NICE-MedicationAgreement
Description
This profile is for submitting data to the NICE related to periods in which medication was agreed upon and ordered for a patient.
Click here to go to the NICE-MedicationAgreement Simplifier page
NICE data dictionary links
MDS |
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Chronic Obstructive Pulmonary Disease |
Diabetes |
Immunological insufficiency |
Thrombolytic therapy following acute myocardial infarction |
Vasoactive medication |
Source
This profile is used to submit medication order related information to the Dutch National Intensive Care Evaluation (NICE). It was derived from the Nictiz Health and Care Information Model (HCIM; Dutch: Zorginformatiebouwsteen or ZIB) MedicationRequest, 2017 release version 3.1
MedicationRequest | I | MedicationRequest | There are no (further) constraints on this element Element idMedicationRequest MedicationAgreement Alternate namesPrescription, Order, Medicatieafspraak DefinitionA 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.
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id | Σ | 0..1 | id | There are no (further) constraints on this element Element idMedicationRequest.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
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meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idMedicationRequest.meta Metadata about the resource DefinitionThe 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.
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implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idMedicationRequest.implicitRules A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. 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.
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language | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.language Language of the resource content DefinitionThe base language in which the resource is written. 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). A human language. Common Languages (extensible)Constraints
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text | I | 0..1 | Narrative | There are no (further) constraints on this element Element idMedicationRequest.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA 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. 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.
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contained | 0..* | Resource | There are no (further) constraints on this element Element idMedicationRequest.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese 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. 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.
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extension | I | 1..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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periodOfUse | I | 0..1 | Extension(Period) | There are no (further) constraints on this element Element idMedicationRequest.extension:periodOfUse PeriodOfUse Alternate namesextensions, user content, Gebruiksperiode DefinitionStart 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. http://nictiz.nl/fhir/StructureDefinition/zib-Medication-PeriodOfUse Constraints
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usageDuration | I | 0..1 | Extension(Duration) | There are no (further) constraints on this element Element idMedicationRequest.extension:usageDuration Duration Alternate namesextensions, user content, Duur DefinitionDuration: 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. http://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-Duration Constraints
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additionalInformation | I | 0..* | Extension(CodeableConcept) | There are no (further) constraints on this element Element idMedicationRequest.extension:additionalInformation MedicationAgreementAdditionalInformation Alternate namesextensions, user content, MedicatieafspraakAanvullendeInformatie DefinitionAdditional 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. 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. http://nictiz.nl/fhir/StructureDefinition/zib-Medication-AdditionalInformation Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.extension:additionalInformation.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.extension:additionalInformation.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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url | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idMedicationRequest.extension:additionalInformation.url identifies the meaning of the extension DefinitionSource of the definition for the extension code - a logical name or a URL. The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
http://nictiz.nl/fhir/StructureDefinition/zib-Medication-AdditionalInformation
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valueCodeableConcept | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationRequest.extension:additionalInformation.value[x]:valueCodeableConcept Value of extension DefinitionValue of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). MedicatieafspraakAanvullendeInformatieCodelijst MedicatieafspraakAanvullendeInformatieCodelijst (extensible)Constraints
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
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medicationTreatment | I | 0..1 | Extension(Identifier) | There are no (further) constraints on this element Element idMedicationRequest.extension:medicationTreatment Medication Treatment Alternate namesextensions, user content, Medicamenteuze behandeling DefinitionThis 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. No HCIM concept is available for this element. Therefore a mapping to the relevant element Medication Process data element is provided. http://nictiz.nl/fhir/StructureDefinition/zib-Medication-MedicationTreatment Constraints
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nl-core-episodeofcare | I | 0..* | Extension(Reference(nl-core-episodeofcare)) | There are no (further) constraints on this element Element idMedicationRequest.extension:nl-core-episodeofcare Optional Extensions Element Alternate namesextensions, user content DefinitionOptional Extension Element - found in all resources. It is recommended to use the nl-core-episodeofcare extension to reference nl-core-episodeofcare (EpisodeOfCare) instances rather than the Extension(Reference(nl-core-episodeofcare)) Extension URLhttp://nictiz.nl/fhir/StructureDefinition/extension-context-nl-core-episodeofcare Constraints
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Verified | S I | 1..1 | Extension(CodeableConcept) | Element idMedicationRequest.extension:Verified Is the instance validated by a medical professional? Alternate namesextensions, user content DefinitionExtension that is used to indicate whether the entire instance has been validated. Every instance shall be validated by a hospital member / datamanager. However, this is not always feasible in case of automated submission of NICE data elements. This extensions shall be used to indicate the validation status of the instance. 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. https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-Verified-2022Q1 Constraints
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periodOfUse | S I | 0..* | Extension | Element idMedicationRequest.extension:periodOfUse Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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stopType | ?! I | 0..1 | Extension(CodeableConcept) | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension:stopType StopType Alternate namesextensions, user content DefinitionThe manner in which (and indicator that) this medication is discontinued (temporarily or permanently). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. http://nictiz.nl/fhir/StructureDefinition/zib-Medication-StopType Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension:stopType.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension:stopType.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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url | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension:stopType.url identifies the meaning of the extension DefinitionSource of the definition for the extension code - a logical name or a URL. The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
http://nictiz.nl/fhir/StructureDefinition/zib-Medication-StopType
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valueCodeableConcept | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension:stopType.value[x]:valueCodeableConcept Value of extension DefinitionValue of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). StopType MedicatieafspraakStopTypeCodelijst (required)Constraints
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repeatPeriodCyclicalSchedule | ?! I | 0..1 | Extension(Duration) | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension:repeatPeriodCyclicalSchedule RepeatPeriodCyclicalSchedule Alternate namesextensions, user content DefinitionThe 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 There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. http://nictiz.nl/fhir/StructureDefinition/zib-Medication-RepeatPeriodCyclicalSchedule Constraints
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identifier | 0..* | Identifier | There are no (further) constraints on this element Element idMedicationRequest.identifier External ids for this request DefinitionThis 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.
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definition | Σ I | 0..* | Reference(ActivityDefinition | PlanDefinition) | There are no (further) constraints on this element Element idMedicationRequest.definition Protocol or definition DefinitionProtocol or definition followed by this request. 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. Reference(ActivityDefinition | PlanDefinition) Constraints
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basedOn | Σ I | 0..* | Reference(CarePlan | MedicationRequest | ProcedureRequest | ReferralRequest) | There are no (further) constraints on this element Element idMedicationRequest.basedOn What request fulfills DefinitionA plan or request that is fulfilled in whole or in part by this medication request. 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. Reference(CarePlan | MedicationRequest | ProcedureRequest | ReferralRequest) Constraints
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groupIdentifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationRequest.groupIdentifier Composite request this is part of DefinitionA 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. 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.
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status | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.status active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown DefinitionA code specifying the current state of the order. Generally this will be active or completed state. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription MedicationRequestStatus (required)Constraints
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intent | S Σ ?! | 1..1 | codeBindingFixed Value | Element idMedicationRequest.intent order DefinitionWhether the request is a proposal, plan, or an original order. Only medication requests that are actually ordered should be sent to NICE. 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. The kind of medication order MedicationRequestIntent (required)Constraints
order
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category | 1..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationRequest.category Type of medication usage DefinitionIndicates the type of medication order and where the medication is expected to be consumed or administered. 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. A coded concept identifying where the medication ordered is expected to be consumed or administered MedicationRequestCategory (preferred)Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.category.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.category.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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coding | Σ | 0..* | Coding | There are no (further) constraints on this element Element idMedicationRequest.category.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. 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. Unordered, Open, by code(Value) Constraints
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medicationAgreementCode | Σ | 0..* | Coding | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode MedicationAgreementCode DefinitionCategory code used for indexing/retrieval of the ZIB MedicationAgreeement. The snomed code is stated in the Medication Process v09. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. 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.
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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system | Σ | 0..1 | uriFixed Value | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. 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.
http://snomed.info/sct
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.version Version of the system - if relevant DefinitionThe 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. 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.
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code | Σ | 0..1 | codeFixed Value | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.code Symbol in syntax defined by the system DefinitionA 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). Need to refer to a particular code in the system. Note that FHIR strings may not exceed 1MB in size
16076005
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings may not exceed 1MB in size
Prescription (procedure)
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). 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. 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.
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text | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.category.text Plain text representation of the concept DefinitionA 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. 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. Very often the text is the same as a displayName of one of the codings.
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priority | Σ | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.priority routine | urgent | stat | asap DefinitionIndicates how quickly the Medication Request should be addressed with respect to other requests. Note that FHIR strings may not exceed 1MB in size Identifies the level of importance to be assigned to actioning the request MedicationRequestPriority (required)Constraints
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medicationReference | S Σ | 1..1 | Reference(https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-PharmaceuticalProduct-2022Q1) | Element idMedicationRequest.medicationReference:medicationReference AgreedMedicine Alternate namesAfgesprokengeneesmiddel DefinitionThe medicine agreed upon to be used. Reference(https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-PharmaceuticalProduct-2022Q1) Constraints
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subject | S Σ I | 1..1 | Reference(NICE-Patient) | Element idMedicationRequest.subject Who or group medication request is for DefinitionA link to a resource representing the person or set of individuals to whom the medication will be given. 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.
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context | S I | 0..1 | Reference(HCIM Encounter | nl-core-episodeofcare | NICE-Encounter) | Element idMedicationRequest.context Created during encounter/admission/stay DefinitionA link to an encounter, or episode of care, that identifies the particular occurrence or set occurrences of contact between patient and health care provider. It is recommended to use the nl-core-episodeofcare extension to reference nl-core-episodeofcare (EpisodeOfCare) instances rather than the Reference(HCIM Encounter | nl-core-episodeofcare | NICE-Encounter) Constraints
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supportingInformation | I | 0..* | Reference(Resource) | There are no (further) constraints on this element Element idMedicationRequest.supportingInformation Information to support ordering of the medication DefinitionInclude additional information (for example, patient height and weight) that supports the ordering of the medication. 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.
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authoredOn | Σ | 1..1 | dateTime | There are no (further) constraints on this element Element idMedicationRequest.authoredOn MedicationAgreementDateTime Alternate namesAfspraakdatum DefinitionThe 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)
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requester | Σ I | 0..1 | BackboneElement | There are no (further) constraints on this element Element idMedicationRequest.requester Prescriber Alternate namesVoorschrijver DefinitionThe health professional that entered the medication agreement with the patient. 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.
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.requester.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.requester.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.requester.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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agent | Σ I | 1..1 | Reference(nl-core-practitioner | nl-core-organization | nl-core-patient | nl-core-relatedperson | Device) | There are no (further) constraints on this element Element idMedicationRequest.requester.agent Who ordered the initial medication(s) DefinitionThe healthcare professional responsible for authorizing the initial prescription. The health professional's speciality, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile. Reference(nl-core-practitioner | nl-core-organization | nl-core-patient | nl-core-relatedperson | Device) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.requester.agent.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.requester.agent.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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practitionerRole | I | 0..1 | Extension(Reference(nl-core-practitionerrole)) | There are no (further) constraints on this element Element idMedicationRequest.requester.agent.extension:practitionerRole Optional Extensions Element Alternate namesextensions, user content DefinitionOptional Extension Element - found in all resources. 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. Extension(Reference(nl-core-practitionerrole)) Extension URLhttp://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference Constraints
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reference | Σ I | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.requester.agent.reference Literal reference, Relative, internal or absolute URL DefinitionA 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. 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.
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identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationRequest.requester.agent.identifier Logical reference, when literal reference is not known DefinitionAn 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. 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.
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.requester.agent.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. 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.
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onBehalfOf | Σ I | 0..1 | Reference(nl-core-organization) | There are no (further) constraints on this element Element idMedicationRequest.requester.onBehalfOf Organization agent is acting for DefinitionThe organization the device or practitioner was acting on behalf of. Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when authoring the request. 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. Reference(nl-core-organization) Constraints
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recorder | I | 0..1 | Reference(nl-core-practitioner) | There are no (further) constraints on this element Element idMedicationRequest.recorder Person who entered the request DefinitionThe person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order. 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. Reference(nl-core-practitioner) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.recorder.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.recorder.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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practitionerRole | I | 0..1 | Extension(Reference(nl-core-practitionerrole)) | There are no (further) constraints on this element Element idMedicationRequest.recorder.extension:practitionerRole Optional Extensions Element Alternate namesextensions, user content DefinitionOptional Extension Element - found in all resources. 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. Extension(Reference(nl-core-practitionerrole)) Extension URLhttp://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference Constraints
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reference | Σ I | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.recorder.reference Literal reference, Relative, internal or absolute URL DefinitionA 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. 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.
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identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationRequest.recorder.identifier Logical reference, when literal reference is not known DefinitionAn 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. 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.
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.recorder.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. 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.
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reasonCode | 0..* | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationRequest.reasonCode ReasonMedicationAgreement Alternate namesRedenMedicatieafspraak DefinitionReason for this agreement. This can be the reason to start, change or stop the medication treatment. This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference. RedenWijzigenOfStakenCodelijst RedenWijzigenOfStakenCodelijst (extensible)Constraints
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reasonReference | I | 0..* | Reference(Observation | HCIM Problem) | There are no (further) constraints on this element Element idMedicationRequest.reasonReference PrescriptionReason Alternate namesRedenVanVoorschrijven DefinitionThe 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”. This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode. Reference(Observation | HCIM Problem) Constraints
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note | 0..* | Annotation | There are no (further) constraints on this element Element idMedicationRequest.note Comment Alternate namesToelichting DefinitionExplanation for the medication agreement. This explanation can contain e.g. information on why a prescriber makes a medication agreement that deviates from the norm. 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).
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dosageInstruction | 0..* | HCIM InstructionsForUse | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction InstructionsForUse Alternate namesGebruiksinstructie DefinitionInstructions for the use of the medication, e.g. dose and route of administration 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.
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dispenseRequest | 0..1 | BackboneElement | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest Medication supply authorization DefinitionIndicates 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.
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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validityPeriod | I | 0..1 | Period | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.validityPeriod Time period supply is authorized for DefinitionThis indicates the validity period of a prescription (stale dating the Prescription). Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription. 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.
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numberOfRepeatsAllowed | 0..1 | positiveInt | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.numberOfRepeatsAllowed Number of refills authorized DefinitionAn 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. If displaying "number of authorized fills", add 1 to this number.
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quantity | I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.quantity Amount of medication to supply per dispense DefinitionThe amount that is to be dispensed for one fill. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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expectedSupplyDuration | I | 0..1 | Duration | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.expectedSupplyDuration Number of days supply per dispense DefinitionIdentifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last. 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.
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performer | I | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.performer Intended dispenser DefinitionIndicates the intended dispensing Organization specified by the prescriber. 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.
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substitution | 0..1 | BackboneElement | There are no (further) constraints on this element Element idMedicationRequest.substitution Any restrictions on medication substitution DefinitionIndicates 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.
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.substitution.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.substitution.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.substitution.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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allowed | ?! | 1..1 | boolean | There are no (further) constraints on this element Element idMedicationRequest.substitution.allowed Whether substitution is allowed or not DefinitionTrue if the prescriber allows a different drug to be dispensed from what was prescribed. This element is labeled as a modifer because whether substitution is allow or not cannot be ignored.
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reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idMedicationRequest.substitution.reason Why should (not) substitution be made DefinitionIndicates the reason for the substitution, or why substitution must or must not be performed. 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. A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed. SubstanceAdminSubstitutionReason (example)Constraints
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priorPrescription | I | 0..1 | Reference(MedicationRequest) | There are no (further) constraints on this element Element idMedicationRequest.priorPrescription An order/prescription that is being replaced DefinitionA link to a resource representing an earlier order related order or prescription. 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.
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detectedIssue | I | 0..* | Reference(DetectedIssue) | There are no (further) constraints on this element Element idMedicationRequest.detectedIssue Clinical Issue with action Alternate namesContraindication, Drug Utilization Review (DUR), Alert DefinitionIndicates 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. 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.
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eventHistory | I | 0..* | Reference(Provenance) | There are no (further) constraints on this element Element idMedicationRequest.eventHistory A list of events of interest in the lifecycle DefinitionLinks 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. 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.).
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MedicationRequest | I | MedicationRequest | There are no (further) constraints on this element Element idMedicationRequest MedicationAgreement Alternate namesPrescription, Order, Medicatieafspraak DefinitionA 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.
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id | Σ | 0..1 | id | There are no (further) constraints on this element Element idMedicationRequest.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
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meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idMedicationRequest.meta Metadata about the resource DefinitionThe 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.
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implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idMedicationRequest.implicitRules A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. 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.
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language | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.language Language of the resource content DefinitionThe base language in which the resource is written. 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). A human language. Common Languages (extensible)Constraints
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text | I | 0..1 | Narrative | There are no (further) constraints on this element Element idMedicationRequest.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA 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. 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.
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contained | 0..* | Resource | There are no (further) constraints on this element Element idMedicationRequest.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese 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. 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.
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extension | I | 1..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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periodOfUse | I | 0..1 | Extension(Period) | There are no (further) constraints on this element Element idMedicationRequest.extension:periodOfUse PeriodOfUse Alternate namesextensions, user content, Gebruiksperiode DefinitionStart 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. http://nictiz.nl/fhir/StructureDefinition/zib-Medication-PeriodOfUse Constraints
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usageDuration | I | 0..1 | Extension(Duration) | There are no (further) constraints on this element Element idMedicationRequest.extension:usageDuration Duration Alternate namesextensions, user content, Duur DefinitionDuration: 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. http://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-Duration Constraints
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additionalInformation | I | 0..* | Extension(CodeableConcept) | There are no (further) constraints on this element Element idMedicationRequest.extension:additionalInformation MedicationAgreementAdditionalInformation Alternate namesextensions, user content, MedicatieafspraakAanvullendeInformatie DefinitionAdditional 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. 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. http://nictiz.nl/fhir/StructureDefinition/zib-Medication-AdditionalInformation Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.extension:additionalInformation.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.extension:additionalInformation.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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url | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idMedicationRequest.extension:additionalInformation.url identifies the meaning of the extension DefinitionSource of the definition for the extension code - a logical name or a URL. The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
http://nictiz.nl/fhir/StructureDefinition/zib-Medication-AdditionalInformation
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valueCodeableConcept | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationRequest.extension:additionalInformation.value[x]:valueCodeableConcept Value of extension DefinitionValue of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). MedicatieafspraakAanvullendeInformatieCodelijst MedicatieafspraakAanvullendeInformatieCodelijst (extensible)Constraints
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
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medicationTreatment | I | 0..1 | Extension(Identifier) | There are no (further) constraints on this element Element idMedicationRequest.extension:medicationTreatment Medication Treatment Alternate namesextensions, user content, Medicamenteuze behandeling DefinitionThis 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. No HCIM concept is available for this element. Therefore a mapping to the relevant element Medication Process data element is provided. http://nictiz.nl/fhir/StructureDefinition/zib-Medication-MedicationTreatment Constraints
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nl-core-episodeofcare | I | 0..* | Extension(Reference(nl-core-episodeofcare)) | There are no (further) constraints on this element Element idMedicationRequest.extension:nl-core-episodeofcare Optional Extensions Element Alternate namesextensions, user content DefinitionOptional Extension Element - found in all resources. It is recommended to use the nl-core-episodeofcare extension to reference nl-core-episodeofcare (EpisodeOfCare) instances rather than the Extension(Reference(nl-core-episodeofcare)) Extension URLhttp://nictiz.nl/fhir/StructureDefinition/extension-context-nl-core-episodeofcare Constraints
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Verified | S I | 1..1 | Extension(CodeableConcept) | Element idMedicationRequest.extension:Verified Is the instance validated by a medical professional? Alternate namesextensions, user content DefinitionExtension that is used to indicate whether the entire instance has been validated. Every instance shall be validated by a hospital member / datamanager. However, this is not always feasible in case of automated submission of NICE data elements. This extensions shall be used to indicate the validation status of the instance. 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. https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-Verified-2022Q1 Constraints
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periodOfUse | S I | 0..* | Extension | Element idMedicationRequest.extension:periodOfUse Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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stopType | ?! I | 0..1 | Extension(CodeableConcept) | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension:stopType StopType Alternate namesextensions, user content DefinitionThe manner in which (and indicator that) this medication is discontinued (temporarily or permanently). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. http://nictiz.nl/fhir/StructureDefinition/zib-Medication-StopType Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension:stopType.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension:stopType.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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url | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension:stopType.url identifies the meaning of the extension DefinitionSource of the definition for the extension code - a logical name or a URL. The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
http://nictiz.nl/fhir/StructureDefinition/zib-Medication-StopType
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valueCodeableConcept | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension:stopType.value[x]:valueCodeableConcept Value of extension DefinitionValue of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). StopType MedicatieafspraakStopTypeCodelijst (required)Constraints
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repeatPeriodCyclicalSchedule | ?! I | 0..1 | Extension(Duration) | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension:repeatPeriodCyclicalSchedule RepeatPeriodCyclicalSchedule Alternate namesextensions, user content DefinitionThe 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 There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. http://nictiz.nl/fhir/StructureDefinition/zib-Medication-RepeatPeriodCyclicalSchedule Constraints
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identifier | 0..* | Identifier | There are no (further) constraints on this element Element idMedicationRequest.identifier External ids for this request DefinitionThis 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.
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definition | Σ I | 0..* | Reference(ActivityDefinition | PlanDefinition) | There are no (further) constraints on this element Element idMedicationRequest.definition Protocol or definition DefinitionProtocol or definition followed by this request. 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. Reference(ActivityDefinition | PlanDefinition) Constraints
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basedOn | Σ I | 0..* | Reference(CarePlan | MedicationRequest | ProcedureRequest | ReferralRequest) | There are no (further) constraints on this element Element idMedicationRequest.basedOn What request fulfills DefinitionA plan or request that is fulfilled in whole or in part by this medication request. 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. Reference(CarePlan | MedicationRequest | ProcedureRequest | ReferralRequest) Constraints
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groupIdentifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationRequest.groupIdentifier Composite request this is part of DefinitionA 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. 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.
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status | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.status active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown DefinitionA code specifying the current state of the order. Generally this will be active or completed state. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription MedicationRequestStatus (required)Constraints
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intent | S Σ ?! | 1..1 | codeBindingFixed Value | Element idMedicationRequest.intent order DefinitionWhether the request is a proposal, plan, or an original order. Only medication requests that are actually ordered should be sent to NICE. 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. The kind of medication order MedicationRequestIntent (required)Constraints
order
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category | 1..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationRequest.category Type of medication usage DefinitionIndicates the type of medication order and where the medication is expected to be consumed or administered. 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. A coded concept identifying where the medication ordered is expected to be consumed or administered MedicationRequestCategory (preferred)Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.category.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.category.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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coding | Σ | 0..* | Coding | There are no (further) constraints on this element Element idMedicationRequest.category.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. 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. Unordered, Open, by code(Value) Constraints
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medicationAgreementCode | Σ | 0..* | Coding | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode MedicationAgreementCode DefinitionCategory code used for indexing/retrieval of the ZIB MedicationAgreeement. The snomed code is stated in the Medication Process v09. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. 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.
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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system | Σ | 0..1 | uriFixed Value | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. 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.
http://snomed.info/sct
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.version Version of the system - if relevant DefinitionThe 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. 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.
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code | Σ | 0..1 | codeFixed Value | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.code Symbol in syntax defined by the system DefinitionA 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). Need to refer to a particular code in the system. Note that FHIR strings may not exceed 1MB in size
16076005
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings may not exceed 1MB in size
Prescription (procedure)
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). 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. 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.
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text | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.category.text Plain text representation of the concept DefinitionA 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. 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. Very often the text is the same as a displayName of one of the codings.
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priority | Σ | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.priority routine | urgent | stat | asap DefinitionIndicates how quickly the Medication Request should be addressed with respect to other requests. Note that FHIR strings may not exceed 1MB in size Identifies the level of importance to be assigned to actioning the request MedicationRequestPriority (required)Constraints
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medicationReference | S Σ | 1..1 | Reference(https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-PharmaceuticalProduct-2022Q1) | Element idMedicationRequest.medicationReference:medicationReference AgreedMedicine Alternate namesAfgesprokengeneesmiddel DefinitionThe medicine agreed upon to be used. Reference(https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-PharmaceuticalProduct-2022Q1) Constraints
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subject | S Σ I | 1..1 | Reference(NICE-Patient) | Element idMedicationRequest.subject Who or group medication request is for DefinitionA link to a resource representing the person or set of individuals to whom the medication will be given. 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.
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context | S I | 0..1 | Reference(HCIM Encounter | nl-core-episodeofcare | NICE-Encounter) | Element idMedicationRequest.context Created during encounter/admission/stay DefinitionA link to an encounter, or episode of care, that identifies the particular occurrence or set occurrences of contact between patient and health care provider. It is recommended to use the nl-core-episodeofcare extension to reference nl-core-episodeofcare (EpisodeOfCare) instances rather than the Reference(HCIM Encounter | nl-core-episodeofcare | NICE-Encounter) Constraints
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supportingInformation | I | 0..* | Reference(Resource) | There are no (further) constraints on this element Element idMedicationRequest.supportingInformation Information to support ordering of the medication DefinitionInclude additional information (for example, patient height and weight) that supports the ordering of the medication. 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.
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authoredOn | Σ | 1..1 | dateTime | There are no (further) constraints on this element Element idMedicationRequest.authoredOn MedicationAgreementDateTime Alternate namesAfspraakdatum DefinitionThe 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)
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requester | Σ I | 0..1 | BackboneElement | There are no (further) constraints on this element Element idMedicationRequest.requester Prescriber Alternate namesVoorschrijver DefinitionThe health professional that entered the medication agreement with the patient. 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.
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.requester.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.requester.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.requester.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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agent | Σ I | 1..1 | Reference(nl-core-practitioner | nl-core-organization | nl-core-patient | nl-core-relatedperson | Device) | There are no (further) constraints on this element Element idMedicationRequest.requester.agent Who ordered the initial medication(s) DefinitionThe healthcare professional responsible for authorizing the initial prescription. The health professional's speciality, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile. Reference(nl-core-practitioner | nl-core-organization | nl-core-patient | nl-core-relatedperson | Device) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.requester.agent.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.requester.agent.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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practitionerRole | I | 0..1 | Extension(Reference(nl-core-practitionerrole)) | There are no (further) constraints on this element Element idMedicationRequest.requester.agent.extension:practitionerRole Optional Extensions Element Alternate namesextensions, user content DefinitionOptional Extension Element - found in all resources. 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. Extension(Reference(nl-core-practitionerrole)) Extension URLhttp://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference Constraints
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reference | Σ I | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.requester.agent.reference Literal reference, Relative, internal or absolute URL DefinitionA 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. 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.
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identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationRequest.requester.agent.identifier Logical reference, when literal reference is not known DefinitionAn 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. 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.
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.requester.agent.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. 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.
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onBehalfOf | Σ I | 0..1 | Reference(nl-core-organization) | There are no (further) constraints on this element Element idMedicationRequest.requester.onBehalfOf Organization agent is acting for DefinitionThe organization the device or practitioner was acting on behalf of. Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when authoring the request. 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. Reference(nl-core-organization) Constraints
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recorder | I | 0..1 | Reference(nl-core-practitioner) | There are no (further) constraints on this element Element idMedicationRequest.recorder Person who entered the request DefinitionThe person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order. 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. Reference(nl-core-practitioner) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.recorder.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.recorder.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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practitionerRole | I | 0..1 | Extension(Reference(nl-core-practitionerrole)) | There are no (further) constraints on this element Element idMedicationRequest.recorder.extension:practitionerRole Optional Extensions Element Alternate namesextensions, user content DefinitionOptional Extension Element - found in all resources. 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. Extension(Reference(nl-core-practitionerrole)) Extension URLhttp://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference Constraints
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reference | Σ I | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.recorder.reference Literal reference, Relative, internal or absolute URL DefinitionA 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. 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.
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identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationRequest.recorder.identifier Logical reference, when literal reference is not known DefinitionAn 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. 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.
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.recorder.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. 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.
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reasonCode | 0..* | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationRequest.reasonCode ReasonMedicationAgreement Alternate namesRedenMedicatieafspraak DefinitionReason for this agreement. This can be the reason to start, change or stop the medication treatment. This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference. RedenWijzigenOfStakenCodelijst RedenWijzigenOfStakenCodelijst (extensible)Constraints
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reasonReference | I | 0..* | Reference(Observation | HCIM Problem) | There are no (further) constraints on this element Element idMedicationRequest.reasonReference PrescriptionReason Alternate namesRedenVanVoorschrijven DefinitionThe 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”. This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode. Reference(Observation | HCIM Problem) Constraints
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note | 0..* | Annotation | There are no (further) constraints on this element Element idMedicationRequest.note Comment Alternate namesToelichting DefinitionExplanation for the medication agreement. This explanation can contain e.g. information on why a prescriber makes a medication agreement that deviates from the norm. 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).
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dosageInstruction | 0..* | HCIM InstructionsForUse | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction InstructionsForUse Alternate namesGebruiksinstructie DefinitionInstructions for the use of the medication, e.g. dose and route of administration 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.
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dispenseRequest | 0..1 | BackboneElement | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest Medication supply authorization DefinitionIndicates 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.
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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validityPeriod | I | 0..1 | Period | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.validityPeriod Time period supply is authorized for DefinitionThis indicates the validity period of a prescription (stale dating the Prescription). Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription. 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.
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numberOfRepeatsAllowed | 0..1 | positiveInt | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.numberOfRepeatsAllowed Number of refills authorized DefinitionAn 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. If displaying "number of authorized fills", add 1 to this number.
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quantity | I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.quantity Amount of medication to supply per dispense DefinitionThe amount that is to be dispensed for one fill. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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expectedSupplyDuration | I | 0..1 | Duration | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.expectedSupplyDuration Number of days supply per dispense DefinitionIdentifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last. 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.
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performer | I | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.performer Intended dispenser DefinitionIndicates the intended dispensing Organization specified by the prescriber. 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.
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substitution | 0..1 | BackboneElement | There are no (further) constraints on this element Element idMedicationRequest.substitution Any restrictions on medication substitution DefinitionIndicates 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.
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.substitution.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.substitution.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.substitution.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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allowed | ?! | 1..1 | boolean | There are no (further) constraints on this element Element idMedicationRequest.substitution.allowed Whether substitution is allowed or not DefinitionTrue if the prescriber allows a different drug to be dispensed from what was prescribed. This element is labeled as a modifer because whether substitution is allow or not cannot be ignored.
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reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idMedicationRequest.substitution.reason Why should (not) substitution be made DefinitionIndicates the reason for the substitution, or why substitution must or must not be performed. 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. A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed. SubstanceAdminSubstitutionReason (example)Constraints
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priorPrescription | I | 0..1 | Reference(MedicationRequest) | There are no (further) constraints on this element Element idMedicationRequest.priorPrescription An order/prescription that is being replaced DefinitionA link to a resource representing an earlier order related order or prescription. 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.
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detectedIssue | I | 0..* | Reference(DetectedIssue) | There are no (further) constraints on this element Element idMedicationRequest.detectedIssue Clinical Issue with action Alternate namesContraindication, Drug Utilization Review (DUR), Alert DefinitionIndicates 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. 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.
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eventHistory | I | 0..* | Reference(Provenance) | There are no (further) constraints on this element Element idMedicationRequest.eventHistory A list of events of interest in the lifecycle DefinitionLinks 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. 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.).
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MedicationRequest | I | MedicationRequest | There are no (further) constraints on this element Element idMedicationRequest MedicationAgreement Alternate namesPrescription, Order, Medicatieafspraak DefinitionA 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.
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id | Σ | 0..1 | id | There are no (further) constraints on this element Element idMedicationRequest.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
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meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idMedicationRequest.meta Metadata about the resource DefinitionThe 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.
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implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idMedicationRequest.implicitRules A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. 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.
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language | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.language Language of the resource content DefinitionThe base language in which the resource is written. 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). A human language. Common Languages (extensible)Constraints
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text | I | 0..1 | Narrative | There are no (further) constraints on this element Element idMedicationRequest.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA 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. 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.
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contained | 0..* | Resource | There are no (further) constraints on this element Element idMedicationRequest.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese 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. 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.
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extension | I | 1..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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periodOfUse | I | 0..1 | Extension(Period) | There are no (further) constraints on this element Element idMedicationRequest.extension:periodOfUse PeriodOfUse Alternate namesextensions, user content, Gebruiksperiode DefinitionStart 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. http://nictiz.nl/fhir/StructureDefinition/zib-Medication-PeriodOfUse Constraints
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usageDuration | I | 0..1 | Extension(Duration) | There are no (further) constraints on this element Element idMedicationRequest.extension:usageDuration Duration Alternate namesextensions, user content, Duur DefinitionDuration: 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. http://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-Duration Constraints
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additionalInformation | I | 0..* | Extension(CodeableConcept) | There are no (further) constraints on this element Element idMedicationRequest.extension:additionalInformation MedicationAgreementAdditionalInformation Alternate namesextensions, user content, MedicatieafspraakAanvullendeInformatie DefinitionAdditional 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. 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. http://nictiz.nl/fhir/StructureDefinition/zib-Medication-AdditionalInformation Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.extension:additionalInformation.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.extension:additionalInformation.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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url | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idMedicationRequest.extension:additionalInformation.url identifies the meaning of the extension DefinitionSource of the definition for the extension code - a logical name or a URL. The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
http://nictiz.nl/fhir/StructureDefinition/zib-Medication-AdditionalInformation
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valueCodeableConcept | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationRequest.extension:additionalInformation.value[x]:valueCodeableConcept Value of extension DefinitionValue of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). MedicatieafspraakAanvullendeInformatieCodelijst MedicatieafspraakAanvullendeInformatieCodelijst (extensible)Constraints
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
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medicationTreatment | I | 0..1 | Extension(Identifier) | There are no (further) constraints on this element Element idMedicationRequest.extension:medicationTreatment Medication Treatment Alternate namesextensions, user content, Medicamenteuze behandeling DefinitionThis 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. No HCIM concept is available for this element. Therefore a mapping to the relevant element Medication Process data element is provided. http://nictiz.nl/fhir/StructureDefinition/zib-Medication-MedicationTreatment Constraints
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nl-core-episodeofcare | I | 0..* | Extension(Reference(nl-core-episodeofcare)) | There are no (further) constraints on this element Element idMedicationRequest.extension:nl-core-episodeofcare Optional Extensions Element Alternate namesextensions, user content DefinitionOptional Extension Element - found in all resources. It is recommended to use the nl-core-episodeofcare extension to reference nl-core-episodeofcare (EpisodeOfCare) instances rather than the Extension(Reference(nl-core-episodeofcare)) Extension URLhttp://nictiz.nl/fhir/StructureDefinition/extension-context-nl-core-episodeofcare Constraints
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Verified | S I | 1..1 | Extension(CodeableConcept) | Element idMedicationRequest.extension:Verified Is the instance validated by a medical professional? Alternate namesextensions, user content DefinitionExtension that is used to indicate whether the entire instance has been validated. Every instance shall be validated by a hospital member / datamanager. However, this is not always feasible in case of automated submission of NICE data elements. This extensions shall be used to indicate the validation status of the instance. 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. https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-Verified-2022Q1 Constraints
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periodOfUse | S I | 0..* | Extension | Element idMedicationRequest.extension:periodOfUse Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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stopType | ?! I | 0..1 | Extension(CodeableConcept) | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension:stopType StopType Alternate namesextensions, user content DefinitionThe manner in which (and indicator that) this medication is discontinued (temporarily or permanently). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. http://nictiz.nl/fhir/StructureDefinition/zib-Medication-StopType Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension:stopType.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension:stopType.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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url | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension:stopType.url identifies the meaning of the extension DefinitionSource of the definition for the extension code - a logical name or a URL. The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
http://nictiz.nl/fhir/StructureDefinition/zib-Medication-StopType
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valueCodeableConcept | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension:stopType.value[x]:valueCodeableConcept Value of extension DefinitionValue of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). StopType MedicatieafspraakStopTypeCodelijst (required)Constraints
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repeatPeriodCyclicalSchedule | ?! I | 0..1 | Extension(Duration) | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension:repeatPeriodCyclicalSchedule RepeatPeriodCyclicalSchedule Alternate namesextensions, user content DefinitionThe 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 There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. http://nictiz.nl/fhir/StructureDefinition/zib-Medication-RepeatPeriodCyclicalSchedule Constraints
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identifier | 0..* | Identifier | There are no (further) constraints on this element Element idMedicationRequest.identifier External ids for this request DefinitionThis 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.
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definition | Σ I | 0..* | Reference(ActivityDefinition | PlanDefinition) | There are no (further) constraints on this element Element idMedicationRequest.definition Protocol or definition DefinitionProtocol or definition followed by this request. 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. Reference(ActivityDefinition | PlanDefinition) Constraints
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basedOn | Σ I | 0..* | Reference(CarePlan | MedicationRequest | ProcedureRequest | ReferralRequest) | There are no (further) constraints on this element Element idMedicationRequest.basedOn What request fulfills DefinitionA plan or request that is fulfilled in whole or in part by this medication request. 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. Reference(CarePlan | MedicationRequest | ProcedureRequest | ReferralRequest) Constraints
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groupIdentifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationRequest.groupIdentifier Composite request this is part of DefinitionA 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. 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.
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status | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.status active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown DefinitionA code specifying the current state of the order. Generally this will be active or completed state. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription MedicationRequestStatus (required)Constraints
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intent | S Σ ?! | 1..1 | codeBindingFixed Value | Element idMedicationRequest.intent order DefinitionWhether the request is a proposal, plan, or an original order. Only medication requests that are actually ordered should be sent to NICE. 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. The kind of medication order MedicationRequestIntent (required)Constraints
order
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category | 1..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationRequest.category Type of medication usage DefinitionIndicates the type of medication order and where the medication is expected to be consumed or administered. 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. A coded concept identifying where the medication ordered is expected to be consumed or administered MedicationRequestCategory (preferred)Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.category.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.category.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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coding | Σ | 0..* | Coding | There are no (further) constraints on this element Element idMedicationRequest.category.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. 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. Unordered, Open, by code(Value) Constraints
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medicationAgreementCode | Σ | 0..* | Coding | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode MedicationAgreementCode DefinitionCategory code used for indexing/retrieval of the ZIB MedicationAgreeement. The snomed code is stated in the Medication Process v09. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. 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.
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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system | Σ | 0..1 | uriFixed Value | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. 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.
http://snomed.info/sct
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.version Version of the system - if relevant DefinitionThe 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. 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.
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code | Σ | 0..1 | codeFixed Value | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.code Symbol in syntax defined by the system DefinitionA 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). Need to refer to a particular code in the system. Note that FHIR strings may not exceed 1MB in size
16076005
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings may not exceed 1MB in size
Prescription (procedure)
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationRequest.category.coding:medicationAgreementCode.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). 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. 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.
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text | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.category.text Plain text representation of the concept DefinitionA 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. 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. Very often the text is the same as a displayName of one of the codings.
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priority | Σ | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.priority routine | urgent | stat | asap DefinitionIndicates how quickly the Medication Request should be addressed with respect to other requests. Note that FHIR strings may not exceed 1MB in size Identifies the level of importance to be assigned to actioning the request MedicationRequestPriority (required)Constraints
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medicationReference | S Σ | 1..1 | Reference(https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-PharmaceuticalProduct-2022Q1) | Element idMedicationRequest.medicationReference:medicationReference AgreedMedicine Alternate namesAfgesprokengeneesmiddel DefinitionThe medicine agreed upon to be used. Reference(https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-PharmaceuticalProduct-2022Q1) Constraints
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subject | S Σ I | 1..1 | Reference(NICE-Patient) | Element idMedicationRequest.subject Who or group medication request is for DefinitionA link to a resource representing the person or set of individuals to whom the medication will be given. 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.
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context | S I | 0..1 | Reference(HCIM Encounter | nl-core-episodeofcare | NICE-Encounter) | Element idMedicationRequest.context Created during encounter/admission/stay DefinitionA link to an encounter, or episode of care, that identifies the particular occurrence or set occurrences of contact between patient and health care provider. It is recommended to use the nl-core-episodeofcare extension to reference nl-core-episodeofcare (EpisodeOfCare) instances rather than the Reference(HCIM Encounter | nl-core-episodeofcare | NICE-Encounter) Constraints
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supportingInformation | I | 0..* | Reference(Resource) | There are no (further) constraints on this element Element idMedicationRequest.supportingInformation Information to support ordering of the medication DefinitionInclude additional information (for example, patient height and weight) that supports the ordering of the medication. 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.
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authoredOn | Σ | 1..1 | dateTime | There are no (further) constraints on this element Element idMedicationRequest.authoredOn MedicationAgreementDateTime Alternate namesAfspraakdatum DefinitionThe 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)
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requester | Σ I | 0..1 | BackboneElement | There are no (further) constraints on this element Element idMedicationRequest.requester Prescriber Alternate namesVoorschrijver DefinitionThe health professional that entered the medication agreement with the patient. 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.
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.requester.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.requester.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.requester.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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agent | Σ I | 1..1 | Reference(nl-core-practitioner | nl-core-organization | nl-core-patient | nl-core-relatedperson | Device) | There are no (further) constraints on this element Element idMedicationRequest.requester.agent Who ordered the initial medication(s) DefinitionThe healthcare professional responsible for authorizing the initial prescription. The health professional's speciality, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile. Reference(nl-core-practitioner | nl-core-organization | nl-core-patient | nl-core-relatedperson | Device) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.requester.agent.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.requester.agent.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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practitionerRole | I | 0..1 | Extension(Reference(nl-core-practitionerrole)) | There are no (further) constraints on this element Element idMedicationRequest.requester.agent.extension:practitionerRole Optional Extensions Element Alternate namesextensions, user content DefinitionOptional Extension Element - found in all resources. 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. Extension(Reference(nl-core-practitionerrole)) Extension URLhttp://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference Constraints
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reference | Σ I | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.requester.agent.reference Literal reference, Relative, internal or absolute URL DefinitionA 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. 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.
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identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationRequest.requester.agent.identifier Logical reference, when literal reference is not known DefinitionAn 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. 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.
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.requester.agent.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. 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.
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onBehalfOf | Σ I | 0..1 | Reference(nl-core-organization) | There are no (further) constraints on this element Element idMedicationRequest.requester.onBehalfOf Organization agent is acting for DefinitionThe organization the device or practitioner was acting on behalf of. Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when authoring the request. 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. Reference(nl-core-organization) Constraints
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recorder | I | 0..1 | Reference(nl-core-practitioner) | There are no (further) constraints on this element Element idMedicationRequest.recorder Person who entered the request DefinitionThe person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order. 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. Reference(nl-core-practitioner) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.recorder.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.recorder.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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practitionerRole | I | 0..1 | Extension(Reference(nl-core-practitionerrole)) | There are no (further) constraints on this element Element idMedicationRequest.recorder.extension:practitionerRole Optional Extensions Element Alternate namesextensions, user content DefinitionOptional Extension Element - found in all resources. 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. Extension(Reference(nl-core-practitionerrole)) Extension URLhttp://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference Constraints
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reference | Σ I | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.recorder.reference Literal reference, Relative, internal or absolute URL DefinitionA 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. 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.
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identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationRequest.recorder.identifier Logical reference, when literal reference is not known DefinitionAn 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. 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.
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.recorder.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. 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.
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reasonCode | 0..* | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationRequest.reasonCode ReasonMedicationAgreement Alternate namesRedenMedicatieafspraak DefinitionReason for this agreement. This can be the reason to start, change or stop the medication treatment. This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference. RedenWijzigenOfStakenCodelijst RedenWijzigenOfStakenCodelijst (extensible)Constraints
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reasonReference | I | 0..* | Reference(Observation | HCIM Problem) | There are no (further) constraints on this element Element idMedicationRequest.reasonReference PrescriptionReason Alternate namesRedenVanVoorschrijven DefinitionThe 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”. This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode. Reference(Observation | HCIM Problem) Constraints
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note | 0..* | Annotation | There are no (further) constraints on this element Element idMedicationRequest.note Comment Alternate namesToelichting DefinitionExplanation for the medication agreement. This explanation can contain e.g. information on why a prescriber makes a medication agreement that deviates from the norm. 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).
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dosageInstruction | 0..* | HCIM InstructionsForUse | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction InstructionsForUse Alternate namesGebruiksinstructie DefinitionInstructions for the use of the medication, e.g. dose and route of administration 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.
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dispenseRequest | 0..1 | BackboneElement | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest Medication supply authorization DefinitionIndicates 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.
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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validityPeriod | I | 0..1 | Period | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.validityPeriod Time period supply is authorized for DefinitionThis indicates the validity period of a prescription (stale dating the Prescription). Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription. 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.
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numberOfRepeatsAllowed | 0..1 | positiveInt | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.numberOfRepeatsAllowed Number of refills authorized DefinitionAn 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. If displaying "number of authorized fills", add 1 to this number.
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quantity | I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.quantity Amount of medication to supply per dispense DefinitionThe amount that is to be dispensed for one fill. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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expectedSupplyDuration | I | 0..1 | Duration | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.expectedSupplyDuration Number of days supply per dispense DefinitionIdentifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last. 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.
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performer | I | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.performer Intended dispenser DefinitionIndicates the intended dispensing Organization specified by the prescriber. 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.
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substitution | 0..1 | BackboneElement | There are no (further) constraints on this element Element idMedicationRequest.substitution Any restrictions on medication substitution DefinitionIndicates 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.
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.substitution.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.substitution.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.substitution.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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allowed | ?! | 1..1 | boolean | There are no (further) constraints on this element Element idMedicationRequest.substitution.allowed Whether substitution is allowed or not DefinitionTrue if the prescriber allows a different drug to be dispensed from what was prescribed. This element is labeled as a modifer because whether substitution is allow or not cannot be ignored.
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reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idMedicationRequest.substitution.reason Why should (not) substitution be made DefinitionIndicates the reason for the substitution, or why substitution must or must not be performed. 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. A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed. SubstanceAdminSubstitutionReason (example)Constraints
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priorPrescription | I | 0..1 | Reference(MedicationRequest) | There are no (further) constraints on this element Element idMedicationRequest.priorPrescription An order/prescription that is being replaced DefinitionA link to a resource representing an earlier order related order or prescription. 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.
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detectedIssue | I | 0..* | Reference(DetectedIssue) | There are no (further) constraints on this element Element idMedicationRequest.detectedIssue Clinical Issue with action Alternate namesContraindication, Drug Utilization Review (DUR), Alert DefinitionIndicates 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. 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.
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eventHistory | I | 0..* | Reference(Provenance) | There are no (further) constraints on this element Element idMedicationRequest.eventHistory A list of events of interest in the lifecycle DefinitionLinks 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. 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.).
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Mapping FHIR profile NICE data dictionary
Path | identity | map | comment |
---|---|---|---|
MedicationRequest.extension:periodOfUse | NICE-Datadictionary-MDS | https://www.stichting-nice.nl/dd/#57 | Chronic Obstructive Pulmonary Disease |
MedicationRequest.extension:periodOfUse | NICE-Datadictionary-MDS | https://www.stichting-nice.nl/dd/#78 | Diabetes |
MedicationRequest.extension:periodOfUse | NICE-Datadictionary-MDS | https://www.stichting-nice.nl/dd/#159 | Immunological insufficiency |
MedicationRequest.extension:periodOfUse | NICE-Datadictionary-MDS | https://www.stichting-nice.nl/dd/#411 | Thrombolytic therapy following acute myocardial infarction |
MedicationRequest.extension:periodOfUse | NICE-Datadictionary-MDS | https://www.stichting-nice.nl/dd/#432 | Vasoactive medication |
{ "resourceType": "Device", "id": "NICE-MedicationAgreement-Example-01", "meta": { "profile": [ "https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-MedicationAgreement-2022Q1" ] }, "text": { "status": "generated", --- We have skipped the narrative for better readability of the resource --- }, "extension": [ { "url": "https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-Verified-2022Q1", "valueCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/ValueSet/v2-0532", "code": "Y", "display": "Yes" } ] } } ], "status": "active", "type": { "coding": [ { "system": "http://snomed.info/sct", "code": "16076005" } ] }, "patient": { "reference": "Patient/NICE-Patient-01", "display": "P. Petersen" } }
<Device xmlns="http://hl7.org/fhir"> <id value="NICE-MedicationAgreement-Example-01" /> <meta> <profile value="https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-MedicationAgreement-2022Q1" /> </meta> <text> <status value="generated" /> --- We have skipped the narrative for better readability of the resource --- </text> <extension url="https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-Verified-2022Q1"> <valueCodeableConcept> <coding> <system value="http://terminology.hl7.org/ValueSet/v2-0532" /> <code value="Y" /> <display value="Yes" /> </coding> </valueCodeableConcept> </extension> <status value="active" /> <type> <coding> <system value="http://snomed.info/sct" /> <code value="16076005" /> </coding> </type> <patient> <reference value="Patient/NICE-Patient-01" /> <display value="P. Petersen" /> </patient> </Device>