NICE-MedicationUse
Description
This profile is for submitting data to the nice related to the period of medication use.
Click here to go to the NICE-MedicationUse 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 period of medication use 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) MedicationStatement, 2017 release version 3.1
MedicationStatement | I | MedicationStatement | There are no (further) constraints on this element Element idMedicationStatement MedicationUse Alternate namesMedicatiegebruik DefinitionMedicationUse is a statement on the historic, current or intended use of a certain medicine. When interpreting a medicationStatement, the value of the status and NotTaken needed to be considered: MedicationStatement.status + MedicationStatement.wasNotTaken Status=Active + NotTaken=T = Not currently taking Status=Completed + NotTaken=T = Not taken in the past Status=Intended + NotTaken=T = No intention of taking Status=Active + NotTaken=F = Taking, but not as prescribed Status=Active + NotTaken=F = Taking Status=Intended +NotTaken= F = Will be taking (not started) Status=Completed + NotTaken=F = Taken in past Status=In Error + NotTaken=N/A = In Error.
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id | Σ | 0..1 | id | There are no (further) constraints on this element Element idMedicationStatement.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 idMedicationStatement.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 idMedicationStatement.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 idMedicationStatement.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 idMedicationStatement.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 idMedicationStatement.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 | 0..* | Extension | There are no (further) constraints on this element Element idMedicationStatement.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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asAgreedIndicator | I | 0..1 | Extension(boolean) | There are no (further) constraints on this element Element idMedicationStatement.extension:asAgreedIndicator AsAgreedIndicator Alternate namesextensions, user content, VolgensAfspraakIndicator DefinitionIs the medicine used as outlined in the medication agreement? 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-AsAgreedIndicator Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.extension:asAgreedIndicator.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 idMedicationStatement.extension:asAgreedIndicator.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 idMedicationStatement.extension:asAgreedIndicator.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-MedicationUse-AsAgreedIndicator
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valueBoolean | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationStatement.extension:asAgreedIndicator.value[x]:valueBoolean 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).
Example of asAgreed true Mappings
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prescriber | I | 0..1 | Extension(Reference(nl-core-practitionerrole | nl-core-practitioner)) | There are no (further) constraints on this element Element idMedicationStatement.extension:prescriber Prescriber Alternate namesextensions, user content, Voorschrijver DefinitionThe health professional that entered the medication agreement with the patient. The health professional's specialty, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile. Extension(Reference(nl-core-practitionerrole | nl-core-practitioner)) Extension URLhttp://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-Prescriber Constraints
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author | I | 0..1 | Extension(Reference(nl-core-practitionerrole | nl-core-practitioner | nl-core-organization | nl-core-patient)) | There are no (further) constraints on this element Element idMedicationStatement.extension:author Author Alternate namesextensions, user content, Auteur DefinitionThe author of this MedicationStatement. This is either a patient, a health professional or a healthcare provicer. The health professional's specialty, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile. Extension(Reference(nl-core-practitionerrole | nl-core-practitioner | nl-core-organization | nl-core-patient)) Extension URLhttp://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-Author Constraints
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medicationTreatment | I | 0..1 | Extension(Identifier) | There are no (further) constraints on this element Element idMedicationStatement.extension:medicationTreatment Medical Treatment Alternate namesextensions, user content, Medicamenteuze Behandeling DefinitionThis extension is to describe which overarching medical treatment this information is part of. This is done by the use of an identifier of that medical 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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reasonForChangeOrDiscontinuationOfUse | I | 0..* | Extension(CodeableConcept) | There are no (further) constraints on this element Element idMedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse ReasonForChangeOrDiscontinuationOfUse Alternate namesextensions, user content, RedenWijzigenOfStoppenGebruik, Reden wijzigen of stoppen gebruik DefinitionReason for changing or discontinuing use of medication. 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-ReasonForChangeOrDiscontinuationOfUse Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.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 idMedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.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 idMedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.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-MedicationUse-ReasonForChangeOrDiscontinuationOfUse
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valueCodeableConcept | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.value[x]:valueCodeableConcept ReasonForChangeOrDiscontinuationOfUse Alternate namesReden wijzigen of stoppen gebruik DefinitionReason for changing or discontinuing use of medication. ReasonForChangeOrDiscontinuationOfUseCodeList RedenWijzigenOfStoppenGebruikCodelijst (extensible)Constraints
Example of ReasonForChangeOrDiscontinuationOfUse { "coding": [ { "system": "http://snomed.info/sct", "code": "79899007", "display": "Drug interaction (finding)" } ] } Mappings
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modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationStatement.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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repeatPeriodCyclicalSchedule | ?! I | 0..1 | Extension(Duration) | There are no (further) constraints on this element Element idMedicationStatement.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 | Σ | 0..* | Identifier | There are no (further) constraints on this element Element idMedicationStatement.identifier External identifier DefinitionExternal identifier - FHIR will generate its own internal identifiers (probably URLs) which do not need to be explicitly managed by the resource. The identifier here is one that would be used by another non-FHIR system - for example an automated medication pump would provide a record each time it operated; an administration while the patient was off the ward might be made with a different system and entered after the event. Particularly important if these records have to be updated.
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basedOn | Σ I | 0..* | Reference(MedicationRequest | CarePlan | ProcedureRequest | ReferralRequest) | There are no (further) constraints on this element Element idMedicationStatement.basedOn Fulfils plan, proposal or order DefinitionA plan, proposal or order that is fulfilled in whole or in part by this event. Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon. 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(MedicationRequest | CarePlan | ProcedureRequest | ReferralRequest) Constraints
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partOf | Σ I | 0..* | Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Observation) | There are no (further) constraints on this element Element idMedicationStatement.partOf Part of referenced event DefinitionA larger event of which this particular event is a component or step. This should not be used when indicating which resource a MedicationStatement has been derived from. If that is the use case, then MedicationStatement.derivedFrom should be used. 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(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Observation) Constraints
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context | S Σ I | 0..1 | Reference(NICE-Encounter) | Element idMedicationStatement.context Encounter associated with MedicationStatement DefinitionThe encounter or episode of care that establishes the context for this MedicationStatement. The encounter SHALL always be an Encounter that is related to an ICU submission. Even though the MedicationStatement is established within an earlier -different- Encounter. 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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status | S Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idMedicationStatement.status MedicationUseStopType Alternate namesMedicatieGebruikStopType DefinitionA code representing the patient or other source's judgment about the state of the medication used that this statement is about. Generally this will be active or completed. MedicationStatement is a statement at a point in time. The status is only representative at the point when it was asserted. The value set for MedicationStatement.status contains codes that assert the status of the use of the medication by the patient (for example, stopped or on hold) as well as codes that assert the status of the medication statement itself (for example, entered in error). This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. This element is also used for the concept 'Stop type'; the manner in which this medication is discontinued (temporary or definitive). Allergy Intolerance critically Code list MedicationStatementStatus (required)Permitted Values MedicationUseStopTypeCodeLijst-to-MedicationStatementStatus Constraints
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category | S Σ | 1..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationStatement.category Type of medication usage DefinitionIndicates where type of medication statement 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 included in the medicationstatement is expected to be consumed or administered MedicationStatementCategory (preferred)Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.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 idMedicationStatement.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 idMedicationStatement.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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medicationUseCode | Σ | 0..* | Coding | There are no (further) constraints on this element Element idMedicationStatement.category.coding:medicationUseCode MedicationUseCode DefinitionCategory code used for indexing/retrieval of the ZIB MedicationUse. The system and code are 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 idMedicationStatement.category.coding:medicationUseCode.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 idMedicationStatement.category.coding:medicationUseCode.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 idMedicationStatement.category.coding:medicationUseCode.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.
urn:oid:2.16.840.1.113883.2.4.3.11.60.20.77.5.3
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.category.coding:medicationUseCode.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 idMedicationStatement.category.coding:medicationUseCode.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
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.category.coding:medicationUseCode.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
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationStatement.category.coding:medicationUseCode.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 idMedicationStatement.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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medicationReference | S Σ | 1..1 | Reference(https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-PharmaceuticalProduct-2022Q1) | Element idMedicationStatement.medicationReference:medicationReference ProductUsed Alternate namesGebruiksproduct DefinitionIdentifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications. Reference(https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-PharmaceuticalProduct-2022Q1) Constraints
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effectivePeriod | Σ | 0..1 | Period | Element idMedicationStatement.effectivePeriod:effectivePeriod PeriodOfUse Alternate namesGebruiksperiode DefinitionMedication use can be recorded for a certain moment or over a certain period. Thus, medication use can be recorded multiple times during the use of medication. The usage period is the period or moment over which the data is recorded. Start date: This is the time at which the agreement was to take effect (or took effect or will take effect). Duration: The intended duration of use. E.g. 5 days or 8 weeks. It is not allowed to indicate the duration in months, because different months have a variable duration in days. End date: The time at which the period of use ends (or ended or will end). To avoid confusion between 'to' and 'up to', the submission of time is always mandatory for the end date. This attribute reflects the period over which the patient consumed the medication and is expected to be populated on the majority of Medication Statements. If the medication is still being taken at the time the statement is recorded, the "end" date will be omitted.
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.effective[x]:effectivePeriod.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 idMedicationStatement.effective[x]:effectivePeriod.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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Duration | I | 0..1 | Extension(Duration) | There are no (further) constraints on this element Element idMedicationStatement.effective[x]:effectivePeriod.extension:Duration Duration Alternate namesextensions, user content, tijdsDuur DefinitionThe 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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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.effective[x]:effectivePeriod.extension:Duration.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 idMedicationStatement.effective[x]:effectivePeriod.extension:Duration.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 idMedicationStatement.effective[x]:effectivePeriod.extension:Duration.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-MedicationUse-Duration
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valueDuration | 0..1 | Duration | There are no (further) constraints on this element Element idMedicationStatement.effective[x]:effectivePeriod.extension:Duration.value[x]:valueDuration UsageDuration Alternate namesGebruiksduur DefinitionValue of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).
Example of Duration { "value": 3, "unit": "day", "system": "http://unitsofmeasure.org", "code": "d" } Mappings
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start | Σ I | 0..1 | dateTime | There are no (further) constraints on this element Element idMedicationStatement.effective[x]:effectivePeriod.start StartDate Alternate namesIngangsdatum DefinitionThis is the time at which the agreement was to take effect (or took effect or will take effect). If the low element is missing, the meaning is that the low boundary is not known.
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end | Σ I | 0..1 | dateTime | There are no (further) constraints on this element Element idMedicationStatement.effective[x]:effectivePeriod.end EndDate Alternate namesEinddatum DefinitionThe time at which the period of use ends (or ended or will end). To avoid confusion between 'to' and 'up to', the submission of time is always mandatory for the end date. The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03. If the end of the period is missing, it means that the period is ongoing
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dateAsserted | S Σ | 1..1 | dateTime | There are no (further) constraints on this element Element idMedicationStatement.dateAsserted MedicationUseDateTime Alternate namesRegistratiedatum DefinitionDate on which this use is entered.
Example of MedicationUseDateTime 2017-06-14 Mappings
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informationSource | I | 0..1 | Reference(nl-core-patient | nl-core-practitioner | nl-core-relatedperson | nl-core-organization) | There are no (further) constraints on this element Element idMedicationStatement.informationSource Person or organization that provided the information about the taking of this medication DefinitionThe person or organization that provided the information about the taking of this medication. Note: Use derivedFrom when a MedicationStatement is derived from other resources, e.g Claim or MedicationRequest. If a health professional is the informationSource the PractitionerRole reference extension can be used for a PractitionerRole reference. The health professional's specialty, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile. Reference(nl-core-patient | nl-core-practitioner | nl-core-relatedperson | nl-core-organization) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.informationSource.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 idMedicationStatement.informationSource.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 idMedicationStatement.informationSource.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 idMedicationStatement.informationSource.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 idMedicationStatement.informationSource.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 idMedicationStatement.informationSource.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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subject | S Σ I | 1..1 | Reference(NICE-Patient) | Element idMedicationStatement.subject Who is/was taking the medication DefinitionThe person, animal or group who is/was taking 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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derivedFrom | I | 0..* | Reference(Resource) | There are no (further) constraints on this element Element idMedicationStatement.derivedFrom Additional supporting information DefinitionAllows linking the MedicationStatement to the underlying MedicationRequest, or to other information that supports or is used to derive the MedicationStatement. Likely references would be to MedicationRequest, MedicationDispense, Claim, Observation or QuestionnaireAnswers. The most common use cases for deriving a MedicationStatement comes from creating a MedicationStatement from a MedicationRequest or from a lab observation or a claim. it should be noted that the amount of information that is available varies from the type resource that you derive the MedicationStatement from.
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taken | Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idMedicationStatement.taken UseIndicator Alternate namesGebruikIndicator DefinitionIs this medicine used or not? This element is labeled as a modifier because it indicates that the medication was not taken. A coded concept identifying level of certainty if patient has taken or has not taken the medication MedicationStatementTaken (required)Constraints
Example of taken y Mappings
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reasonNotTaken | I | 0..* | CodeableConcept | There are no (further) constraints on this element Element idMedicationStatement.reasonNotTaken True if asserting medication was not given DefinitionA code indicating why the medication was not taken. 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 indicating the reason why the medication was not taken SNOMED CT Drugs not taken/completed Codes (example)Constraints
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reasonCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element idMedicationStatement.reasonCode Reason for why the medication is being/was taken DefinitionA reason for why the medication is being/was taken. This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonForUseReference. A coded concept identifying why the medication is being taken. Condition/Problem/Diagnosis Codes (example)Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.reasonCode.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 idMedicationStatement.reasonCode.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 idMedicationStatement.reasonCode.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.
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text | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.reasonCode.text ReasonForUse Alternate namesRedenGebruik DefinitionThe reason for using the medication, particularly in self-care medicine purchased by the patient themselves. 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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reasonReference | I | 0..* | Reference(Condition | Observation) | There are no (further) constraints on this element Element idMedicationStatement.reasonReference Condition or observation that supports why the medication is being/was taken DefinitionCondition or observation that supports why the medication is being/was taken. This is a reference to a condition that is the reason why the medication is being/was taken. If only a code exists, use reasonForUseCode. Reference(Condition | Observation) Constraints
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note | 0..* | Annotation | There are no (further) constraints on this element Element idMedicationStatement.note Comment Alternate namesToelichting DefinitionComments on the medication use. 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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dosage | 0..* | HCIM InstructionsForUse | There are no (further) constraints on this element Element idMedicationStatement.dosage InstructionsForUse Alternate namesGebruiksinstructie DefinitionInstructions for the use of the medication, e.g. dose and route of administration. In the event of medication use, this is the pattern of use established by the patient or which the patient followed 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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MedicationStatement | I | MedicationStatement | There are no (further) constraints on this element Element idMedicationStatement MedicationUse Alternate namesMedicatiegebruik DefinitionMedicationUse is a statement on the historic, current or intended use of a certain medicine. When interpreting a medicationStatement, the value of the status and NotTaken needed to be considered: MedicationStatement.status + MedicationStatement.wasNotTaken Status=Active + NotTaken=T = Not currently taking Status=Completed + NotTaken=T = Not taken in the past Status=Intended + NotTaken=T = No intention of taking Status=Active + NotTaken=F = Taking, but not as prescribed Status=Active + NotTaken=F = Taking Status=Intended +NotTaken= F = Will be taking (not started) Status=Completed + NotTaken=F = Taken in past Status=In Error + NotTaken=N/A = In Error.
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id | Σ | 0..1 | id | There are no (further) constraints on this element Element idMedicationStatement.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 idMedicationStatement.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 idMedicationStatement.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 idMedicationStatement.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 idMedicationStatement.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 idMedicationStatement.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 | 0..* | Extension | There are no (further) constraints on this element Element idMedicationStatement.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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asAgreedIndicator | I | 0..1 | Extension(boolean) | There are no (further) constraints on this element Element idMedicationStatement.extension:asAgreedIndicator AsAgreedIndicator Alternate namesextensions, user content, VolgensAfspraakIndicator DefinitionIs the medicine used as outlined in the medication agreement? 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-AsAgreedIndicator Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.extension:asAgreedIndicator.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 idMedicationStatement.extension:asAgreedIndicator.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 idMedicationStatement.extension:asAgreedIndicator.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-MedicationUse-AsAgreedIndicator
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valueBoolean | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationStatement.extension:asAgreedIndicator.value[x]:valueBoolean 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).
Example of asAgreed true Mappings
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prescriber | I | 0..1 | Extension(Reference(nl-core-practitionerrole | nl-core-practitioner)) | There are no (further) constraints on this element Element idMedicationStatement.extension:prescriber Prescriber Alternate namesextensions, user content, Voorschrijver DefinitionThe health professional that entered the medication agreement with the patient. The health professional's specialty, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile. Extension(Reference(nl-core-practitionerrole | nl-core-practitioner)) Extension URLhttp://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-Prescriber Constraints
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author | I | 0..1 | Extension(Reference(nl-core-practitionerrole | nl-core-practitioner | nl-core-organization | nl-core-patient)) | There are no (further) constraints on this element Element idMedicationStatement.extension:author Author Alternate namesextensions, user content, Auteur DefinitionThe author of this MedicationStatement. This is either a patient, a health professional or a healthcare provicer. The health professional's specialty, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile. Extension(Reference(nl-core-practitionerrole | nl-core-practitioner | nl-core-organization | nl-core-patient)) Extension URLhttp://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-Author Constraints
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medicationTreatment | I | 0..1 | Extension(Identifier) | There are no (further) constraints on this element Element idMedicationStatement.extension:medicationTreatment Medical Treatment Alternate namesextensions, user content, Medicamenteuze Behandeling DefinitionThis extension is to describe which overarching medical treatment this information is part of. This is done by the use of an identifier of that medical 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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reasonForChangeOrDiscontinuationOfUse | I | 0..* | Extension(CodeableConcept) | There are no (further) constraints on this element Element idMedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse ReasonForChangeOrDiscontinuationOfUse Alternate namesextensions, user content, RedenWijzigenOfStoppenGebruik, Reden wijzigen of stoppen gebruik DefinitionReason for changing or discontinuing use of medication. 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-ReasonForChangeOrDiscontinuationOfUse Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.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 idMedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.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 idMedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.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-MedicationUse-ReasonForChangeOrDiscontinuationOfUse
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valueCodeableConcept | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.value[x]:valueCodeableConcept ReasonForChangeOrDiscontinuationOfUse Alternate namesReden wijzigen of stoppen gebruik DefinitionReason for changing or discontinuing use of medication. ReasonForChangeOrDiscontinuationOfUseCodeList RedenWijzigenOfStoppenGebruikCodelijst (extensible)Constraints
Example of ReasonForChangeOrDiscontinuationOfUse { "coding": [ { "system": "http://snomed.info/sct", "code": "79899007", "display": "Drug interaction (finding)" } ] } Mappings
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modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationStatement.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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repeatPeriodCyclicalSchedule | ?! I | 0..1 | Extension(Duration) | There are no (further) constraints on this element Element idMedicationStatement.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 | Σ | 0..* | Identifier | There are no (further) constraints on this element Element idMedicationStatement.identifier External identifier DefinitionExternal identifier - FHIR will generate its own internal identifiers (probably URLs) which do not need to be explicitly managed by the resource. The identifier here is one that would be used by another non-FHIR system - for example an automated medication pump would provide a record each time it operated; an administration while the patient was off the ward might be made with a different system and entered after the event. Particularly important if these records have to be updated.
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basedOn | Σ I | 0..* | Reference(MedicationRequest | CarePlan | ProcedureRequest | ReferralRequest) | There are no (further) constraints on this element Element idMedicationStatement.basedOn Fulfils plan, proposal or order DefinitionA plan, proposal or order that is fulfilled in whole or in part by this event. Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon. 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(MedicationRequest | CarePlan | ProcedureRequest | ReferralRequest) Constraints
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partOf | Σ I | 0..* | Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Observation) | There are no (further) constraints on this element Element idMedicationStatement.partOf Part of referenced event DefinitionA larger event of which this particular event is a component or step. This should not be used when indicating which resource a MedicationStatement has been derived from. If that is the use case, then MedicationStatement.derivedFrom should be used. 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(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Observation) Constraints
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context | S Σ I | 0..1 | Reference(NICE-Encounter) | Element idMedicationStatement.context Encounter associated with MedicationStatement DefinitionThe encounter or episode of care that establishes the context for this MedicationStatement. The encounter SHALL always be an Encounter that is related to an ICU submission. Even though the MedicationStatement is established within an earlier -different- Encounter. 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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status | S Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idMedicationStatement.status MedicationUseStopType Alternate namesMedicatieGebruikStopType DefinitionA code representing the patient or other source's judgment about the state of the medication used that this statement is about. Generally this will be active or completed. MedicationStatement is a statement at a point in time. The status is only representative at the point when it was asserted. The value set for MedicationStatement.status contains codes that assert the status of the use of the medication by the patient (for example, stopped or on hold) as well as codes that assert the status of the medication statement itself (for example, entered in error). This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. This element is also used for the concept 'Stop type'; the manner in which this medication is discontinued (temporary or definitive). Allergy Intolerance critically Code list MedicationStatementStatus (required)Permitted Values MedicationUseStopTypeCodeLijst-to-MedicationStatementStatus Constraints
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category | S Σ | 1..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationStatement.category Type of medication usage DefinitionIndicates where type of medication statement 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 included in the medicationstatement is expected to be consumed or administered MedicationStatementCategory (preferred)Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.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 idMedicationStatement.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 idMedicationStatement.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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medicationUseCode | Σ | 0..* | Coding | There are no (further) constraints on this element Element idMedicationStatement.category.coding:medicationUseCode MedicationUseCode DefinitionCategory code used for indexing/retrieval of the ZIB MedicationUse. The system and code are 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 idMedicationStatement.category.coding:medicationUseCode.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 idMedicationStatement.category.coding:medicationUseCode.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 idMedicationStatement.category.coding:medicationUseCode.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.
urn:oid:2.16.840.1.113883.2.4.3.11.60.20.77.5.3
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.category.coding:medicationUseCode.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 idMedicationStatement.category.coding:medicationUseCode.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
6
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.category.coding:medicationUseCode.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
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationStatement.category.coding:medicationUseCode.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 idMedicationStatement.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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medicationReference | S Σ | 1..1 | Reference(https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-PharmaceuticalProduct-2022Q1) | Element idMedicationStatement.medicationReference:medicationReference ProductUsed Alternate namesGebruiksproduct DefinitionIdentifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications. Reference(https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-PharmaceuticalProduct-2022Q1) Constraints
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effectivePeriod | Σ | 0..1 | Period | Element idMedicationStatement.effectivePeriod:effectivePeriod PeriodOfUse Alternate namesGebruiksperiode DefinitionMedication use can be recorded for a certain moment or over a certain period. Thus, medication use can be recorded multiple times during the use of medication. The usage period is the period or moment over which the data is recorded. Start date: This is the time at which the agreement was to take effect (or took effect or will take effect). Duration: The intended duration of use. E.g. 5 days or 8 weeks. It is not allowed to indicate the duration in months, because different months have a variable duration in days. End date: The time at which the period of use ends (or ended or will end). To avoid confusion between 'to' and 'up to', the submission of time is always mandatory for the end date. This attribute reflects the period over which the patient consumed the medication and is expected to be populated on the majority of Medication Statements. If the medication is still being taken at the time the statement is recorded, the "end" date will be omitted.
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.effective[x]:effectivePeriod.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 idMedicationStatement.effective[x]:effectivePeriod.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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Duration | I | 0..1 | Extension(Duration) | There are no (further) constraints on this element Element idMedicationStatement.effective[x]:effectivePeriod.extension:Duration Duration Alternate namesextensions, user content, tijdsDuur DefinitionThe 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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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.effective[x]:effectivePeriod.extension:Duration.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 idMedicationStatement.effective[x]:effectivePeriod.extension:Duration.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 idMedicationStatement.effective[x]:effectivePeriod.extension:Duration.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-MedicationUse-Duration
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valueDuration | 0..1 | Duration | There are no (further) constraints on this element Element idMedicationStatement.effective[x]:effectivePeriod.extension:Duration.value[x]:valueDuration UsageDuration Alternate namesGebruiksduur DefinitionValue of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).
Example of Duration { "value": 3, "unit": "day", "system": "http://unitsofmeasure.org", "code": "d" } Mappings
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start | Σ I | 0..1 | dateTime | There are no (further) constraints on this element Element idMedicationStatement.effective[x]:effectivePeriod.start StartDate Alternate namesIngangsdatum DefinitionThis is the time at which the agreement was to take effect (or took effect or will take effect). If the low element is missing, the meaning is that the low boundary is not known.
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end | Σ I | 0..1 | dateTime | There are no (further) constraints on this element Element idMedicationStatement.effective[x]:effectivePeriod.end EndDate Alternate namesEinddatum DefinitionThe time at which the period of use ends (or ended or will end). To avoid confusion between 'to' and 'up to', the submission of time is always mandatory for the end date. The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03. If the end of the period is missing, it means that the period is ongoing
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dateAsserted | S Σ | 1..1 | dateTime | There are no (further) constraints on this element Element idMedicationStatement.dateAsserted MedicationUseDateTime Alternate namesRegistratiedatum DefinitionDate on which this use is entered.
Example of MedicationUseDateTime 2017-06-14 Mappings
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informationSource | I | 0..1 | Reference(nl-core-patient | nl-core-practitioner | nl-core-relatedperson | nl-core-organization) | There are no (further) constraints on this element Element idMedicationStatement.informationSource Person or organization that provided the information about the taking of this medication DefinitionThe person or organization that provided the information about the taking of this medication. Note: Use derivedFrom when a MedicationStatement is derived from other resources, e.g Claim or MedicationRequest. If a health professional is the informationSource the PractitionerRole reference extension can be used for a PractitionerRole reference. The health professional's specialty, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile. Reference(nl-core-patient | nl-core-practitioner | nl-core-relatedperson | nl-core-organization) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.informationSource.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 idMedicationStatement.informationSource.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 idMedicationStatement.informationSource.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 idMedicationStatement.informationSource.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 idMedicationStatement.informationSource.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 idMedicationStatement.informationSource.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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subject | S Σ I | 1..1 | Reference(NICE-Patient) | Element idMedicationStatement.subject Who is/was taking the medication DefinitionThe person, animal or group who is/was taking 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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derivedFrom | I | 0..* | Reference(Resource) | There are no (further) constraints on this element Element idMedicationStatement.derivedFrom Additional supporting information DefinitionAllows linking the MedicationStatement to the underlying MedicationRequest, or to other information that supports or is used to derive the MedicationStatement. Likely references would be to MedicationRequest, MedicationDispense, Claim, Observation or QuestionnaireAnswers. The most common use cases for deriving a MedicationStatement comes from creating a MedicationStatement from a MedicationRequest or from a lab observation or a claim. it should be noted that the amount of information that is available varies from the type resource that you derive the MedicationStatement from.
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taken | Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idMedicationStatement.taken UseIndicator Alternate namesGebruikIndicator DefinitionIs this medicine used or not? This element is labeled as a modifier because it indicates that the medication was not taken. A coded concept identifying level of certainty if patient has taken or has not taken the medication MedicationStatementTaken (required)Constraints
Example of taken y Mappings
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reasonNotTaken | I | 0..* | CodeableConcept | There are no (further) constraints on this element Element idMedicationStatement.reasonNotTaken True if asserting medication was not given DefinitionA code indicating why the medication was not taken. 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 indicating the reason why the medication was not taken SNOMED CT Drugs not taken/completed Codes (example)Constraints
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reasonCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element idMedicationStatement.reasonCode Reason for why the medication is being/was taken DefinitionA reason for why the medication is being/was taken. This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonForUseReference. A coded concept identifying why the medication is being taken. Condition/Problem/Diagnosis Codes (example)Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.reasonCode.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 idMedicationStatement.reasonCode.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 idMedicationStatement.reasonCode.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.
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text | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.reasonCode.text ReasonForUse Alternate namesRedenGebruik DefinitionThe reason for using the medication, particularly in self-care medicine purchased by the patient themselves. 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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reasonReference | I | 0..* | Reference(Condition | Observation) | There are no (further) constraints on this element Element idMedicationStatement.reasonReference Condition or observation that supports why the medication is being/was taken DefinitionCondition or observation that supports why the medication is being/was taken. This is a reference to a condition that is the reason why the medication is being/was taken. If only a code exists, use reasonForUseCode. Reference(Condition | Observation) Constraints
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note | 0..* | Annotation | There are no (further) constraints on this element Element idMedicationStatement.note Comment Alternate namesToelichting DefinitionComments on the medication use. 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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dosage | 0..* | HCIM InstructionsForUse | There are no (further) constraints on this element Element idMedicationStatement.dosage InstructionsForUse Alternate namesGebruiksinstructie DefinitionInstructions for the use of the medication, e.g. dose and route of administration. In the event of medication use, this is the pattern of use established by the patient or which the patient followed 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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MedicationStatement | I | MedicationStatement | There are no (further) constraints on this element Element idMedicationStatement MedicationUse Alternate namesMedicatiegebruik DefinitionMedicationUse is a statement on the historic, current or intended use of a certain medicine. When interpreting a medicationStatement, the value of the status and NotTaken needed to be considered: MedicationStatement.status + MedicationStatement.wasNotTaken Status=Active + NotTaken=T = Not currently taking Status=Completed + NotTaken=T = Not taken in the past Status=Intended + NotTaken=T = No intention of taking Status=Active + NotTaken=F = Taking, but not as prescribed Status=Active + NotTaken=F = Taking Status=Intended +NotTaken= F = Will be taking (not started) Status=Completed + NotTaken=F = Taken in past Status=In Error + NotTaken=N/A = In Error.
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id | Σ | 0..1 | id | There are no (further) constraints on this element Element idMedicationStatement.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 idMedicationStatement.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 idMedicationStatement.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 idMedicationStatement.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 idMedicationStatement.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 idMedicationStatement.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 | 0..* | Extension | There are no (further) constraints on this element Element idMedicationStatement.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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asAgreedIndicator | I | 0..1 | Extension(boolean) | There are no (further) constraints on this element Element idMedicationStatement.extension:asAgreedIndicator AsAgreedIndicator Alternate namesextensions, user content, VolgensAfspraakIndicator DefinitionIs the medicine used as outlined in the medication agreement? 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-AsAgreedIndicator Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.extension:asAgreedIndicator.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 idMedicationStatement.extension:asAgreedIndicator.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 idMedicationStatement.extension:asAgreedIndicator.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-MedicationUse-AsAgreedIndicator
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valueBoolean | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationStatement.extension:asAgreedIndicator.value[x]:valueBoolean 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).
Example of asAgreed true Mappings
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prescriber | I | 0..1 | Extension(Reference(nl-core-practitionerrole | nl-core-practitioner)) | There are no (further) constraints on this element Element idMedicationStatement.extension:prescriber Prescriber Alternate namesextensions, user content, Voorschrijver DefinitionThe health professional that entered the medication agreement with the patient. The health professional's specialty, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile. Extension(Reference(nl-core-practitionerrole | nl-core-practitioner)) Extension URLhttp://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-Prescriber Constraints
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author | I | 0..1 | Extension(Reference(nl-core-practitionerrole | nl-core-practitioner | nl-core-organization | nl-core-patient)) | There are no (further) constraints on this element Element idMedicationStatement.extension:author Author Alternate namesextensions, user content, Auteur DefinitionThe author of this MedicationStatement. This is either a patient, a health professional or a healthcare provicer. The health professional's specialty, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile. Extension(Reference(nl-core-practitionerrole | nl-core-practitioner | nl-core-organization | nl-core-patient)) Extension URLhttp://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-Author Constraints
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medicationTreatment | I | 0..1 | Extension(Identifier) | There are no (further) constraints on this element Element idMedicationStatement.extension:medicationTreatment Medical Treatment Alternate namesextensions, user content, Medicamenteuze Behandeling DefinitionThis extension is to describe which overarching medical treatment this information is part of. This is done by the use of an identifier of that medical 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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reasonForChangeOrDiscontinuationOfUse | I | 0..* | Extension(CodeableConcept) | There are no (further) constraints on this element Element idMedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse ReasonForChangeOrDiscontinuationOfUse Alternate namesextensions, user content, RedenWijzigenOfStoppenGebruik, Reden wijzigen of stoppen gebruik DefinitionReason for changing or discontinuing use of medication. 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-ReasonForChangeOrDiscontinuationOfUse Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.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 idMedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.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 idMedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.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-MedicationUse-ReasonForChangeOrDiscontinuationOfUse
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valueCodeableConcept | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.value[x]:valueCodeableConcept ReasonForChangeOrDiscontinuationOfUse Alternate namesReden wijzigen of stoppen gebruik DefinitionReason for changing or discontinuing use of medication. ReasonForChangeOrDiscontinuationOfUseCodeList RedenWijzigenOfStoppenGebruikCodelijst (extensible)Constraints
Example of ReasonForChangeOrDiscontinuationOfUse { "coding": [ { "system": "http://snomed.info/sct", "code": "79899007", "display": "Drug interaction (finding)" } ] } Mappings
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modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationStatement.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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repeatPeriodCyclicalSchedule | ?! I | 0..1 | Extension(Duration) | There are no (further) constraints on this element Element idMedicationStatement.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 | Σ | 0..* | Identifier | There are no (further) constraints on this element Element idMedicationStatement.identifier External identifier DefinitionExternal identifier - FHIR will generate its own internal identifiers (probably URLs) which do not need to be explicitly managed by the resource. The identifier here is one that would be used by another non-FHIR system - for example an automated medication pump would provide a record each time it operated; an administration while the patient was off the ward might be made with a different system and entered after the event. Particularly important if these records have to be updated.
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basedOn | Σ I | 0..* | Reference(MedicationRequest | CarePlan | ProcedureRequest | ReferralRequest) | There are no (further) constraints on this element Element idMedicationStatement.basedOn Fulfils plan, proposal or order DefinitionA plan, proposal or order that is fulfilled in whole or in part by this event. Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon. 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(MedicationRequest | CarePlan | ProcedureRequest | ReferralRequest) Constraints
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partOf | Σ I | 0..* | Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Observation) | There are no (further) constraints on this element Element idMedicationStatement.partOf Part of referenced event DefinitionA larger event of which this particular event is a component or step. This should not be used when indicating which resource a MedicationStatement has been derived from. If that is the use case, then MedicationStatement.derivedFrom should be used. 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(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Observation) Constraints
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context | S Σ I | 0..1 | Reference(NICE-Encounter) | Element idMedicationStatement.context Encounter associated with MedicationStatement DefinitionThe encounter or episode of care that establishes the context for this MedicationStatement. The encounter SHALL always be an Encounter that is related to an ICU submission. Even though the MedicationStatement is established within an earlier -different- Encounter. 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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status | S Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idMedicationStatement.status MedicationUseStopType Alternate namesMedicatieGebruikStopType DefinitionA code representing the patient or other source's judgment about the state of the medication used that this statement is about. Generally this will be active or completed. MedicationStatement is a statement at a point in time. The status is only representative at the point when it was asserted. The value set for MedicationStatement.status contains codes that assert the status of the use of the medication by the patient (for example, stopped or on hold) as well as codes that assert the status of the medication statement itself (for example, entered in error). This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. This element is also used for the concept 'Stop type'; the manner in which this medication is discontinued (temporary or definitive). Allergy Intolerance critically Code list MedicationStatementStatus (required)Permitted Values MedicationUseStopTypeCodeLijst-to-MedicationStatementStatus Constraints
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category | S Σ | 1..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationStatement.category Type of medication usage DefinitionIndicates where type of medication statement 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 included in the medicationstatement is expected to be consumed or administered MedicationStatementCategory (preferred)Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.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 idMedicationStatement.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 idMedicationStatement.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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medicationUseCode | Σ | 0..* | Coding | There are no (further) constraints on this element Element idMedicationStatement.category.coding:medicationUseCode MedicationUseCode DefinitionCategory code used for indexing/retrieval of the ZIB MedicationUse. The system and code are 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 idMedicationStatement.category.coding:medicationUseCode.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 idMedicationStatement.category.coding:medicationUseCode.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 idMedicationStatement.category.coding:medicationUseCode.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.
urn:oid:2.16.840.1.113883.2.4.3.11.60.20.77.5.3
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.category.coding:medicationUseCode.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 idMedicationStatement.category.coding:medicationUseCode.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
6
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.category.coding:medicationUseCode.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
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationStatement.category.coding:medicationUseCode.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 idMedicationStatement.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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medicationReference | S Σ | 1..1 | Reference(https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-PharmaceuticalProduct-2022Q1) | Element idMedicationStatement.medicationReference:medicationReference ProductUsed Alternate namesGebruiksproduct DefinitionIdentifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications. Reference(https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-PharmaceuticalProduct-2022Q1) Constraints
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effectivePeriod | Σ | 0..1 | Period | Element idMedicationStatement.effectivePeriod:effectivePeriod PeriodOfUse Alternate namesGebruiksperiode DefinitionMedication use can be recorded for a certain moment or over a certain period. Thus, medication use can be recorded multiple times during the use of medication. The usage period is the period or moment over which the data is recorded. Start date: This is the time at which the agreement was to take effect (or took effect or will take effect). Duration: The intended duration of use. E.g. 5 days or 8 weeks. It is not allowed to indicate the duration in months, because different months have a variable duration in days. End date: The time at which the period of use ends (or ended or will end). To avoid confusion between 'to' and 'up to', the submission of time is always mandatory for the end date. This attribute reflects the period over which the patient consumed the medication and is expected to be populated on the majority of Medication Statements. If the medication is still being taken at the time the statement is recorded, the "end" date will be omitted.
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.effective[x]:effectivePeriod.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 idMedicationStatement.effective[x]:effectivePeriod.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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Duration | I | 0..1 | Extension(Duration) | There are no (further) constraints on this element Element idMedicationStatement.effective[x]:effectivePeriod.extension:Duration Duration Alternate namesextensions, user content, tijdsDuur DefinitionThe 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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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.effective[x]:effectivePeriod.extension:Duration.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 idMedicationStatement.effective[x]:effectivePeriod.extension:Duration.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 idMedicationStatement.effective[x]:effectivePeriod.extension:Duration.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-MedicationUse-Duration
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valueDuration | 0..1 | Duration | There are no (further) constraints on this element Element idMedicationStatement.effective[x]:effectivePeriod.extension:Duration.value[x]:valueDuration UsageDuration Alternate namesGebruiksduur DefinitionValue of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).
Example of Duration { "value": 3, "unit": "day", "system": "http://unitsofmeasure.org", "code": "d" } Mappings
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start | Σ I | 0..1 | dateTime | There are no (further) constraints on this element Element idMedicationStatement.effective[x]:effectivePeriod.start StartDate Alternate namesIngangsdatum DefinitionThis is the time at which the agreement was to take effect (or took effect or will take effect). If the low element is missing, the meaning is that the low boundary is not known.
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end | Σ I | 0..1 | dateTime | There are no (further) constraints on this element Element idMedicationStatement.effective[x]:effectivePeriod.end EndDate Alternate namesEinddatum DefinitionThe time at which the period of use ends (or ended or will end). To avoid confusion between 'to' and 'up to', the submission of time is always mandatory for the end date. The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03. If the end of the period is missing, it means that the period is ongoing
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dateAsserted | S Σ | 1..1 | dateTime | There are no (further) constraints on this element Element idMedicationStatement.dateAsserted MedicationUseDateTime Alternate namesRegistratiedatum DefinitionDate on which this use is entered.
Example of MedicationUseDateTime 2017-06-14 Mappings
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informationSource | I | 0..1 | Reference(nl-core-patient | nl-core-practitioner | nl-core-relatedperson | nl-core-organization) | There are no (further) constraints on this element Element idMedicationStatement.informationSource Person or organization that provided the information about the taking of this medication DefinitionThe person or organization that provided the information about the taking of this medication. Note: Use derivedFrom when a MedicationStatement is derived from other resources, e.g Claim or MedicationRequest. If a health professional is the informationSource the PractitionerRole reference extension can be used for a PractitionerRole reference. The health professional's specialty, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile. Reference(nl-core-patient | nl-core-practitioner | nl-core-relatedperson | nl-core-organization) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.informationSource.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 idMedicationStatement.informationSource.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 idMedicationStatement.informationSource.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 idMedicationStatement.informationSource.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 idMedicationStatement.informationSource.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 idMedicationStatement.informationSource.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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subject | S Σ I | 1..1 | Reference(NICE-Patient) | Element idMedicationStatement.subject Who is/was taking the medication DefinitionThe person, animal or group who is/was taking 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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derivedFrom | I | 0..* | Reference(Resource) | There are no (further) constraints on this element Element idMedicationStatement.derivedFrom Additional supporting information DefinitionAllows linking the MedicationStatement to the underlying MedicationRequest, or to other information that supports or is used to derive the MedicationStatement. Likely references would be to MedicationRequest, MedicationDispense, Claim, Observation or QuestionnaireAnswers. The most common use cases for deriving a MedicationStatement comes from creating a MedicationStatement from a MedicationRequest or from a lab observation or a claim. it should be noted that the amount of information that is available varies from the type resource that you derive the MedicationStatement from.
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taken | Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idMedicationStatement.taken UseIndicator Alternate namesGebruikIndicator DefinitionIs this medicine used or not? This element is labeled as a modifier because it indicates that the medication was not taken. A coded concept identifying level of certainty if patient has taken or has not taken the medication MedicationStatementTaken (required)Constraints
Example of taken y Mappings
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reasonNotTaken | I | 0..* | CodeableConcept | There are no (further) constraints on this element Element idMedicationStatement.reasonNotTaken True if asserting medication was not given DefinitionA code indicating why the medication was not taken. 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 indicating the reason why the medication was not taken SNOMED CT Drugs not taken/completed Codes (example)Constraints
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reasonCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element idMedicationStatement.reasonCode Reason for why the medication is being/was taken DefinitionA reason for why the medication is being/was taken. This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonForUseReference. A coded concept identifying why the medication is being taken. Condition/Problem/Diagnosis Codes (example)Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.reasonCode.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 idMedicationStatement.reasonCode.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 idMedicationStatement.reasonCode.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.
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text | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationStatement.reasonCode.text ReasonForUse Alternate namesRedenGebruik DefinitionThe reason for using the medication, particularly in self-care medicine purchased by the patient themselves. 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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reasonReference | I | 0..* | Reference(Condition | Observation) | There are no (further) constraints on this element Element idMedicationStatement.reasonReference Condition or observation that supports why the medication is being/was taken DefinitionCondition or observation that supports why the medication is being/was taken. This is a reference to a condition that is the reason why the medication is being/was taken. If only a code exists, use reasonForUseCode. Reference(Condition | Observation) Constraints
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note | 0..* | Annotation | There are no (further) constraints on this element Element idMedicationStatement.note Comment Alternate namesToelichting DefinitionComments on the medication use. 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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dosage | 0..* | HCIM InstructionsForUse | There are no (further) constraints on this element Element idMedicationStatement.dosage InstructionsForUse Alternate namesGebruiksinstructie DefinitionInstructions for the use of the medication, e.g. dose and route of administration. In the event of medication use, this is the pattern of use established by the patient or which the patient followed 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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Mapping FHIR profile NICE data dictionary
Path | identity | map | comment |
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MedicationStatement.effectivePeriod:effectivePeriod | NICE-Datadictionary-MDS | https://www.stichting-nice.nl/dd/#57 | Chronic Obstructive Pulmonary Disease |
MedicationStatement.effectivePeriod:effectivePeriod | NICE-Datadictionary-MDS | https://www.stichting-nice.nl/dd/#78 | Diabetes |
MedicationStatement.effectivePeriod:effectivePeriod | NICE-Datadictionary-MDS | https://www.stichting-nice.nl/dd/#159 | Immunological insufficiency |
MedicationStatement.effectivePeriod:effectivePeriod | NICE-Datadictionary-MDS | https://www.stichting-nice.nl/dd/#411 | Thrombolytic therapy following acute myocardial infarction |
MedicationStatement.effectivePeriod:effectivePeriod | NICE-Datadictionary-MDS | https://www.stichting-nice.nl/dd/#432 | Vasoactive medication |
{ "resourceType": "MedicationStatement", "id": "NICE-MedicationUse-Example-01", "meta": { "profile": [ "https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-MedicationUse-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" } ] } } ], "context": { "reference": "Encounter/NICE-Encounter-01" }, "status": "completed", "category": { "coding": [ { "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.20.77.5.3", "code": "6" } ] }, "medicationReference": { "reference": "Medication/NICE-Medication-Example-01" }, "effectivePeriod": { "start": "2021-01-05T08:43:00+02:00", "end": "2022-01-08T08:43:00+02:00" }, "dateAsserted": "2022-01-08T08:43:00+02:00", "subject": { "reference": "Patient/NICE-Patient-01", "display": "P. Petersen" }, "taken": "y" }
<MedicationStatement xmlns="http://hl7.org/fhir"> <id value="NICE-MedicationUse-Example-01" /> <meta> <profile value="https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-MedicationUse-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> <context> <reference value="Encounter/NICE-Encounter-01" /> </context> <status value="completed" /> <category> <coding> <system value="urn:oid:2.16.840.1.113883.2.4.3.11.60.20.77.5.3" /> <code value="6" /> </coding> </category> <medicationReference> <reference value="Medication/NICE-Medication-Example-01" /> </medicationReference> <effectivePeriod> <start value="2021-01-05T08:43:00+02:00" /> <end value="2022-01-08T08:43:00+02:00" /> </effectivePeriod> <dateAsserted value="2022-01-08T08:43:00+02:00" /> <subject> <reference value="Patient/NICE-Patient-01" /> <display value="P. Petersen" /> </subject> <taken value="y" /> </MedicationStatement>