept:valueCodeableConcept Short description Value of extension Definition Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). Data type CodeableConcept Binding StopType ?? (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a rim: N/A
repeatPeriodCyclicalSchedule	?! I	0..1	Extension	Element id MedicationRequest.modifierExtension:repeatPeriodCyclicalSchedule Short description RepeatPeriodCyclicalSchedule Alternate names extensions, user content Definition The repeated period in a cyclical schedule (of one or more dosing instructions). A cyclic schedule is noted in days, the corresponding dosing duration is also in days. Examples of a cyclical schedule: contraceptive pill (21 days, 1 pill 1x a day, then skip for 7 days, repeat), repeat period here is 28 days. RepeatPeriodCyclicalSchedule Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Extension URL http://nictiz.nl/fhir/StructureDefinition/zib-Medication-RepeatPeriodCyclicalSchedule Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A hcim-instructionsforuse-v1.0-2017EN: NL-CM:9.12.22505
identifier		0..*	Identifier	Element id MedicationRequest.identifier Short description External ids for this request Definition This records identifiers associated with this medication request that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. For example a re-imbursement system might issue its own id for each prescription that is created. This is particularly important where FHIR only provides part of an entire workflow process where records must be tracked through an entire system. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier workflow: …identifer script10.6: Message/Header/PrescriberOrderNumber v2: ORC-2-Placer Order Number / ORC-3-Filler Order Number rim: .id w5: id hcim-basicelements-v1.0-2017EN: NL-CM:0.0.6
definition	Σ I	0..*	Reference(http://hl7.org/fhir/StructureDefinition/ActivityDefinition \| http://hl7.org/fhir/StructureDefinition/PlanDefinition)	There are no (further) constraints on this element Element id MedicationRequest.definition Short description Protocol or definition Definition Protocol or definition followed by this request. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(http://hl7.org/fhir/StructureDefinition/ActivityDefinition \| http://hl7.org/fhir/StructureDefinition/PlanDefinition) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: …definition rim: .outboundRelationship[typeCode=DEFN].target[classCode=unspecified]
basedOn	Σ I	0..*	Reference(http://hl7.org/fhir/StructureDefinition/CarePlan \| http://hl7.org/fhir/StructureDefinition/MedicationRequest \| http://hl7.org/fhir/StructureDefinition/ProcedureRequest \| http://hl7.org/fhir/StructureDefinition/ReferralRequest)	There are no (further) constraints on this element Element id MedicationRequest.basedOn Short description What request fulfills Definition A plan or request that is fulfilled in whole or in part by this medication request. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(http://hl7.org/fhir/StructureDefinition/CarePlan \| http://hl7.org/fhir/StructureDefinition/MedicationRequest \| http://hl7.org/fhir/StructureDefinition/ProcedureRequest \| http://hl7.org/fhir/StructureDefinition/ReferralRequest) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: …basedOn rim: .outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]
groupIdentifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element id MedicationRequest.groupIdentifier Short description Composite request this is part of Definition A shared identifier common to all requests that were authorized more or less simultaneously by a single author, representing the identifier of the requisition or prescription. Requirements Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier workflow: …groupIdentifier rim: .outboundRelationship(typeCode=COMP].target[classCode=SBADM, moodCode=INT].id
status	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element id MedicationRequest.status Short description active \| on-hold \| cancelled \| completed \| entered-in-error \| stopped \| draft \| unknown Definition A code specifying the current state of the order. Generally this will be active or completed state. Comments This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. Data type code Binding A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription ?? (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a workflow: …status script10.6: no mapping rim: .statusCode w5: status
intent	Σ ?!	1..1	codeBindingFixed Value	Element id MedicationRequest.intent Short description proposal \| plan \| order \| instance-order Definition Whether the request is a proposal, plan, or an original order. Comments It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only. An instance-order is an instantiation of a request or order and may be used to populate Medication Administration Record. This element is labeled as a modifier because the intent alters when and how the resource is actually applicable. Data type code Binding The kind of medication order ?? (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed value order Mappings rim: n/a workflow: …intent rim: .moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere) w5: class
category		1..1	CodeableConceptBinding	There are no (further) constraints on this element Element id MedicationRequest.category Short description Type of medication usage Definition Indicates the type of medication order and where the medication is expected to be consumed or administered. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding A coded concept identifying where the medication ordered is expected to be consumed or administered ?? (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD script10.6: Message/Body/NewRx/MedicationPrescribed/Directions or Message/Body/NewRx/MedicationPrescribed/StructuredSIG rim: .inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication usage"].value w5: class
id		0..1	string	There are no (further) constraints on this element Element id MedicationRequest.category.id Short description xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Comments Note that FHIR strings may not exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationRequest.category.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
coding	Σ	0..*	Coding	Element id MedicationRequest.category.coding Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data type Coding Sliced: Unordered, Open, by code(Value) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim: CV orim: fhir:Coding rdfs:subClassOf dt:CDCoding v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
medicationAgreementCode	Σ	0..*	Coding	Element id MedicationRequest.category.coding:medicationAgreementCode Short description MedicationAgreementCode Definition Category SNOMED code used for indexing/retrieval of the HCIM MedicationAgreement. The SNOMED code 16076005 for this resource is stated in the Medication Process v09. Requirements Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data type Coding Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim: CV orim: fhir:Coding rdfs:subClassOf dt:CDCoding v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
id		0..1	string	There are no (further) constraints on this element Element id MedicationRequest.category.coding:medicationAgreementCode.id Short description xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Comments Note that FHIR strings may not exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationRequest.category.coding:medicationAgreementCode.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
system	Σ	0..1	uriFixed Value	Element id MedicationRequest.category.coding:medicationAgreementCode.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed value http://snomed.info/sct Mappings rim: n/a v2: CE.3 rim:* ./codeSystem orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element id MedicationRequest.category.coding:medicationAgreementCode.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: CE.7 rim:* ./codeSystemVersion orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	Σ	0..1	codeFixed Value	Element id MedicationRequest.category.coding:medicationAgreementCode.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Comments Note that FHIR strings may not exceed 1MB in size Data type code Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Fixed value 16076005 Mappings rim: n/a v2: CE.1 rim:* ./code orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	Element id MedicationRequest.category.coding:medicationAgreementCode.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Comments Note that FHIR strings may not exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Default value Prescription (procedure) Mappings rim: n/a v2: CE.2 - but note this is not well followed rim:* CV.displayName orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element id MedicationRequest.category.coding:medicationAgreementCode.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: Sometimes implied by being first rim: CD.codingRationale orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
text	Σ	0..1	string	There are no (further) constraints on this element Element id MedicationRequest.category.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: CE.9. But note many systems use CE.2 for this rim: ./originalText[mediaType/code="text/plain"]/data orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
priority	Σ	0..1	codeBinding	There are no (further) constraints on this element Element id MedicationRequest.priority Short description routine \| urgent \| stat \| asap Definition Indicates how quickly the Medication Request should be addressed with respect to other requests. Comments Note that FHIR strings may not exceed 1MB in size Data type code Binding Identifies the level of importance to be assigned to actioning the request ?? (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a workflow: …priority rim: .priorityCode w5: grade
medicationReference	Σ	1..1	Reference(http://nictiz.nl/fhir/StructureDefinition/zib-Product)	Element id MedicationRequest.medication[x]:medicationReference Short description AgreedMedicine Alternate names Afgesprokengeneesmiddel Definition The medicine agreed upon to be used. Comments Data type Reference(http://nictiz.nl/fhir/StructureDefinition/zib-Product) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a workflow: …code script10.6: Message/Body/NewRx/MedicationPrescribed Medication.code.coding.code = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCode Medication.code.coding.system = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCodeQualifier Medication.code.coding.display = Message/Body/NewRx/MedicationPrescribed/DrugDescription v2: RXE-2-Give Code / RXO-1-Requested Give Code / RXC-2-Component Code rim: consumable.administrableMedication w5: what hcim-medicationagreement-v1.0-2017EN: NL-CM:9.6.19925
subject	Σ I	1..1	Reference(http://fhir.nl/fhir/StructureDefinition/nl-core-patient \| http://hl7.org/fhir/StructureDefinition/Group)	Element id MedicationRequest.subject Short description Who or group medication request is for Definition A link to a resource representing the person or set of individuals to whom the medication will be given. Comments The subject on a medication request is mandatory. For the secondary use case where the actual subject is not provided, there still must be an anonymized subject specified. Data type Reference(http://fhir.nl/fhir/StructureDefinition/nl-core-patient \| http://hl7.org/fhir/StructureDefinition/Group) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: …subject script10.6: Message/Body/NewRx/Patient (need detail to link to specific patient … Patient.Identification in SCRIPT) v2: PID-3-Patient ID List rim: .participation[typeCode=AUT].role w5: who.focus hcim-basicelements-v1.0-2017EN: NL-CM:0.0.11
context	I	0..1	Reference(http://nictiz.nl/fhir/StructureDefinition/zib-Encounter \| http://fhir.nl/fhir/StructureDefinition/nl-core-episodeofcare)	Element id MedicationRequest.context Short description Created during encounter/admission/stay Definition A link to an encounter, or episode of care, that identifies the particular occurrence or set occurrences of contact between patient and health care provider. Comments It is recommended to use the nl-core-episodeofcare extension to reference nl-core-episodeofcare (EpisodeOfCare) instances rather than the `context` element, as this approach will be enforced in FHIR R4. Data type Reference(http://nictiz.nl/fhir/StructureDefinition/zib-Encounter \| http://fhir.nl/fhir/StructureDefinition/nl-core-episodeofcare) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: …context script10.6: no mapping v2: PV1-19-Visit Number rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"] w5: context
supportingInformation	I	0..*	Reference(http://hl7.org/fhir/StructureDefinition/Resource)	There are no (further) constraints on this element Element id MedicationRequest.supportingInformation Short description Information to support ordering of the medication Definition Include additional information (for example, patient height and weight) that supports the ordering of the medication. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(http://hl7.org/fhir/StructureDefinition/Resource) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .outboundRelationship[typeCode=PERT].target[A_SupportingClinicalStatement CMET minimal with many different choices of classCodes(ORG, ENC, PROC, SPLY, SBADM, OBS) and each of the act class codes draws from one or more of the following moodCodes (EVN, DEF, INT PRMS, RQO, PRP, APT, ARQ, GOL)] w5: context
authoredOn	Σ	1..1	dateTime	Element id MedicationRequest.authoredOn Short description MedicationAgreementDateTime Alternate names Afspraakdatum Definition The time at which the agreement was made. Appointment date + time are required (order of the appointments must be clear in cases with multiple appointments on one day) Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a workflow: …authoredOn script10.6: Message/Body/NewRx/MedicationPrescribed/WrittenDate v2: RXE-32-Original Order Date/Time / ORC-9-Date/Time of Transaction rim: author.time w5: when.recorded hcim-medicationagreement-v1.0-2017EN: NL-CM:9.6.19757
requester	Σ I	0..1	BackboneElement	Element id MedicationRequest.requester Short description Prescriber Alternate names Voorschrijver Definition The health professional that entered the medication agreement with the patient. Comments Note that in FHIR STU3, there is an agent Reference type PractitionerRole missing. PractitionerRole, contrary to Practitioner, allows for specialism and organization. This issue has been fixed in FHIR R4. For FHIR STU3, you can use the practitionerrole-reference extension on requester.agent. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` mps-1: onBehalfOf can only be specified if agent is practitioner or device `(agent.resolve().empty()) or (agent.resolve() is Device) or (agent.resolve() is Practitioner) or onBehalfOf.exists().not()` Mappings rim: n/a workflow: …requester rim: .participation[typeCode=AUT].role w5: who.author hcim-medicationagreement-v1.0-2017EN: NL-CM:9.6.1030 hcim-basicelements-v1.0-2017EN: NL-CM:0.0.7
id		0..1	string	There are no (further) constraints on this element Element id MedicationRequest.requester.id Short description xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Comments Note that FHIR strings may not exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationRequest.requester.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id MedicationRequest.requester.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
agent	Σ I	1..1	Reference(http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner \| http://fhir.nl/fhir/StructureDefinition/nl-core-organization \| http://fhir.nl/fhir/StructureDefinition/nl-core-patient \| http://fhir.nl/fhir/StructureDefinition/nl-core-relatedperson \| http://hl7.org/fhir/StructureDefinition/Device)	Element id MedicationRequest.requester.agent Short description Who ordered the initial medication(s) Definition The healthcare professional responsible for authorizing the initial prescription. Comments The health professional's speciality, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile. Data type Reference(http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner \| http://fhir.nl/fhir/StructureDefinition/nl-core-organization \| http://fhir.nl/fhir/StructureDefinition/nl-core-patient \| http://fhir.nl/fhir/StructureDefinition/nl-core-relatedperson \| http://hl7.org/fhir/StructureDefinition/Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: ….agent script10.6: Message/Body/NewRx/Prescriber (need detail to link to specific prescriber … Prescriber.Identification in SCRIPT) v2: RXE-13-Ordering Provider's DEA Number / RXO-14-Ordering Provider's DEA Number / RXE-14-Pharmacist/Treatment Supplier's Verifier ID / RXO-15-Pharmacist/Treatment Supplier's Verifier ID / ORC-12-Ordering Provider / PRT-5-Participation Person: PRT-4-Participation='OP' (all but last deprecated) rim: .player
id		0..1	string	There are no (further) constraints on this element Element id MedicationRequest.requester.agent.id Short description xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Comments Note that FHIR strings may not exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a
extension	I	0..*	Extension	Element id MedicationRequest.requester.agent.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
practitionerRole	I	0..1	Extension	Element id MedicationRequest.requester.agent.extension:practitionerRole Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Extension URL http://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
reference	Σ I	0..1	string	There are no (further) constraints on this element Element id MedicationRequest.requester.agent.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a rim: N/A
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element id MedicationRequest.requester.agent.identifier Short description Logical reference, when literal reference is not known Definition An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier rim: .identifier
display	Σ	0..1	string	There are no (further) constraints on this element Element id MedicationRequest.requester.agent.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a rim: N/A
onBehalfOf	Σ I	0..1	Reference(http://fhir.nl/fhir/StructureDefinition/nl-core-organization)	Element id MedicationRequest.requester.onBehalfOf Short description Organization agent is acting for Definition The organization the device or practitioner was acting on behalf of. Requirements Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when authoring the request. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(http://fhir.nl/fhir/StructureDefinition/nl-core-organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: ….onBehalfOf rim: .scoper
recorder	I	0..1	Reference(http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner)	Element id MedicationRequest.recorder Short description Person who entered the request Definition The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .participation[typeCode=TRANS].role[classCode=ASSIGNED].code (HealthcareProviderType) w5: who
id		0..1	string	There are no (further) constraints on this element Element id MedicationRequest.recorder.id Short description xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Comments Note that FHIR strings may not exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a
extension	I	0..*	Extension	Element id MedicationRequest.recorder.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
practitionerRole	I	0..1	Extension	Element id MedicationRequest.recorder.extension:practitionerRole Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Extension URL http://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
reference	Σ I	0..1	string	There are no (further) constraints on this element Element id MedicationRequest.recorder.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a rim: N/A
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element id MedicationRequest.recorder.identifier Short description Logical reference, when literal reference is not known Definition An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier rim: .identifier
display	Σ	0..1	string	There are no (further) constraints on this element Element id MedicationRequest.recorder.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a rim: N/A
reasonCode		0..*	CodeableConceptBinding	Element id MedicationRequest.reasonCode Short description ReasonMedicationAgreement Alternate names RedenMedicatieafspraak Definition Reason for this agreement. This can be the reason to start, change or stop the medication treatment. Comments This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference. Data type CodeableConcept Binding RedenWijzigenOfStakenCodelijst ?? (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: …reasonCode script10.6: Message/Body/NewRx/MedicationPrescribed/Diagnosis/Primary/Value v2: ORC-16-Order Control Code Reason /RXE-27-Give Indication/RXO-20-Indication / RXD-21-Indication / RXG-22-Indication / RXA-19-Indication rim: reason.observation.reasonCode w5: why hcim-medicationagreement-v1.0-2017EN: NL-CM:9.6.22094
reasonReference	I	0..*	Reference(http://hl7.org/fhir/StructureDefinition/Observation \| http://nictiz.nl/fhir/StructureDefinition/zib-Problem)	Element id MedicationRequest.reasonReference Short description PrescriptionReason Alternate names RedenVanVoorschrijven Definition The medical reason for the prescription or for use of the medication. This can be used to enter a medical indication which was the direct cause for prescription or for use of the medication in question. It can concern every type of problem (or condition) of the patient, almost all diagnoses, complaints or symptoms. Please note: The BST401T file of the G standard contains a “special reference” to indicate that “exchange of the reason for prescription is essential”. Comments This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode. Data type Reference(http://hl7.org/fhir/StructureDefinition/Observation \| http://nictiz.nl/fhir/StructureDefinition/zib-Problem) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: …reasonReference script10.6: no mapping rim: reason.observation[code=ASSERTION].value w5: why hcim-medicationagreement-v1.0-2017EN: NL-CM:9.6.23133
note		0..*	Annotation	Element id MedicationRequest.note Short description Comment Alternate names Toelichting Definition Explanation for the medication agreement. This explanation can contain e.g. information on why a prescriber makes a medication agreement that deviates from the norm. Comments For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible). Data type Annotation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: N/A rim: Act workflow: …note script10.6: Message/Body/NewRx/MedicationPrescribed/Note rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=OBS,moodCode=EVN,code="annotation"].value hcim-medicationagreement-v1.0-2017EN: NL-CM:9.6.22273
dosageInstruction		0..*	http://nictiz.nl/fhir/StructureDefinition/zib-InstructionsForUse	Element id MedicationRequest.dosageInstruction Short description InstructionsForUse Alternate names Gebruiksinstructie Definition Instructions for the use of the medication, e.g. dose and route of administration Comments The wiki page https://informatiestandaarden.nictiz.nl/wiki/mp:V9.0_Voorbeelden_doseringen provides dosage instruction examples. These examples consists of functional data and their representation in FHIR and CDA. Data type http://nictiz.nl/fhir/StructureDefinition/zib-InstructionsForUse Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a rim: .outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT] workflow: …occurrence[x] rim: see dosageInstruction mapping hcim-instructionsforuse-v1.1-2017EN: NL-CM:9.12.22504 hcim-medicationagreement-v1.0-2017EN: NL-CM:9.6.23240 hcim-basicelements-v1.0-2017EN: NL-CM:0.0.14
dispenseRequest		0..1	BackboneElement	There are no (further) constraints on this element Element id MedicationRequest.dispenseRequest Short description Medication supply authorization Definition Indicates the specific details for the dispense or medication supply part of a medication request (also known as a Medication Prescription or Medication Order). Note that this information is not always sent with the order. There may be in some settings (e.g. hospitals) institutional or system support for completing the dispense details in the pharmacy department. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a script10.6: Message/Body/NewRx/MedicationPrescribed/ExpirationDate rim: component.supplyEvent
id		0..1	string	There are no (further) constraints on this element Element id MedicationRequest.dispenseRequest.id Short description xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Comments Note that FHIR strings may not exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationRequest.dispenseRequest.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id MedicationRequest.dispenseRequest.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
validityPeriod	I	0..1	Period	There are no (further) constraints on this element Element id MedicationRequest.dispenseRequest.validityPeriod Short description Time period supply is authorized for Definition This indicates the validity period of a prescription (stale dating the Prescription). Requirements Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription. Comments It reflects the prescribers' perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.empty() or end.empty() or (start <= end)` Mappings rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] script10.6: Message/Body/NewRx/MedicationPrescribed/Refills rim: effectiveTime
numberOfRepeatsAllowed		0..1	positiveInt	There are no (further) constraints on this element Element id MedicationRequest.dispenseRequest.numberOfRepeatsAllowed Short description Number of refills authorized Definition An integer indicating the number of times, in addition to the original dispense, (aka refills or repeats) that the patient can receive the prescribed medication. Usage Notes: This integer does not include the original order dispense. This means that if an order indicates dispense 30 tablets plus "3 repeats", then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets. Comments If displaying "number of authorized fills", add 1 to this number. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a script10.6: Message/Body/NewRx/MedicationPrescribed/Quantity v2: RXE-12-Number of Refills rim: repeatNumber
quantity	I	0..1	http://hl7.org/fhir/StructureDefinition/SimpleQuantity	There are no (further) constraints on this element Element id MedicationRequest.dispenseRequest.quantity Short description Amount of medication to supply per dispense Definition The amount that is to be dispensed for one fill. Comments The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator. Data type http://hl7.org/fhir/StructureDefinition/SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` sqty-1: The comparator is not used on a SimpleQuantity `comparator.empty()` Mappings rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values script10.6: Message/Body/NewRx/MedicationPrescribed/DaysSupply v2: RXD-4-Actual Dispense Amount / RXD-5.1-Actual Dispense Units.code / RXD-5.3-Actual Dispense Units.name of coding system rim: quantity
expectedSupplyDuration	I	0..1	Duration	There are no (further) constraints on this element Element id MedicationRequest.dispenseRequest.expectedSupplyDuration Short description Number of days supply per dispense Definition Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last. Comments In some situations, this attribute may be used instead of quantity to identify the amount supplied by how long it is expected to last, rather than the physical quantity issued, e.g. 90 days supply of medication (based on an ordered dosage) When possible, it is always better to specify quantity, as this tends to be more precise. expectedSupplyDuration will always be an estimate that can be influenced by external factors. Data type Duration Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM. `code.exists() implies ((system = %ucum) and value.exists())` Mappings rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values rim: PQ, IVL<PQ> depending on the values script10.6: Message/Body/NewRx/MedicationPrescribed/Substitutions rim: expectedUseTime
performer	I	0..1	Reference(http://hl7.org/fhir/StructureDefinition/Organization)	There are no (further) constraints on this element Element id MedicationRequest.dispenseRequest.performer Short description Intended dispenser Definition Indicates the intended dispensing Organization specified by the prescriber. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(http://hl7.org/fhir/StructureDefinition/Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .outboundRelationship[typeCode=COMP].target[classCode=SPLY, moodCode=RQO] .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE] w5: who
substitution		0..1	BackboneElement	There are no (further) constraints on this element Element id MedicationRequest.substitution Short description Any restrictions on medication substitution Definition Indicates whether or not substitution can or should be part of the dispense. In some cases substitution must happen, in other cases substitution must not happen. This block explains the prescriber's intent. If nothing is specified substitution may be done. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a script10.6: specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions rim: subjectOf.substitutionPersmission
id		0..1	string	There are no (further) constraints on this element Element id MedicationRequest.substitution.id Short description xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Comments Note that FHIR strings may not exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationRequest.substitution.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id MedicationRequest.substitution.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
allowed	?!	1..1	boolean	There are no (further) constraints on this element Element id MedicationRequest.substitution.allowed Short description Whether substitution is allowed or not Definition True if the prescriber allows a different drug to be dispensed from what was prescribed. Comments This element is labeled as a modifer because whether substitution is allow or not cannot be ignored. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a script10.6: specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions v2: RXO-9-Allow Substitutions / RXE-9-Substitution Status rim: code
reason		0..1	CodeableConcept	There are no (further) constraints on this element Element id MedicationRequest.substitution.reason Short description Why should (not) substitution be made Definition Indicates the reason for the substitution, or why substitution must or must not be performed. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed. ?? (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD script10.6: not mapped v2: RXE-9 Substition status rim: reasonCode
priorPrescription	I	0..1	Reference(http://hl7.org/fhir/StructureDefinition/MedicationRequest)	There are no (further) constraints on this element Element id MedicationRequest.priorPrescription Short description An order/prescription that is being replaced Definition A link to a resource representing an earlier order related order or prescription. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(http://hl7.org/fhir/StructureDefinition/MedicationRequest) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: …replaces script10.6: not mapped rim: .outboundRelationship[typeCode=?RPLC or ?SUCC]/target[classCode=SBADM,moodCode=RQO]
detectedIssue	I	0..*	Reference(http://hl7.org/fhir/StructureDefinition/DetectedIssue)	There are no (further) constraints on this element Element id MedicationRequest.detectedIssue Short description Clinical Issue with action Alternate names Contraindication, Drug Utilization Review (DUR), Alert Definition Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etc. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(http://hl7.org/fhir/StructureDefinition/DetectedIssue) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=ALRT,moodCode=EVN].value
eventHistory	I	0..*	Reference(http://hl7.org/fhir/StructureDefinition/Provenance)	There are no (further) constraints on this element Element id MedicationRequest.eventHistory Short description A list of events of interest in the lifecycle Definition Links to Provenance records for past versions of this resource or fulfilling request or event resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resource. Comments This may not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.). Data type Reference(http://hl7.org/fhir/StructureDefinition/Provenance) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: …relevantHistory rim: .inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]

Custom rules

Supported properties

The properties of zib-MedicationAgreement that we support are:

extension.periodOfUse
extension.usageDuration
status
intent
category
medicationReference
subject
authoredOn
requester
note
dosageInstruction

From the property dosageInstruction, only the following sub-properties are supported:

additionalInstruction
timing.repeat.bounds
timing.repeat.frequency
timing.repeat.period
timing.repeat.periodUnit
timing.repeat.dayOfWeek
timing.repeat.timeOfDay
asNeededCodeableConcept
route
doseQuantity

REST API

API	Supported	Command	Comment
read	yes	GET /MedicationRequest/
vread	no		If a version is specified, we ignore it, the latest version is always returned
update	no
update with optimistic locking	no
update (conditional)	no
patch	no
patch (conditional)	no
delete	no
delete (conditional)	no
history	no
create	no
create (conditional)	no
search	yes	GET /MedicationRequest?[search parameters]	See Overview of FHIR Search.
chained search	no	chained searches are not supported atm
reverse chained search	no	chained searches are not supported atm
batch	no
transaction	no
paging	no
intermediaries	no

Example

{
    "resourceType": "MedicationRequest",
    "id": "50556",
    "meta": {
        "lastUpdated": "2021-10-04T09:22:44.367+02:00",
        "profile": [
            "http://nictiz.nl/fhir/StructureDefinition/zib-MedicationAgreement"
        ],
        "versionId": "ticks/637689361643670000"
    },
    "extension": [
        {
            "url": "http://nictiz.nl/fhir/StructureDefinition/zib-Medication-PeriodOfUse",
            "valuePeriod": {
                "start": "2021-10-04T09:22:44.39+02:00",
                "end": "2021-10-31T00:00:00+02:00"
            }
        },
        {
            "url": "http://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-Duration",
            "valueDuration": {
                "value": 26.6092084490741,
                "unit": "day",
                "system": "http://unitsofmeasure.org",
                "code": "d"
            }
        }
    ],
    "status": "active",
    "intent": "order",
    "category": {
        "coding": [
            {
                "system": "http://hl7.org/fhir/medication-request-category",
                "code": "inpatient"
            }
        ]
    },
    "medicationReference": {
        "reference": "Medication/ArticleGroup.3931",
        "display": "PARACETAMOL KAUWTABLET 120MG"
    },
    "subject": {
        "reference": "Patient/20422306",
        "display": "Engel"
    },
    "authoredOn": "2021-10-04T10:22:44.367+02:00",
    "requester": {
        "agent": {
            "reference": "User/3975",
            "display": "_michael"
        }
    },
    "note": [
        {
            "text": "Volg schema"
        }
    ],
    "dosageInstruction": [
        {
            "additionalInstruction": [
                {
                    "coding": [
                        {
                            "system": "https://referentiemodel.nhg.org/tabellen/nhg-tabel-25-gebruiksvoorschrift#aanvullend-numeriek",
                            "code": "193"
                        }
                    ],
                    "text": "De tablet mag worden fijngemalen"
                }
            ],
            "timing": {
                "repeat": {
                    "boundsPeriod": {
                        "start": "2021-10-04T09:22:44.39+02:00",
                        "end": "2021-10-31T00:00:00+02:00"
                    },
                    "frequency": 1,
                    "period": 1.00,
                    "periodUnit": "d",
                    "timeOfDay": [
                        "12:00"
                    ]
                }
            },
            "asNeededCodeableConcept": {
                "coding": [
                    {
                        "system": "https://referentiemodel.nhg.org/tabellen/nhg-tabel-25-gebruiksvoorschrift#aanvullend-numeriek",
                        "code": "1137"
                    }
                ],
                "text": "zo nodig"
            },
            "route": {
                "coding": [
                    {
                        "system": "urn:oid:2.16.840.1.113883.2.4.4.9",
                        "code": "9"
                    }
                ],
                "text": "ORAAL"
            },
            "doseQuantity": {
                "value": 1.00,
                "unit": "STUK",
                "system": "urn:oid:2.16.840.1.113883.2.4.4.1.900.2",
                "code": "245"
            }
        }
    ]
}