| MedicationStatement | C | | http://hl7.org/fhir/StructureDefinition/DomainResource | Element idMedicationStatement Short descriptionRecord of medication being taken by a patient DefinitionA record of a medication that is being consumed by a patient. A MedicationStatement may indicate that the patient may be taking the medication now, or has taken the medication in the past or will be taking the medication in the future. The source of this information can be the patient, significant other (such as a family member or spouse), or a clinician. A common scenario where this information is captured is during the history taking process during a patient visit or stay. The medication information may come from sources such as the patient's memory, from a prescription bottle, or from a list of medications the patient, clinician or other party maintains
The primary difference between a medication statement and a medication administration is that the medication administration has complete administration information and is based on actual administration information from the person who administered the medication. A medication statement is often, if not always, less specific. There is no required date/time when the medication was administered, in fact we only know that a source has reported the patient is taking this medication, where details such as time, quantity, or rate or even medication product may be incomplete or missing or less precise. As stated earlier, the medication statement information may come from the patient's memory, from a prescription bottle or from a list of medications the patient, clinician or other party maintains. Medication administration is more formal and is not missing detailed information.
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.
http://hl7.org/fhir/StructureDefinition/DomainResource Constraints- dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
contained.contained.empty() - dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative
contained.text.empty() - dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() - dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
contained.where(('#'+id in %resource.descendants().reference).not()).empty() - mst-1: Reason not taken is only permitted if Taken is No
reasonNotTaken.exists().not() or (taken = 'n')
Mappings- rim: Entity. Role, or Act
- workflow: ..Event
- rim: SubstanceAdministration
- w5: clinical.medication
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| id | Σ | 0..1 | id | There are no (further) constraints on this element Element idMedicationStatement.id Short descriptionLogical 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.
id |
| meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idMedicationStatement.meta Short descriptionMetadata 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.
Meta |
| implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idMedicationStatement.implicitRules Short descriptionA 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.
uri |
| language | | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationStatement.language Short descriptionLanguage 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).
code BindingA human language. http://hl7.org/fhir/ValueSet/languages (extensible) Binding extensions |
| text | C | 0..1 | Narrative | There are no (further) constraints on this element Element idMedicationStatement.text Short descriptionText 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.
Narrative ConditionsThe cardinality or value of this element may be affected by these constraints: dom-1 Mappings |
| contained | | 0..* | Resource | There are no (further) constraints on this element Element idMedicationStatement.contained Short descriptionContained, 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.
Resource Mappings |
| extension | | 0..* | Extension | There are no (further) constraints on this element Element idMedicationStatement.extension Short descriptionAdditional 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.
Extension SlicingUnordered, Open, by url(Value) Extensions are always sliced by (at least) url Mappings |
| modifierExtension | ?! | 0..* | Extension | There are no (further) constraints on this element Element idMedicationStatement.modifierExtension Short descriptionExtensions 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.
Extension SlicingUnordered, Open, by url(Value) Extensions are always sliced by (at least) url Mappings |
| identifier | Σ | 0..* | Identifier | There are no (further) constraints on this element Element idMedicationStatement.identifier Short descriptionExternal 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.
Identifier Mappings- workflow: …identifer
- rim: .id
- w5: id
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| basedOn | Σ | 0..* | Reference(http://hl7.org/fhir/StructureDefinition/MedicationRequest | http://hl7.org/fhir/StructureDefinition/CarePlan | http://hl7.org/fhir/StructureDefinition/ProcedureRequest | http://hl7.org/fhir/StructureDefinition/ReferralRequest) | There are no (further) constraints on this element Element idMedicationStatement.basedOn Short descriptionFulfils 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.
Reference(http://hl7.org/fhir/StructureDefinition/MedicationRequest | http://hl7.org/fhir/StructureDefinition/CarePlan | http://hl7.org/fhir/StructureDefinition/ProcedureRequest | http://hl7.org/fhir/StructureDefinition/ReferralRequest) Mappings- workflow: …basedOn
- rim: .outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]
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| partOf | Σ | 0..* | Reference(http://hl7.org/fhir/StructureDefinition/MedicationAdministration | http://hl7.org/fhir/StructureDefinition/MedicationDispense | http://hl7.org/fhir/StructureDefinition/MedicationStatement | http://hl7.org/fhir/StructureDefinition/Procedure | http://hl7.org/fhir/StructureDefinition/Observation) | There are no (further) constraints on this element Element idMedicationStatement.partOf Short descriptionPart 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.
Reference(http://hl7.org/fhir/StructureDefinition/MedicationAdministration | http://hl7.org/fhir/StructureDefinition/MedicationDispense | http://hl7.org/fhir/StructureDefinition/MedicationStatement | http://hl7.org/fhir/StructureDefinition/Procedure | http://hl7.org/fhir/StructureDefinition/Observation) Mappings- workflow: …part of
- rim: .outboundRelationship[typeCode=COMP]/target[classCode=SPLY or SBADM or PROC or OBS,moodCode=EVN]
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| context | Σ | 0..1 | Reference(http://hl7.org/fhir/StructureDefinition/Encounter | http://hl7.org/fhir/StructureDefinition/EpisodeOfCare) | There are no (further) constraints on this element Element idMedicationStatement.context Short descriptionEncounter / Episode associated with MedicationStatement DefinitionThe encounter or episode of care that establishes the context for this MedicationStatement.
Reference(http://hl7.org/fhir/StructureDefinition/Encounter | http://hl7.org/fhir/StructureDefinition/EpisodeOfCare) Mappings- workflow: …context
- rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]
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| status | Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idMedicationStatement.status Short descriptionactive | completed | entered-in-error | intended | stopped | on-hold 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.
code BindingA coded concept indicating the current status of a MedicationStatement. http://hl7.org/fhir/ValueSet/medication-statement-status (required) Mappings- workflow: …status
- rim: .statusCode
- w5: status
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| category | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationStatement.category Short descriptionType of medication usage DefinitionIndicates where type of medication statement and where the medication is expected to be consumed or administered.
CodeableConcept BindingA coded concept identifying where the medication included in the medicationstatement is expected to be consumed or administered http://hl7.org/fhir/ValueSet/medication-statement-category (preferred) Mappings- rim: .inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication usage"].value
- w5: class
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| medication[x] | Σ | 1..1 | | There are no (further) constraints on this element Element idMedicationStatement.medication[x] Short descriptionWhat medication was taken 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.
If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example if you require form or lot number, then you must reference the Medication resource. .
A coded concept identifying the substance or product being taken. http://hl7.org/fhir/ValueSet/medication-codes (example) Mappings- workflow: …code
- rim: .participation[typeCode=CSM].role[classCode=ADMM or MANU]
- w5: what
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| medicationCodeableConcept | | | CodeableConcept | There are no (further) constraints on this element Data typeCodeableConcept |
| medicationReference | | | Reference(http://hl7.org/fhir/StructureDefinition/Medication) | There are no (further) constraints on this element Data typeReference(http://hl7.org/fhir/StructureDefinition/Medication) |
| effective[x] | Σ | 0..1 | | There are no (further) constraints on this element Element idMedicationStatement.effective[x] Short descriptionThe date/time or interval when the medication was taken DefinitionThe interval of time during which it is being asserted that the patient was taking the medication (or was not taking, when the wasNotGiven element is true).
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.
- workflow: …occurrence[x]
- rim: .effectiveTime
- w5: when.done
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| effectiveDateTime | | | dateTime | There are no (further) constraints on this element Data typedateTime |
| effectivePeriod | | | Period | There are no (further) constraints on this element Data typePeriod |
| dateAsserted | Σ | 0..1 | dateTime | There are no (further) constraints on this element Element idMedicationStatement.dateAsserted Short descriptionWhen the statement was asserted? DefinitionThe date when the medication statement was asserted by the information source.
dateTime Mappings- rim: .participation[typeCode=AUT].time
- w5: when.recorded
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| informationSource | | 0..1 | Reference(http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/Practitioner | http://hl7.org/fhir/StructureDefinition/RelatedPerson | http://hl7.org/fhir/StructureDefinition/Organization) | There are no (further) constraints on this element Element idMedicationStatement.informationSource Short descriptionPerson 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.
Reference(http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/Practitioner | http://hl7.org/fhir/StructureDefinition/RelatedPerson | http://hl7.org/fhir/StructureDefinition/Organization) Mappings- rim: .participation[typeCode=INF].role[classCode=PAT, or codes for Practioner or Related Person (if PAT is the informer, then syntax for self-reported =true)
- w5: who.source
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| subject | Σ | 1..1 | Reference(http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/Group) | There are no (further) constraints on this element Element idMedicationStatement.subject Short descriptionWho is/was taking the medication DefinitionThe person, animal or group who is/was taking the medication.
Reference(http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/Group) Mappings- workflow: …subject
- v2: PID-3-Patient ID List
- rim: .participation[typeCode=SBJ].role[classCode=PAT]
- w5: who
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| derivedFrom | | 0..* | Reference(http://hl7.org/fhir/StructureDefinition/Resource) | There are no (further) constraints on this element Element idMedicationStatement.derivedFrom Short descriptionAdditional 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.
Reference(http://hl7.org/fhir/StructureDefinition/Resource) Mappings- rim: .outboundRelationship[typeCode=SPRT]/target[classCode=ACT,moodCode=EVN]
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| taken | Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idMedicationStatement.taken Short descriptiony | n | unk | na DefinitionIndicator of the certainty of whether the medication was taken by the patient.
This element is labeled as a modifier because it indicates that the medication was not taken.
code BindingA coded concept identifying level of certainty if patient has taken or has not taken the medication http://hl7.org/fhir/ValueSet/medication-statement-taken (required) Mappings- workflow: …notDone
- rim: .actionNegationInd
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| reasonNotTaken | C | 0..* | CodeableConcept | There are no (further) constraints on this element Element idMedicationStatement.reasonNotTaken Short descriptionTrue if asserting medication was not given DefinitionA code indicating why the medication was not taken.
CodeableConcept BindingA coded concept indicating the reason why the medication was not taken http://hl7.org/fhir/ValueSet/reason-medication-not-taken-codes (example) ConditionsThe cardinality or value of this element may be affected by these constraints: mst-1 Mappings- rim: .outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="reason not taken"].value
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| reasonCode | | 0..* | CodeableConcept | There are no (further) constraints on this element Element idMedicationStatement.reasonCode Short descriptionReason 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.
CodeableConcept BindingA coded concept identifying why the medication is being taken. http://hl7.org/fhir/ValueSet/condition-code (example) Mappings- workflow: …reasoneCodeableConcept
- rim: .reasonCode
- w5: why
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| reasonReference | | 0..* | Reference(http://hl7.org/fhir/StructureDefinition/Condition | http://hl7.org/fhir/StructureDefinition/Observation) | There are no (further) constraints on this element Element idMedicationStatement.reasonReference Short descriptionCondition 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(http://hl7.org/fhir/StructureDefinition/Condition | http://hl7.org/fhir/StructureDefinition/Observation) Mappings- workflow: …reasonReference
- rim: .outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="reason for use"].value
- w5: why
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| note | | 0..* | Annotation | There are no (further) constraints on this element Element idMedicationStatement.note Short descriptionFurther information about the statement DefinitionProvides extra information about the medication statement that is not conveyed by the other attributes.
Annotation Mappings- workflow: …note
- rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=OBS,moodCode=EVN,code="annotation"].value
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| dosage | | 0..* | Dosage | There are no (further) constraints on this element Element idMedicationStatement.dosage Short descriptionDetails of how medication is/was taken or should be taken DefinitionIndicates how the medication is/was or should be taken by the patient.
The dates included in the dosage on a Medication Statement reflect the dates for a given dose. For example, "from November 1, 2016 to November 3, 2016, take one tablet daily and from November 4, 2016 to November 7, 2016, take two tablets daily." It is expected that this specificity may only be populated where the patient brings in their labeled container or where the Medication Statement is derived from a MedicationRequest.
Dosage Mappings- rim: refer dosageInstruction mapping
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