DwMedicationRequestOrder
Purpose
The purpose of this resource is to request or order supply of medication and its instructions to the patient for administration. This resource covers the supply of all types of medication orders, example - inpatient, outpatient, community orders, over-the-counter medications, total parenteral nutrition, diet/ vitamin supplements and medication-related devices.
| MedicationRequest | I | MedicationRequest | There are no (further) constraints on this element Element idMedicationRequest Ordering of medication for patient or group Alternate namesPrescription, Order DefinitionAn order or request for both supply of the medication and the instructions for administration of the medication to a patient. The resource is called "MedicationRequest" rather than "MedicationPrescription" or "MedicationOrder" to generalize the use across inpatient and outpatient settings, including care plans, etc., and to harmonize with workflow patterns.
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| id | S Σ | 1..1 | string | There are no (further) constraints on this element Element idMedicationRequest.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. |
| meta | S Σ | 0..1 | Meta | There are no (further) constraints on this element Element idMedicationRequest.meta Metadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.meta.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.meta.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| versionId | Σ | 0..1 | id | There are no (further) constraints on this element Element idMedicationRequest.meta.versionId Version specific identifier DefinitionThe version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted. The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.
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| lastUpdated | S Σ | 1..1 | instant | There are no (further) constraints on this element Element idMedicationRequest.meta.lastUpdated When the resource version last changed DefinitionWhen the resource last changed - e.g. when the version changed. This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.
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| source | S Σ | 1..1 | uri | There are no (further) constraints on this element Element idMedicationRequest.meta.source Identifies where the resource comes from DefinitionA uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc. In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
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| profile | Σ | 0..* | canonical(StructureDefinition) | Element idMedicationRequest.meta.profile Profiles this resource claims to conform to DefinitionA list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. Usage: Each implementation project will determine if this will be supported. It may be useful for validating message instances against this specific profile. It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set. canonical(StructureDefinition) Constraints
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| security | Σ | 0..* | CodingBinding | There are no (further) constraints on this element Element idMedicationRequest.meta.security Security Labels applied to this resource DefinitionSecurity labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure. The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. Security Labels from the Healthcare Privacy and Security Classification System.
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| tag | Σ | 0..* | Coding | There are no (further) constraints on this element Element idMedicationRequest.meta.tag Tags applied to this resource DefinitionTags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource. The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored. Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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| implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idMedicationRequest.implicitRules A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. 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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
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| language | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.language Language of the resource content DefinitionThe base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). A human language.
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| text | S | 0..1 | Narrative | There are no (further) constraints on this element Element idMedicationRequest.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource and can 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 information is added later.
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| contained | S | 0..0 | Resource | There are no (further) constraints on this element Element idMedicationRequest.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| DispenserInstructions | I | 0..1 | Extension(Complex) | Element idMedicationRequest.extension:DispenserInstructions 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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Alignment: MedicationOrder.extension:pharmacyInstructions Usage Note: If available, this should be included 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(Complex) Extension URLhttps://example.org/fhir/StructureDefinition/DispenserInstructions Constraints
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| NoRenewalsFlag | I | 0..1 | Extension(Complex) | Element idMedicationRequest.extension:NoRenewalsFlag 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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Alignment: PrescribeIT: MedicationOrder.extension:noRenewals 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(Complex) Extension URLhttps://example.org/fhir/StructureDefinition/NoRenewalsFlag Constraints
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| StatusChanged | I | 0..1 | Extension(Complex) | Element idMedicationRequest.extension:StatusChanged Optional Extensions Element Alternate namesextensions, user content DefinitionThe date (and perhaps time) when the status was changed. Usage Note: This is a pre-adoption of an R5 data element, and reflects the dateTime that the status was changed https://build.fhir.org/medicationrequest-definitions.html#MedicationRequest.statusChanged Extension(Complex) Extension URLhttp://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationRequest.statusChanged Constraints
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| RenderedDosageInstruction | I | 0..1 | Extension(string) | Element idMedicationRequest.extension:RenderedDosageInstruction Optional Extensions Element Alternate namesextensions, user content DefinitionOptional Extension Element - found in all resources. PrescribeIT - Rendered Dosage Instruction http://prescribeit.ca/fhir/StructureDefinition/ext-rendered-dosage-instruction Constraints
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| modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| identifier | S | 0..* | Identifier | Element idMedicationRequest.identifier External ids for this request DefinitionIdentifiers associated with this medication request that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server. Conformance Rule: If an order identifier is available from the source system, this may be populated. Mapping: PrescribeIT MedicationOrder.identifier This is a business identifier, not a resource identifier. Unordered, Open, by type.coding.code(Value) Constraints
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| (All Slices) | There are no (further) constraints on this element | |||
| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.identifier.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.identifier.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| use | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.identifier.use usual | official | temp | secondary | old (If known) DefinitionThe purpose of this identifier. Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Identifies the purpose for this identifier, if known .
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| type | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationRequest.identifier.type Description of identifier DefinitionA coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Allows users to make use of identifiers when the identifier system is not known. This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
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| system | S Σ | 1..1 | uri | There are no (further) constraints on this element Element idMedicationRequest.identifier.system The namespace for the identifier value DefinitionEstablishes the namespace for the value - that is, a URL that describes a set values that are unique. There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. Identifier.system is always case sensitive.
General http://www.acme.com/identifiers/patient Mappings
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| value | S Σ | 1..1 | string | Element idMedicationRequest.identifier.value The value that is unique DefinitionThe portion of the identifier typically relevant to the user and which is unique within the context of the system. If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
General 123456 Mappings
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| period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element idMedicationRequest.identifier.period Time period when id is/was valid for use DefinitionTime period during which identifier is/was valid for use. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration.
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| assigner | Σ I | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element idMedicationRequest.identifier.assigner Organization that issued id (may be just text) DefinitionOrganization that issued/manages the identifier. The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
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| Placer | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationRequest.identifier:Placer External ids for this request DefinitionIdentifiers associated with this medication request that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server. This is a business identifier, not a resource identifier.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.identifier:Placer.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.identifier:Placer.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| use | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.identifier:Placer.use usual | official | temp | secondary | old (If known) DefinitionThe purpose of this identifier. Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Identifies the purpose for this identifier, if known .
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| type | S Σ | 1..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationRequest.identifier:Placer.type Description of identifier DefinitionA coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Allows users to make use of identifiers when the identifier system is not known. This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.identifier:Placer.type.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.identifier:Placer.type.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| coding | S Σ | 1..1 | Coding | There are no (further) constraints on this element Element idMedicationRequest.identifier:Placer.type.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for alternative encodings within a code system, and translations to other code systems. Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.identifier:Placer.type.coding.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.identifier:Placer.type.coding.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| system | Σ | 0..1 | uri | There are no (further) constraints on this element Element idMedicationRequest.identifier:Placer.type.coding.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 reference to some definition that establishes the system clearly and unambiguously.
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| version | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.identifier:Placer.type.coding.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 | S Σ | 1..1 | codeFixed Value | Element idMedicationRequest.identifier:Placer.type.coding.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 SHALL NOT exceed 1MB in size
PLAC
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| display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.identifier:Placer.type.coding.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 SHALL NOT exceed 1MB in size
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| userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationRequest.identifier:Placer.type.coding.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
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| text | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.identifier:Placer.type.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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| system | S Σ | 1..1 | uriFixed Value | Element idMedicationRequest.identifier:Placer.system The namespace for the identifier value DefinitionEstablishes the namespace for the value - that is, a URL that describes a set values that are unique. There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. Conformance Rule: Follow the same rule as PrescribeIT for consistency ********** more to come on this PrescribeIT Conformance Rule: This must be an OID of the URI form [Vendor root].[Application instance node].2 (e.g. urn:oid:1.2.3.4). The branch, “.2” is appended to create a unique namespace for the Prescription Identifer Identifier.system is always case sensitive.
http://hl7.org/fhir/identifier-type
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| value | S Σ | 1..1 | string | There are no (further) constraints on this element Element idMedicationRequest.identifier:Placer.value The value that is unique DefinitionThe portion of the identifier typically relevant to the user and which is unique within the context of the system. If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
General 123456 Mappings
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| period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element idMedicationRequest.identifier:Placer.period Time period when id is/was valid for use DefinitionTime period during which identifier is/was valid for use. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration.
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| assigner | Σ I | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element idMedicationRequest.identifier:Placer.assigner Organization that issued id (may be just text) DefinitionOrganization that issued/manages the identifier. The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
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| status | S Σ ?! | 1..1 | codeBinding | Element idMedicationRequest.status active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown DefinitionA code specifying the current state of the order. Generally, this will be active or completed state. Conformance Rule: Sending systems should set all orders should be set to completed. Rationale: The status of an order should not change and therefore all internal prescriptions may be set to completed. Note: this is not the medication status, it is the order status which is complete as soon as the order immediately when the prescription is written. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.
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| statusReason | S | 0..1 | CodeableConcept | Element idMedicationRequest.statusReason Reason for current status DefinitionCaptures the reason for the current state of the MedicationRequest. Usage Note: When radio buttons are used, the status reason is be captured discretely. This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the MedicationRequest was created at all is captured in reasonCode, not here. Identifies the reasons for a given status.
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| intent | S Σ ?! | 1..1 | codeBindingFixed Value | Element idMedicationRequest.intent proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option DefinitionWhether the request is a proposal, plan, or an original order. It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only. An instance-order is an instantiation of a request or order and may be used to populate Medication Administration Record. This element is labeled as a modifier because the intent alters when and how the resource is actually applicable. The kind of medication order.
order
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| category | S | 0..1 | CodeableConceptBinding | Element idMedicationRequest.category Type of medication usage DefinitionIndicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)). Conformance Rule: This should be populated if known The category can be used to include where the medication is expected to be consumed or other types of requests. A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.category.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.category.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| coding | S Σ | 0..* | CodingBinding | Element idMedicationRequest.category.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for alternative encodings within a code system, and translations to other code systems. 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. https://fhir.infoway-inforoute.ca/ValueSet/prescriptiontype (required) Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.category.coding.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.category.coding.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| system | S Σ | 0..1 | uri | There are no (further) constraints on this element Element idMedicationRequest.category.coding.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 reference to some definition that establishes the system clearly and unambiguously.
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| version | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.category.coding.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 | S Σ | 0..1 | code | There are no (further) constraints on this element Element idMedicationRequest.category.coding.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 SHALL NOT exceed 1MB in size
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| display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.category.coding.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 SHALL NOT exceed 1MB in size
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| userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationRequest.category.coding.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - e.g. 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 | 1..1 | string | There are no (further) constraints on this element Element idMedicationRequest.category.text Plain text representation of the concept DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Very often the text is the same as a displayName of one of the codings.
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| priority | Σ | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.priority routine | urgent | asap | stat DefinitionIndicates how quickly the Medication Request should be addressed with respect to other requests. Note that FHIR strings SHALL NOT exceed 1MB in size Identifies the level of importance to be assigned to actioning the request.
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| doNotPerform | Σ ?! | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationRequest.doNotPerform True if request is prohibiting action DefinitionIf true indicates that the provider is asking for the medication request not to occur. If do not perform is not specified, the request is a positive request e.g. "do perform".
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| reported[x] | S Σ | 0..1 | Element idMedicationRequest.reported[x] Reported rather than primary record DefinitionIndicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the report. Conformance Rule: The boolean is mandatory where known, the source resource must be included in the extension:InformationSource. Usage Note: The presence of the boolean = true is set only when the exporting system can be set with certainty. By example, the value would be set to "true" when a record was imported or when the physician has input the prescription data into the EMR from a bottle, prescription, discharge summary or consult report. In these cases the EMR can detect that the prescription being exported was an external prescription. It is recognized that there are other more complex scenarios where this flag cannot be set with certainty and should therefore not be populated. Usage Rule: For migration from EMR-EMR, it is important to ensure that not all records are marked as reported; rather the rules in the source EMR should be respected. Core-CA - supported Note R5 - does not support a reference in this field (in R5 it is an information source) and therefore it will not be supported by extension
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| reportedBoolean | boolean | Data type | ||
| medication[x] | S Σ | 1..1 | Element idMedicationRequest.medication[x] Medication to be taken DefinitionIdentifies the medication being requested. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medications. Usage Note: In cases where the medication Resourse is not available. Medication will be provided as a codeableConcept. 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 or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource. A coded concept identifying substance or product that can be ordered.
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| medicationCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||
| medicationReference | Reference(Medication) | There are no (further) constraints on this element Data type | ||
| subject | S Σ I | 1..1 | Reference(Patient | Group) | There are no (further) constraints on this element Element idMedicationRequest.subject Who or group medication request is for DefinitionA link to a resource representing the person or set of individuals to whom the medication will be given. The subject on a medication request is mandatory. For the secondary use case where the actual subject is not provided, there still must be an anonymized subject specified.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.subject.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.subject.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| reference | S Σ I | 1..1 | string | There are no (further) constraints on this element Element idMedicationRequest.subject.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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| type | Σ | 0..1 | uriBinding | There are no (further) constraints on this element Element idMedicationRequest.subject.type Type the reference refers to (e.g. "Patient") DefinitionThe expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Aa resource (or, for logical models, the URI of the logical model).
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| identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationRequest.subject.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents 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. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
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| display | S Σ | 0..1 | string | Element idMedicationRequest.subject.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. Usage Note: This should contain the name of the Patient, which can then be used in narrative 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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| encounter | S I | 0..1 | Reference(Encounter) | Element idMedicationRequest.encounter Encounter created as part of encounter/admission/stay DefinitionThe Encounter during which this [x] was created or to which the creation of this record is tightly associated. Usage Note: This should be included if there is a definitive link to an encounter in the EMR and when it is deemed to be important for the implmementation. This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter." If there is a need to link to episodes of care they will be handled with an extension.
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| supportingInformation | S I | 0..* | Reference(Resource) | Element idMedicationRequest.supportingInformation Information to support ordering of the medication DefinitionInclude additional information (for example, patient height and weight) that supports the ordering of the medication. Usage Rules: This will be used to support the observations for weight, height, creatinine, eGFR. PrescribeIT mapping: extension, supporting information ** **For MedicationOrders, create a value set that is scoped to weight, height, creatinine, eGFR (extensible) -- LOINC 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. Allowed aggregation: bundled Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.supportingInformation.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.supportingInformation.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| reference | S Σ I | 1..1 | string | There are no (further) constraints on this element Element idMedicationRequest.supportingInformation.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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| type | Σ | 0..1 | uriBinding | There are no (further) constraints on this element Element idMedicationRequest.supportingInformation.type Type the reference refers to (e.g. "Patient") DefinitionThe expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Aa resource (or, for logical models, the URI of the logical model).
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| identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationRequest.supportingInformation.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents 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. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
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| display | S Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.supportingInformation.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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| authoredOn | S Σ | 0..1 | dateTime | Element idMedicationRequest.authoredOn When request was initially authored DefinitionThe date (and perhaps time) when the prescription was initially written or authored on. Alignment: PrescribeIT Mapping: DateWritten Conformance Rule: In the context of "order" this is often the date when the prescription was originally written. If this is an external prescription the date may not be known. In some cases this date will be an estimate by the physician who entered the record. Conformance Rule: Must be either a full date (i.e. yyyy-mm-dd) or a full date and time with timezone (i.e. yyyy-mm-dd-HH:mm:ss.SSS-ZZZZZ). Prescriptions sent within Alberta will support the full date time. Alignment - PS-ON - TELUS asked: Are there any rules around this? Is this always the "initial" prescription date or latest renewal? Eg 7 years ago, rather than the date of the latest renewal? Please update the specification with this level of detail. Answer: They will seek clinical guidance in the future and advise. CA-Core: supported PrescribeIT: Date written PrescribeIT Conformance Rule: Must be either equal to or earlier then the MedicationOrder.dispenseRequest.valididityPeriod.start element.
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| requester | S Σ I | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Element idMedicationRequest.requester Who/What requested the Request DefinitionThe individual, organization, or device that initiated the request and has responsibility for its activation. Usage note: This is not mandatory as the EMR may not always know the prescriber when creating an external prescription. If the role is known, the practitionerRole can be specified which has minimal information. CA - this element is supported 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(Practitioner | PractitionerRole | Organization) Allowed aggregation: bundled Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.requester.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.requester.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| reference | S Σ I | 1..1 | string | There are no (further) constraints on this element Element idMedicationRequest.requester.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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| type | Σ | 0..1 | uriBinding | There are no (further) constraints on this element Element idMedicationRequest.requester.type Type the reference refers to (e.g. "Patient") DefinitionThe expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Aa resource (or, for logical models, the URI of the logical model).
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| identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationRequest.requester.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents 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. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
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| display | S Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.requester.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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| performer | I | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam) | There are no (further) constraints on this element Element idMedicationRequest.performer Intended performer of administration DefinitionThe specified desired performer of the medication treatment (e.g. the performer of the medication administration). 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(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam) Constraints
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| performerType | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idMedicationRequest.performerType Desired kind of performer of the medication administration DefinitionIndicates the type of performer of the administration of the medication. If specified without indicating a performer, this indicates that the performer must be of the specified type. If specified with a performer then it indicates the requirements of the performer if the designated performer is not available. Identifies the type of individual that is desired to administer the medication.
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| recorder | I | 0..1 | Reference(Practitioner | PractitionerRole) | There are no (further) constraints on this element Element idMedicationRequest.recorder Person who entered the request DefinitionThe person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Practitioner | PractitionerRole) Constraints
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| reasonCode | S | 0..* | CodeableConceptBinding | Element idMedicationRequest.reasonCode Reason or indication for ordering or not ordering the medication DefinitionThe reason or the indication for ordering or not ordering the medication. Conformance Rule: In the case where the prescriber wants to send an Indication for Use that is not included in the value set the prescriber must be able to send a text value without a code. This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference. A coded concept indicating why the medication was ordered.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.reasonCode.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| coding | S Σ | 0..* | Coding | There are no (further) constraints on this element Element idMedicationRequest.reasonCode.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for alternative encodings within a code system, and translations to other code systems. Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.reasonCode.coding.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.reasonCode.coding.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| system | S Σ | 0..1 | uri | There are no (further) constraints on this element Element idMedicationRequest.reasonCode.coding.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 reference to some definition that establishes the system clearly and unambiguously.
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| version | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.reasonCode.coding.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 | S Σ | 0..1 | code | There are no (further) constraints on this element Element idMedicationRequest.reasonCode.coding.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 SHALL NOT exceed 1MB in size
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| display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.reasonCode.coding.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 SHALL NOT exceed 1MB in size
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| userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationRequest.reasonCode.coding.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - e.g. 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 | S Σ | 1..1 | string | There are no (further) constraints on this element Element idMedicationRequest.reasonCode.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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| reasonReference | I | 0..* | Reference(Condition | Observation) | There are no (further) constraints on this element Element idMedicationRequest.reasonReference Condition or observation that supports why the prescription is being written DefinitionCondition or observation that supports why the medication was ordered. This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode. Reference(Condition | Observation) Constraints
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| instantiatesCanonical | Σ | 0..* | canonical() | There are no (further) constraints on this element Element idMedicationRequest.instantiatesCanonical Instantiates FHIR protocol or definition DefinitionThe URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest.
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| instantiatesUri | Σ | 0..* | uri | There are no (further) constraints on this element Element idMedicationRequest.instantiatesUri Instantiates external protocol or definition DefinitionThe URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this MedicationRequest. see http://en.wikipedia.org/wiki/Uniform_resource_identifier
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| basedOn | Σ I | 0..* | Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation) | There are no (further) constraints on this element Element idMedicationRequest.basedOn What request fulfills DefinitionA plan or request that is fulfilled in whole or in part by this medication request. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation) Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.basedOn.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.basedOn.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| reference | S Σ I | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.basedOn.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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| type | Σ | 0..1 | uriBinding | There are no (further) constraints on this element Element idMedicationRequest.basedOn.type Type the reference refers to (e.g. "Patient") DefinitionThe expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Aa resource (or, for logical models, the URI of the logical model).
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| identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationRequest.basedOn.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents 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. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
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| display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.basedOn.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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| groupIdentifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationRequest.groupIdentifier Composite request this is part of DefinitionA shared identifier common to all requests that were authorized more or less simultaneously by a single author, representing the identifier of the requisition or prescription. Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.
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| courseOfTherapyType | 0..1 | CodeableConceptBinding | Element idMedicationRequest.courseOfTherapyType Overall pattern of medication administration DefinitionThe description of the overall pattern of the administration of the medication to the patient. Usage Note: This should be included where known Alignment: PrescribeIT Mapping - Extension - TreatmentType This attribute should not be confused with the protocol of the medication. Identifies the overall pattern of medication administration.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.courseOfTherapyType.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.courseOfTherapyType.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| coding | S Σ | 1..1 | Coding | There are no (further) constraints on this element Element idMedicationRequest.courseOfTherapyType.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for alternative encodings within a code system, and translations to other code systems. Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.courseOfTherapyType.coding.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.courseOfTherapyType.coding.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| system | S Σ | 1..1 | uriFixed Value | Element idMedicationRequest.courseOfTherapyType.coding.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 reference to some definition that establishes the system clearly and unambiguously.
http://hl7.org/fhir/v3/ActCode
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| version | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.courseOfTherapyType.coding.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 | S Σ | 1..1 | code | There are no (further) constraints on this element Element idMedicationRequest.courseOfTherapyType.coding.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 SHALL NOT exceed 1MB in size
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| display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.courseOfTherapyType.coding.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 SHALL NOT exceed 1MB in size
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| userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationRequest.courseOfTherapyType.coding.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - e.g. 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 | S Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.courseOfTherapyType.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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| insurance | I | 0..* | Reference(Coverage | ClaimResponse) | There are no (further) constraints on this element Element idMedicationRequest.insurance Associated insurance coverage DefinitionInsurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service. 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(Coverage | ClaimResponse) Constraints
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| note | S | 0..* | Annotation | There are no (further) constraints on this element Element idMedicationRequest.note Information about the prescription DefinitionExtra information about the prescription that could not be conveyed by the other attributes. 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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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.note.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.note.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| author[x] | S Σ | 0..1 | There are no (further) constraints on this element Element idMedicationRequest.note.author[x] Individual responsible for the annotation DefinitionThe individual responsible for making the annotation. Organization is used when there's no need for specific attribution as to who made the comment.
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| authorString | string | There are no (further) constraints on this element Data type | ||
| authorReference | Reference(Practitioner | Patient | RelatedPerson | Organization) | There are no (further) constraints on this element Data type Reference(Practitioner | Patient | RelatedPerson | Organization) | ||
| time | S Σ | 0..1 | dateTime | There are no (further) constraints on this element Element idMedicationRequest.note.time When the annotation was made DefinitionIndicates when this particular annotation was made.
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| text | Σ | 1..1 | markdown | There are no (further) constraints on this element Element idMedicationRequest.note.text The annotation - text content (as markdown) DefinitionThe text of the annotation in markdown format. Systems are not required to have markdown support, so the text should be readable without markdown processing. The markdown syntax is GFM - see https://github.github.com/gfm/
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| dosageInstruction | S | 0..* | Dosage | Element idMedicationRequest.dosageInstruction How the medication should be taken DefinitionIndicates how the medication is to be used by the patient. Conformance Rules - if this is available in discrete form, this should be sent. This represents a single dosage line/instruction. Alignment Note: For sending systems, this will follow the same rules as PrescribeIT with one difference; the sequence data element is an extension in PrescribeIt. There are examples where a medication request may include the option of an oral dose or an Intravenous or Intramuscular dose. For example, "Ondansetron 8mg orally or IV twice a day as needed for nausea" or "Compazine® (prochlorperazine) 5-10mg PO or 25mg PR bid prn nausea or vomiting". In these cases, two medication requests would be created that could be grouped together. The decision on which dose and route of administration to use is based on the patient's condition at the time the dose is needed.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| effectivePeriod | I | 0..1 | Extension | Element idMedicationRequest.dosageInstruction.extension:effectivePeriod Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. https://example.org/fhir/StructureDefinition/effectivePeriod Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.extension:effectivePeriod.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.extension: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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| url | 1..1 | uriFixed Value | Element idMedicationRequest.dosageInstruction.extension:effectivePeriod.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. https://example.org/fhir/StructureDefinition/effectivePeriod
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| value[x] | 0..1 | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.extension:effectivePeriod.value[x] Value of extension DefinitionValue of extension - must be one of a constrained set of the data types (see Extensibility for a list).
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| valueBase64Binary | base64Binary | There are no (further) constraints on this element Data type | ||
| valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
| valueCanonical | canonical() | There are no (further) constraints on this element Data type | ||
| valueCode | code | There are no (further) constraints on this element Data type | ||
| valueDate | date | There are no (further) constraints on this element Data type | ||
| valueDateTime | dateTime | There are no (further) constraints on this element Data type | ||
| valueDecimal | decimal | There are no (further) constraints on this element Data type | ||
| valueId | id | There are no (further) constraints on this element Data type | ||
| valueInstant | instant | There are no (further) constraints on this element Data type | ||
| valueInteger | integer | There are no (further) constraints on this element Data type | ||
| valueMarkdown | markdown | There are no (further) constraints on this element Data type | ||
| valueOid | oid | There are no (further) constraints on this element Data type | ||
| valuePositiveInt | positiveInt | There are no (further) constraints on this element Data type | ||
| valueString | string | There are no (further) constraints on this element Data type | ||
| valueTime | time | There are no (further) constraints on this element Data type | ||
| valueUnsignedInt | unsignedInt | There are no (further) constraints on this element Data type | ||
| valueUri | uri | There are no (further) constraints on this element Data type | ||
| valueUrl | url | There are no (further) constraints on this element Data type | ||
| valueUuid | uuid | There are no (further) constraints on this element Data type | ||
| valueAddress | Address | There are no (further) constraints on this element Data type | ||
| valueAge | Age | There are no (further) constraints on this element Data type | ||
| valueAnnotation | Annotation | There are no (further) constraints on this element Data type | ||
| valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
| valueCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||
| valueCoding | Coding | There are no (further) constraints on this element Data type | ||
| valueContactPoint | ContactPoint | There are no (further) constraints on this element Data type | ||
| valueCount | Count | There are no (further) constraints on this element Data type | ||
| valueDistance | Distance | There are no (further) constraints on this element Data type | ||
| valueDuration | Duration | There are no (further) constraints on this element Data type | ||
| valueHumanName | HumanName | There are no (further) constraints on this element Data type | ||
| valueIdentifier | Identifier | There are no (further) constraints on this element Data type | ||
| valueMoney | Money | There are no (further) constraints on this element Data type | ||
| valuePeriod | Period | There are no (further) constraints on this element Data type | ||
| valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
| valueRange | Range | There are no (further) constraints on this element Data type | ||
| valueRatio | Ratio | There are no (further) constraints on this element Data type | ||
| valueSampledData | SampledData | There are no (further) constraints on this element Data type | ||
| valueSignature | Signature | There are no (further) constraints on this element Data type | ||
| valueTiming | Timing | There are no (further) constraints on this element Data type | ||
| valueContactDetail | ContactDetail | There are no (further) constraints on this element Data type | ||
| valueContributor | Contributor | There are no (further) constraints on this element Data type | ||
| valueDataRequirement | DataRequirement | There are no (further) constraints on this element Data type | ||
| valueExpression | Expression | There are no (further) constraints on this element Data type | ||
| valueParameterDefinition | ParameterDefinition | There are no (further) constraints on this element Data type | ||
| valueRelatedArtifact | RelatedArtifact | There are no (further) constraints on this element Data type | ||
| valueTriggerDefinition | TriggerDefinition | There are no (further) constraints on this element Data type | ||
| valueUsageContext | UsageContext | There are no (further) constraints on this element Data type | ||
| valueDosage | Dosage | There are no (further) constraints on this element Data type | ||
| valueMeta | Meta | There are no (further) constraints on this element Data type | ||
| valueReference | Reference() | There are no (further) constraints on this element Data type | ||
| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| sequence | S Σ | 0..1 | integer | Element idMedicationRequest.dosageInstruction.sequence The order of the dosage instructions DefinitionIndicates the order in which the dosage instructions should be applied or interpreted. If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential. Usage Rule: This indicates the relationship between instruction line. If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. This carries the meaning of AND. If the sequence number is different, then the Dosages are intended to be sequential. and carries a meaning of "THEN".
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| text | S Σ | 0..1 | string | Element idMedicationRequest.dosageInstruction.text Free text dosage instructions e.g. SIG DefinitionFree text dosage instructions e.g. SIG. Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. Additional information about administration or preparation of the medication should be included as text. Note that FHIR strings SHALL NOT exceed 1MB in size
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| additionalInstruction | S Σ | 0..* | CodeableConcept | Element idMedicationRequest.dosageInstruction.additionalInstruction Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" DefinitionSupplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps"). Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded. Usage Note: To convey explicit instructions to the Pharmacist/dispenser related to this medication order. Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text. A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.additionalInstruction.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.additionalInstruction.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| coding | S Σ | 0..1 | Coding | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.additionalInstruction.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for alternative encodings within a code system, and translations to other code systems. Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.additionalInstruction.coding.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.additionalInstruction.coding.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| system | S Σ | 0..1 | uri | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.additionalInstruction.coding.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 reference to some definition that establishes the system clearly and unambiguously.
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| version | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.additionalInstruction.coding.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 | S Σ | 1..1 | code | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.additionalInstruction.coding.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 SHALL NOT exceed 1MB in size
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| display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.additionalInstruction.coding.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 SHALL NOT exceed 1MB in size
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| userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.additionalInstruction.coding.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - e.g. 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 | S Σ | 1..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.additionalInstruction.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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| patientInstruction | Σ | 0..1 | string | Element idMedicationRequest.dosageInstruction.patientInstruction Patient or consumer oriented instructions DefinitionInstructions in terms that are understood by the patient or consumer. This will not be used as EMRs do not have a patient-facing field - MELVA CHR -- Marc will double check but does not have a "Patient Instruction field" PSS - conversion is happening on frequency, but not guaranteed for other shortforms; recipient is pharmacist. Note that FHIR strings SHALL NOT exceed 1MB in size
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| timing | S Σ | 0..1 | Timing | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing When medication should be administered DefinitionWhen medication should be administered. The timing schedule for giving the medication to the patient. This data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period. This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| event | Σ | 0..* | dateTime | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.event When the event occurs DefinitionIdentifies specific times when the event occurs. In a Medication Administration Record, for instance, you need to take a general specification, and turn it into a precise specification.
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| repeat | S Σ I | 0..1 | Element | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.repeat When the event is to occur DefinitionA set of rules that describe when the event is scheduled. Many timing schedules are determined by regular repetitions.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.repeat.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.repeat.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| bounds[x] | S Σ | 0..1 | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.repeat.bounds[x] Length/Range of lengths, or (Start and/or end) limits DefinitionEither a duration for the length of the timing schedule, a range of possible length, or outer bounds for start and/or end limits of the timing schedule.
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| boundsDuration | Duration | There are no (further) constraints on this element Data type | ||
| boundsRange | Range | There are no (further) constraints on this element Data type | ||
| boundsPeriod | Period | There are no (further) constraints on this element Data type | ||
| count | S Σ | 0..1 | positiveInt | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.repeat.count Number of times to repeat DefinitionA total count of the desired number of repetitions across the duration of the entire timing specification. If countMax is present, this element indicates the lower bound of the allowed range of count values. Repetitions may be limited by end time or total occurrences. If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.
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| countMax | S Σ | 0..1 | positiveInt | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.repeat.countMax Maximum number of times to repeat DefinitionIf present, indicates that the count is a range - so to perform the action between [count] and [countMax] times. 32 bit number; for values larger than this, use decimal
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| duration | S Σ | 0..1 | decimal | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.repeat.duration How long when it happens DefinitionHow long this thing happens for when it happens. If durationMax is present, this element indicates the lower bound of the allowed range of the duration. Some activities are not instantaneous and need to be maintained for a period of time. For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).
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| durationMax | S Σ | 0..1 | decimal | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.repeat.durationMax How long when it happens (Max) DefinitionIf present, indicates that the duration is a range - so to perform the action between [duration] and [durationMax] time length. Some activities are not instantaneous and need to be maintained for a period of time. For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).
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| durationUnit | S Σ | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.repeat.durationUnit s | min | h | d | wk | mo | a - unit of time (UCUM) DefinitionThe units of time for the duration, in UCUM units. Note that FHIR strings SHALL NOT exceed 1MB in size A unit of time (units from UCUM).
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| frequency | S Σ | 0..1 | positiveInt | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.repeat.frequency Event occurs frequency times per period DefinitionThe number of times to repeat the action within the specified period. If frequencyMax is present, this element indicates the lower bound of the allowed range of the frequency. 32 bit number; for values larger than this, use decimal If no frequency is stated, the assumption is that the event occurs once per period, but systems SHOULD always be specific about this
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| frequencyMax | S Σ | 0..1 | positiveInt | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.repeat.frequencyMax Event occurs up to frequencyMax times per period DefinitionIf present, indicates that the frequency is a range - so to repeat between [frequency] and [frequencyMax] times within the period or period range. 32 bit number; for values larger than this, use decimal
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| period | S Σ | 0..1 | decimal | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.repeat.period Event occurs frequency times per period DefinitionIndicates the duration of time over which repetitions are to occur; e.g. to express "3 times per day", 3 would be the frequency and "1 day" would be the period. If periodMax is present, this element indicates the lower bound of the allowed range of the period length. Do not use an IEEE type floating point type, instead use something that works like a true decimal, with inbuilt precision (e.g. Java BigInteger)
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| periodMax | S Σ | 0..1 | decimal | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.repeat.periodMax Upper limit of period (3-4 hours) DefinitionIf present, indicates that the period is a range from [period] to [periodMax], allowing expressing concepts such as "do this once every 3-5 days. Do not use an IEEE type floating point type, instead use something that works like a true decimal, with inbuilt precision (e.g. Java BigInteger)
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| periodUnit | S Σ | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.repeat.periodUnit s | min | h | d | wk | mo | a - unit of time (UCUM) DefinitionThe units of time for the period in UCUM units. Note that FHIR strings SHALL NOT exceed 1MB in size A unit of time (units from UCUM).
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| dayOfWeek | Σ | 0..* | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.repeat.dayOfWeek mon | tue | wed | thu | fri | sat | sun DefinitionIf one or more days of week is provided, then the action happens only on the specified day(s). If no days are specified, the action is assumed to happen every day as otherwise specified. The elements frequency and period cannot be used as well as dayOfWeek.
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| timeOfDay | Σ | 0..* | time | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.repeat.timeOfDay Time of day for action DefinitionSpecified time of day for action to take place. When time of day is specified, it is inferred that the action happens every day (as filtered by dayofWeek) on the specified times. The elements when, frequency and period cannot be used as well as timeOfDay.
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| when | Σ | 0..* | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.repeat.when Code for time period of occurrence DefinitionAn approximate time period during the day, potentially linked to an event of daily living that indicates when the action should occur. Timings are frequently determined by occurrences such as waking, eating and sleep. When more than one event is listed, the event is tied to the union of the specified events. Real world event relating to the schedule.
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| offset | Σ | 0..1 | unsignedInt | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.repeat.offset Minutes from event (before or after) DefinitionThe number of minutes from the event. If the event code does not indicate whether the minutes is before or after the event, then the offset is assumed to be after the event. 32 bit number; for values larger than this, use decimal
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| code | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.timing.code BID | TID | QID | AM | PM | QD | QOD | + DefinitionA code for the timing schedule (or just text in code.text). Some codes such as BID are ubiquitous, but many institutions define their own additional codes. If a code is provided, the code is understood to be a complete statement of whatever is specified in the structured timing data, and either the code or the data may be used to interpret the Timing, with the exception that .repeat.bounds still applies over the code (and is not contained in the code). BID etc. are defined as 'at institutionally specified times'. For example, an institution may choose that BID is "always at 7am and 6pm". If it is inappropriate for this choice to be made, the code BID should not be used. Instead, a distinct organization-specific code should be used in place of the HL7-defined BID code and/or a structured representation should be used (in this case, specifying the two event times). Code for a known / defined timing pattern.
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| asNeeded[x] | S Σ | 0..1 | Element idMedicationRequest.dosageInstruction.asNeeded[x] Take "as needed" (for x) DefinitionIndicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept). Conformance Rule: This is ONLY populated when the medication is prescribed on an as needed (i.e. PRN) basis. Conformance Rule: When this is specified, it is not acceptable to express the quantity exclusively as a duration/DAYS_SUPPLY. The DOSAGE_QUANTITY must be provided. Conformance Rule: The CodeableConcept should not be used at this time. If it is present, treat it as though the boolean value is set to true. Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed". A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
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| asNeededBoolean | boolean | There are no (further) constraints on this element Data type | ||
| asNeededCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||
| site | S Σ | 0..1 | CodeableConceptBinding | Element idMedicationRequest.dosageInstruction.site Body site to administer to DefinitionBody site to administer to. A coded specification of the anatomic site where the medication first enters the body. This follows the same conformance rule as PrescribeIT: Conformance Rule: When providing a structured SIG, this should be populated when appropriate. If not structured, this should be part of the SIG (RENDERED_DOSAGE_INSTRUCTION) If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both. A coded concept describing the site location the medicine enters into or onto the body.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.site.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.site.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| coding | S Σ | 0..1 | Coding | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.site.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for alternative encodings within a code system, and translations to other code systems. Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.site.coding.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.site.coding.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| system | S Σ | 1..1 | uri | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.site.coding.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 reference to some definition that establishes the system clearly and unambiguously.
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| version | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.site.coding.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 | S Σ | 1..1 | code | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.site.coding.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 SHALL NOT exceed 1MB in size
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| display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.site.coding.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 SHALL NOT exceed 1MB in size
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| userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.site.coding.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - e.g. 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 | S Σ | 1..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.site.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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| route | S Σ | 0..1 | CodeableConceptBinding | Element idMedicationRequest.dosageInstruction.route How drug should enter body DefinitionHow drug should enter body. A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body. Conformance Rule: Coding should be populated if a code is available. However, text is always required. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| coding | S Σ | 0..* | Coding | Element idMedicationRequest.dosageInstruction.route.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for alternative encodings within a code system, and translations to other code systems. 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 $this(Type) Constraints
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| routeofAdministrationV3PrescribeIT | Σ | 0..* | CodingBinding | Element idMedicationRequest.dosageInstruction.route.coding:routeofAdministrationV3PrescribeIT Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for alternative encodings within a code system, and translations to other code systems. 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. https://fhir.infoway-inforoute.ca/ValueSet/prescriptionrouteofadministration (required) Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeofAdministrationV3PrescribeIT.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeofAdministrationV3PrescribeIT.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| system | S Σ | 0..1 | uri | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeofAdministrationV3PrescribeIT.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 reference to some definition that establishes the system clearly and unambiguously.
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| version | S Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeofAdministrationV3PrescribeIT.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 | S Σ | 0..1 | code | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeofAdministrationV3PrescribeIT.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 SHALL NOT exceed 1MB in size
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| display | S Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeofAdministrationV3PrescribeIT.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 SHALL NOT exceed 1MB in size
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| userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeofAdministrationV3PrescribeIT.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - e.g. 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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| routeSCTCA | S Σ | 0..* | CodingBinding | Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for alternative encodings within a code system, and translations to other code systems. 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. https://fhir.infoway-inforoute.ca/ValueSet/routeofadministration (required) Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| system | S Σ | 0..1 | uri | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.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 reference to some definition that establishes the system clearly and unambiguously.
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| version | S Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.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 | S Σ | 0..1 | code | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.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 SHALL NOT exceed 1MB in size
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| display | S Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.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 SHALL NOT exceed 1MB in size
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.display.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.display.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| translation | I | 0..1 | Extension(Complex) | Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.display.extension:translation Language Translation (Localization) Alternate namesextensions, user content DefinitionLanguage translation from base language of resource to another language. 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(Complex) Extension URLhttp://hl7.org/fhir/StructureDefinition/translation Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.display.extension:translation.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 2..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.display.extension:translation.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| lang | I | 1..1 | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.display.extension:translation.extension:lang Code for Language Alternate namesextensions, user content DefinitionCode for Language. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.display.extension:translation.extension:lang.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..0 | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.display.extension:translation.extension:lang.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| url | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.display.extension:translation.extension:lang.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. lang
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| value[x] | 1..1 | Binding | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.display.extension:translation.extension:lang.value[x] Value of extension DefinitionValue of extension - must be one of a constrained set of the data types (see Extensibility for a list). A human language.
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| valueCode | code | There are no (further) constraints on this element Data type | ||
| content | I | 1..1 | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.display.extension:translation.extension:content Content in other Language Alternate namesextensions, user content DefinitionContent in other Language. The type (string or markdown) must match the context in which it is used.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.display.extension:translation.extension:content.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..0 | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.display.extension:translation.extension:content.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| url | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.display.extension:translation.extension:content.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. content
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| value[x] | 1..1 | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.display.extension:translation.extension:content.value[x] Value of extension DefinitionValue of extension - must be one of a constrained set of the data types (see Extensibility for a list).
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| valueString | string | There are no (further) constraints on this element Data type | ||
| valueMarkdown | markdown | There are no (further) constraints on this element Data type | ||
| url | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.display.extension:translation.url identifies the meaning of the extension DefinitionSource of the definition for the extension code - a logical name or a URL. The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. http://hl7.org/fhir/StructureDefinition/translation
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| value[x] | 0..0 | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.display.extension:translation.value[x] Value of extension DefinitionValue of extension - must be one of a constrained set of the data types (see Extensibility for a list).
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| value | 0..1 | System.String | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.display.value Primitive value for string DefinitionPrimitive value for string System.String Maximum string length1048576 | |
| userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeSCTCA.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - e.g. 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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| routeEMRCode | S Σ | 0..* | Coding | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeEMRCode Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for alternative encodings within a code system, and translations to other code systems. Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeEMRCode.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeEMRCode.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| system | S Σ | 0..1 | uri | Element idMedicationRequest.dosageInstruction.route.coding:routeEMRCode.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. example: urn:telus:emr:ma:*siteIdentifer:medication-route 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 reference to some definition that establishes the system clearly and unambiguously.
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| version | S Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeEMRCode.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 | S Σ | 0..1 | code | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeEMRCode.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 SHALL NOT exceed 1MB in size
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| display | S Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeEMRCode.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 SHALL NOT exceed 1MB in size
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| userSelected | S Σ | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.coding:routeEMRCode.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - e.g. 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 | S Σ | 1..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.route.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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| method | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.method Technique for administering medication DefinitionTechnique for administering medication. A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV. Terminologies used often pre-coordinate this term with the route and or form of administration. A coded concept describing the technique by which the medicine is administered.
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| doseAndRate | S Σ | 0..* | Element | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.doseAndRate Amount of medication administered DefinitionThe amount of medication administered.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.doseAndRate.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.doseAndRate.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| type | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.doseAndRate.type The kind of dose or rate specified DefinitionThe kind of dose or rate specified, for example, ordered or calculated. If the type is not populated, assume to be "ordered". Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The kind of dose or rate specified.
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| dose[x] | S Σ | 0..1 | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.doseAndRate.dose[x] Amount of medication per dose DefinitionAmount of medication per dose. The amount of therapeutic or other substance given at one administration event. Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.
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| doseRange | Range | There are no (further) constraints on this element Data type | ||
| doseQuantity | SimpleQuantity | There are no (further) constraints on this element Data type | ||
| rate[x] | Σ | 0..1 | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.doseAndRate.rate[x] Amount of medication per unit of time DefinitionAmount of medication per unit of time. Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period. It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate. It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammer where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.
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| rateRatio | Ratio | There are no (further) constraints on this element Data type | ||
| rateRange | Range | There are no (further) constraints on this element Data type | ||
| rateQuantity | SimpleQuantity | There are no (further) constraints on this element Data type | ||
| maxDosePerPeriod | S Σ I | 0..1 | Ratio | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerPeriod Upper limit on medication per unit of time DefinitionUpper limit on medication per unit of time. The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours. This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerPeriod.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerPeriod.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| numerator | S Σ I | 0..1 | Quantity | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerPeriod.numerator Numerator value DefinitionThe value of the numerator. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerPeriod.numerator.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerPeriod.numerator.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| value | S Σ | 0..1 | decimal | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerPeriod.numerator.value Numerical value (with implicit precision) DefinitionThe value of the measured amount. The value includes an implicit precision in the presentation of the value. Precision is handled implicitly in almost all cases of measurement. The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).
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| comparator | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerPeriod.numerator.comparator < | <= | >= | > - how to understand the value DefinitionHow the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value. Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. Note that FHIR strings SHALL NOT exceed 1MB in size If there is no comparator, then there is no modification of the value How the Quantity should be understood and represented.
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| unit | S Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerPeriod.numerator.unit Unit representation DefinitionA human-readable form of the unit. There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms. Note that FHIR strings SHALL NOT exceed 1MB in size
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| system | S Σ I | 0..1 | uri | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerPeriod.numerator.system System that defines coded unit form DefinitionThe identification of the system that provides the coded form of the unit. Need to know the system that defines the coded form of the unit. see http://en.wikipedia.org/wiki/Uniform_resource_identifier
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| code | S Σ | 0..1 | codeBinding | Element idMedicationRequest.dosageInstruction.maxDosePerPeriod.numerator.code Coded form of the unit DefinitionA computer processable form of the unit in some unit representation system. Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system. https://fhir.infoway-inforoute.ca/ValueSet/prescriptiondosequantityunit (preferred) Constraints
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| denominator | S Σ I | 0..1 | Quantity | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerPeriod.denominator Denominator value DefinitionThe value of the denominator. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerPeriod.denominator.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerPeriod.denominator.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| value | S Σ | 0..1 | decimal | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerPeriod.denominator.value Numerical value (with implicit precision) DefinitionThe value of the measured amount. The value includes an implicit precision in the presentation of the value. Precision is handled implicitly in almost all cases of measurement. The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).
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| comparator | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerPeriod.denominator.comparator < | <= | >= | > - how to understand the value DefinitionHow the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value. Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. Note that FHIR strings SHALL NOT exceed 1MB in size If there is no comparator, then there is no modification of the value How the Quantity should be understood and represented.
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| unit | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerPeriod.denominator.unit Unit representation DefinitionA human-readable form of the unit. There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms. Note that FHIR strings SHALL NOT exceed 1MB in size
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| system | S Σ I | 0..1 | uriFixed Value | Element idMedicationRequest.dosageInstruction.maxDosePerPeriod.denominator.system System that defines coded unit form DefinitionThe identification of the system that provides the coded form of the unit. Need to know the system that defines the coded form of the unit. see http://en.wikipedia.org/wiki/Uniform_resource_identifier
http://unitsofmeasure.org
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| code | S Σ | 0..1 | code | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerPeriod.denominator.code Coded form of the unit DefinitionA computer processable form of the unit in some unit representation system. Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.
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| maxDosePerAdministration | Σ I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerAdministration Upper limit on medication per administration DefinitionUpper limit on medication per administration. The maximum total quantity of a therapeutic substance that may be administered to a subject per administration. This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.
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| maxDosePerLifetime | Σ I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerLifetime Upper limit on medication per lifetime of the patient DefinitionUpper limit on medication per lifetime of the patient. The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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| dispenseRequest | S | 0..1 | BackboneElement | Element idMedicationRequest.dispenseRequest Medication supply authorization DefinitionIndicates the specific details for the dispense or medication supply part of a medication request (also known as a Medication Prescription or Medication Order). Note that this information is not always sent with the order. There may be in some settings (e.g. hospitals) institutional or system support for completing the dispense details in the pharmacy department. Usage Rule: This will be mandatory for internally created prescriptions (source system is the reported source). This is not expected for external prescriptions that have been manually entered into the EMR by the physician; by exmaple, from a prescription bottle or a discharge summary.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| TotalQuantity | I | 0..1 | Extension(Complex) | Element idMedicationRequest.dispenseRequest.extension:TotalQuantity Optional Extensions Element Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Alignment Note: PrescribeIT - MedicationOrder.dispenseRequest.extension:totalPrescribedQuantity Conformance Rule: The Total Prescribed Quantity is not mandatory but must be supplied if the value is entered by the user or can be calculated by the system. Extension(Complex) Extension URLhttps://example.org/fhir/StructureDefinition/TotalQuantity Constraints
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| DispenseTrial | I | 0..1 | Extension(Complex) | Element idMedicationRequest.dispenseRequest.extension:DispenseTrial Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Alignment: PrescribeIT: Maps to extension MedicationOrder.dispenseRequest.extension:trialEligibility Conformance Rule: If eligible for trial, this must be set to 'true' and presented to the Pharmacist. Conformance Rule: This is ONLY populated if it is for trial, else it is assumed not to be eligble. Note: Prescribers may include this information in notes. Extension(Complex) Extension URLhttps://example.org/fhir/StructureDefinition/DispenseTrial Constraints
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| initialFill | S | 0..1 | BackboneElement | Element idMedicationRequest.dispenseRequest.initialFill First fill details DefinitionIndicates the quantity or duration for the first dispense of the medication. Mapping: PrescribeIT first fill instructions - JN ******** need to add an extension for "date", as per PrescribeIT Conformance Rule: If entry of the first fill information is supported within the EMR as discrete information, this must be populated. For the first fill instructions to be meaningful, the first fill quantity or the first fill expected supply duration must be provided. Both can be provided if available but at minimum one of these must be provided. If populating this element, either the quantity or the duration must be included.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| quantity | S I | 0..1 | SimpleQuantityBinding | Element idMedicationRequest.dispenseRequest.initialFill.quantity First fill quantity DefinitionThe amount or quantity to provide as part of the first dispense. PrescribeIT mapping: The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator. https://fhir.infoway-inforoute.ca/ValueSet/prescribedquantityunit (preferred) Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.quantity.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.quantity.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| value | S Σ | 1..1 | decimal | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.quantity.value Numerical value (with implicit precision) DefinitionThe value of the measured amount. The value includes an implicit precision in the presentation of the value. Precision is handled implicitly in almost all cases of measurement. The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).
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| comparator | Σ ?! | 0..0 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.quantity.comparator < | <= | >= | > - how to understand the value DefinitionNot allowed to be used in this context Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. Note that FHIR strings SHALL NOT exceed 1MB in size If there is no comparator, then there is no modification of the value How the Quantity should be understood and represented.
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| unit | S Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.quantity.unit Unit representation DefinitionA human-readable form of the unit. There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms. Note that FHIR strings SHALL NOT exceed 1MB in size
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| system | S Σ I | 0..1 | uri | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.quantity.system System that defines coded unit form DefinitionThe identification of the system that provides the coded form of the unit. Need to know the system that defines the coded form of the unit. see http://en.wikipedia.org/wiki/Uniform_resource_identifier
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| code | S Σ | 0..1 | code | Element idMedicationRequest.dispenseRequest.initialFill.quantity.code Coded form of the unit DefinitionA computer processable form of the unit in some unit representation system. Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. Conformance Rule: A Code must be supplied if one is available from the PrescribedQuantityUnit subset. If the user picks a prescribed quantity unit that does not have a code in the PrescribedQuantityUnit subset, only then can unit be supplied without a code. If a receiving system receives a code that it doesn't recognize, the system must just display the unit. The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.
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| duration | S I | 0..1 | Duration | Element idMedicationRequest.dispenseRequest.initialFill.duration First fill duration DefinitionThe length of time that the first dispense is expected to last. Conformance Rule: The duration must be expressed as a ‘day(s)’ value and must be coded in the following way; code must be 'd' and system must be 'http://unitsofmeasure.org'. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.duration.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| value | S Σ | 1..1 | decimal | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.duration.value Numerical value (with implicit precision) DefinitionThe value of the measured amount. The value includes an implicit precision in the presentation of the value. Precision is handled implicitly in almost all cases of measurement. The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).
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| comparator | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.duration.comparator < | <= | >= | > - how to understand the value DefinitionHow the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value. Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. Note that FHIR strings SHALL NOT exceed 1MB in size If there is no comparator, then there is no modification of the value How the Quantity should be understood and represented.
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| unit | S Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.duration.unit Unit representation DefinitionA human-readable form of the unit. There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms. Note that FHIR strings SHALL NOT exceed 1MB in size
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| system | S Σ I | 0..1 | uriFixed Value | Element idMedicationRequest.dispenseRequest.initialFill.duration.system System that defines coded unit form DefinitionThe identification of the system that provides the coded form of the unit. Need to know the system that defines the coded form of the unit. see http://en.wikipedia.org/wiki/Uniform_resource_identifier
http://unitsofmeasure.org
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| code | S Σ | 0..1 | code | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.duration.code Coded form of the unit DefinitionA computer processable form of the unit in some unit representation system. Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.
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| dispenseInterval | S I | 0..1 | Duration | Element idMedicationRequest.dispenseRequest.dispenseInterval Minimum period of time between dispenses DefinitionThe minimum period of time that must occur between dispenses of the medication. Mapping: PrescribeIT extension Conformance Rule: Only days are currently support as a measurement of dispenseInterval. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.dispenseInterval.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.dispenseInterval.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| value | S Σ | 0..1 | decimal | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.dispenseInterval.value Numerical value (with implicit precision) DefinitionThe value of the measured amount. The value includes an implicit precision in the presentation of the value. Precision is handled implicitly in almost all cases of measurement. The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).
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| comparator | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.dispenseInterval.comparator < | <= | >= | > - how to understand the value DefinitionHow the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value. Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. Note that FHIR strings SHALL NOT exceed 1MB in size If there is no comparator, then there is no modification of the value How the Quantity should be understood and represented.
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| unit | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.dispenseInterval.unit Unit representation DefinitionA human-readable form of the unit. There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms. Note that FHIR strings SHALL NOT exceed 1MB in size
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| system | S Σ I | 0..1 | uri | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.dispenseInterval.system System that defines coded unit form DefinitionThe identification of the system that provides the coded form of the unit. Need to know the system that defines the coded form of the unit. see http://en.wikipedia.org/wiki/Uniform_resource_identifier
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| code | S Σ | 0..1 | code | Element idMedicationRequest.dispenseRequest.dispenseInterval.code Coded form of the unit DefinitionA computer processable form of the unit in some unit representation system. Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. Conformance Rule: Only days are currently support as a measurement of dispenseInterval. The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.
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| validityPeriod | S I | 0..1 | Period | Element idMedicationRequest.dispenseRequest.validityPeriod Time period supply is authorized for DefinitionThis indicates the validity period of a prescription (stale dating the Prescription). Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription. Usage Rule: If status = on hold//stopped - the date it was put on hold conveyed as the end date. Start Date of Med + Hold/End Date If status = intended - convey future estimated start date If status = not taken - single date - ??? confirm this woudl be a date/time Example: Patient on med from Jan 1-Jan31 - put on hold on Jan 31. Patient never started the med but was formally discontinued on Feb 15th. Option 1** On Hold status - effective Jan 1-Jan 31. Second Med Statement - Feb 15th - Stopped. (single date conveys that the patient was NOT on the drug during the period statement- action by Prescriber) Option 2 - 3 med statements? First: Complete: Jan 1-Jan 31, second:On Hold Jan 31, single date Third: Stopped Feb 15, single date Conformance Rule: Active, Intended, On-Hold will have an effective date that reflects a period of time. ??? Example: For an active and intended med statement, this will be the same as the Prescription Period. For On-Hold, this will reflect the start date of the Prescription and the Hold date will be the end date. ***NOTE; QUEBEC HAS A NOTION OF A QC VALIDITY PERIOD, EXPRESSED AS A PERIOD OF TIME (EG 30 DAYS), BUT THIS IS NOT THE TOTAL DAYS SUPPLY (MEETING 08/31) Mappings for Effective Date: Core-CA - supported EMRAPI: effectiveDate PSS: Available but not supported in the API. Derived from dose, frequency and quantity. End date Is calculated if discrete fields dose, frequency, duration OR dose, frequency and quantity if captured discretely. CPP->Rx->More details->Start Date beside label instructions MA: Patient--> Meds --> new --> start date, No API support MS: start date It reflects the prescribers' perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.validityPeriod.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.validityPeriod.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| start | S Σ I | 0..1 | dateTime | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.validityPeriod.start Starting time with inclusive boundary DefinitionThe start of the period. The boundary is inclusive. If the low element is missing, the meaning is that the low boundary is not known.
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| end | S Σ I | 0..1 | dateTime | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.validityPeriod.end End time with inclusive boundary, if not ongoing DefinitionThe end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time. The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an 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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| numberOfRepeatsAllowed | S | 0..1 | unsignedInt | Element idMedicationRequest.dispenseRequest.numberOfRepeatsAllowed Number of refills authorized DefinitionAn integer indicating the number of times, in addition to the original dispense, (aka refills or repeats) that the patient can receive the prescribed medication. Usage Notes: This integer does not include the original order dispense. This means that if an order indicates dispense 30 tablets plus "3 repeats", then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets. A prescriber may explicitly say that zero refills are permitted after the initial dispense. Conformance Rule: This must be populated when the number of repeats is 1 or more. As this field only allows a positive integer, this is not populated if there are no refills allowed. Guidance: For narcotics, if this is incorrectly populated, the PMS could choose not to reject the message; rather they can adjust for the dispense.If displaying "number of authorized fills", add 1 to this number.
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| quantity | S I | 0..1 | SimpleQuantity | Element idMedicationRequest.dispenseRequest.quantity Amount of medication to supply per dispense DefinitionThe amount that is to be dispensed for one fill. Alignment Mapping: PrescribeIT - total quantity The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.quantity.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.quantity.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| value | S Σ | 0..1 | decimal | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.quantity.value Numerical value (with implicit precision) DefinitionThe value of the measured amount. The value includes an implicit precision in the presentation of the value. Precision is handled implicitly in almost all cases of measurement. The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).
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| comparator | Σ ?! | 0..0 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.quantity.comparator < | <= | >= | > - how to understand the value DefinitionNot allowed to be used in this context Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. Note that FHIR strings SHALL NOT exceed 1MB in size If there is no comparator, then there is no modification of the value How the Quantity should be understood and represented.
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| unit | S Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.quantity.unit Unit representation DefinitionA human-readable form of the unit. There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms. Note that FHIR strings SHALL NOT exceed 1MB in size
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| system | S Σ I | 0..1 | uri | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.quantity.system System that defines coded unit form DefinitionThe identification of the system that provides the coded form of the unit. Need to know the system that defines the coded form of the unit. see http://en.wikipedia.org/wiki/Uniform_resource_identifier
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| code | S Σ | 0..1 | code | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.quantity.code Coded form of the unit DefinitionA computer processable form of the unit in some unit representation system. Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.
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| expectedSupplyDuration | S I | 0..1 | Duration | Element idMedicationRequest.dispenseRequest.expectedSupplyDuration Number of days supply per dispense DefinitionIdentifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last. Alignment PrescribeIT = ExpectedSupplyDuration In some situations, this attribute may be used instead of quantity to identify the amount supplied by how long it is expected to last, rather than the physical quantity issued, e.g. 90 days supply of medication (based on an ordered dosage). When possible, it is always better to specify quantity, as this tends to be more precise. expectedSupplyDuration will always be an estimate that can be influenced by external factors.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.expectedSupplyDuration.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.expectedSupplyDuration.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| value | S Σ | 0..1 | decimal | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.expectedSupplyDuration.value Numerical value (with implicit precision) DefinitionThe value of the measured amount. The value includes an implicit precision in the presentation of the value. Precision is handled implicitly in almost all cases of measurement. The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).
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| comparator | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.expectedSupplyDuration.comparator < | <= | >= | > - how to understand the value DefinitionHow the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value. Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. Note that FHIR strings SHALL NOT exceed 1MB in size If there is no comparator, then there is no modification of the value How the Quantity should be understood and represented.
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| unit | S Σ | 0..1 | stringFixed Value | Element idMedicationRequest.dispenseRequest.expectedSupplyDuration.unit Unit representation DefinitionA human-readable form of the unit. There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms. Note that FHIR strings SHALL NOT exceed 1MB in size
days
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| system | S Σ I | 1..1 | uriFixed Value | Element idMedicationRequest.dispenseRequest.expectedSupplyDuration.system System that defines coded unit form DefinitionThe identification of the system that provides the coded form of the unit. Need to know the system that defines the coded form of the unit. see http://en.wikipedia.org/wiki/Uniform_resource_identifier
http://unitsofmeasure.org
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| code | S Σ | 0..1 | codeFixed Value | Element idMedicationRequest.dispenseRequest.expectedSupplyDuration.code Coded form of the unit DefinitionA computer processable form of the unit in some unit representation system. Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.
d
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| performer | S I | 0..1 | Reference(Organization) | Element idMedicationRequest.dispenseRequest.performer Intended dispenser DefinitionIndicates the intended dispensing Organization specified by the prescriber. Usage Note: The pharmacy should be included when known; ***AB - create org resource with name (1..1) fax number, address, telephone 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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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.performer.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.performer.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| reference | Σ I | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.performer.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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| type | Σ | 0..1 | uriBinding | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.performer.type Type the reference refers to (e.g. "Patient") DefinitionThe expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Aa resource (or, for logical models, the URI of the logical model).
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| identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.performer.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents 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. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
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| display | S Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.performer.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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| substitution | S | 0..1 | BackboneElement | Element idMedicationRequest.substitution Any restrictions on medication substitution DefinitionIndicates whether or not substitution can or should be part of the dispense. In some cases, substitution must happen, in other cases substitution must not happen. This block explains the prescriber's intent. If nothing is specified substitution may be done. Conformance Rule: This MUST be included when the prescriber specifies "no substitution" (boolean = false) Conformance Rule: must be specified when available as a discrete data element in the EMR MS: support PSS: no sub flag is present; there is no reason MA: supported CHR: no sub flag is present Note: This is not supported in PrescribeIT as a discrete data element; it is included in Pharmacist Instructions
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.substitution.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.substitution.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.substitution.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| allowed[x] | S | 1..1 | There are no (further) constraints on this element Element idMedicationRequest.substitution.allowed[x] Whether substitution is allowed or not DefinitionTrue if the prescriber allows a different drug to be dispensed from what was prescribed. This element is labeled as a modifier because whether substitution is allow or not, it cannot be ignored. Identifies the type of substitution allowed.
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| allowedBoolean | boolean | There are no (further) constraints on this element Data type | ||
| allowedCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||
| reason | S | 0..1 | CodeableConcept | Element idMedicationRequest.substitution.reason Why should (not) substitution be made DefinitionIndicates the reason for the substitution, or why substitution must or must not be performed. Conformance Rule: If available this must be sent. A local code may be used or if no code is available then text may be sent
MS: Reasons supported are: Allergy, Intolerence, ExactDosage, CT-ContininingTherapy, Brand Names not good enough, etc
PSS: no reason
MA: Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.substitution.reason.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.substitution.reason.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| coding | S Σ | 0..* | Coding | There are no (further) constraints on this element Element idMedicationRequest.substitution.reason.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for alternative encodings within a code system, and translations to other code systems. Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.substitution.reason.coding.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.substitution.reason.coding.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| system | S Σ | 0..1 | uri | There are no (further) constraints on this element Element idMedicationRequest.substitution.reason.coding.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 reference to some definition that establishes the system clearly and unambiguously.
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| version | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.substitution.reason.coding.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 | S Σ | 0..1 | code | There are no (further) constraints on this element Element idMedicationRequest.substitution.reason.coding.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 SHALL NOT exceed 1MB in size
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| display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.substitution.reason.coding.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 SHALL NOT exceed 1MB in size
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| userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationRequest.substitution.reason.coding.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - e.g. 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 | S Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.substitution.reason.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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| priorPrescription | S I | 0..1 | Reference(MedicationRequest) | Element idMedicationRequest.priorPrescription An order/prescription that is being replaced DefinitionA link to a resource representing an earlier order related order or prescription. Mapping: This is supported by OMD in the CDS specification 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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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.priorPrescription.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.priorPrescription.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| reference | S Σ I | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.priorPrescription.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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| type | Σ | 0..1 | uriBinding | There are no (further) constraints on this element Element idMedicationRequest.priorPrescription.type Type the reference refers to (e.g. "Patient") DefinitionThe expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Aa resource (or, for logical models, the URI of the logical model).
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| identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationRequest.priorPrescription.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents 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. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
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| display | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.priorPrescription.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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| detectedIssue | S I | 0..* | Reference(DetectedIssue) | Element idMedicationRequest.detectedIssue Clinical Issue with action Alternate namesContraindication, Drug Utilization Review (DUR), Alert DefinitionIndicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etc. Conformance Rule: Detected Issue will be used to convey managed drug interactions. If available, this must be sent. PrescribeIT mapping - extension, detected issues This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.detectedIssue.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.detectedIssue.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| reference | S Σ I | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.detectedIssue.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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| type | Σ | 0..1 | uriBinding | There are no (further) constraints on this element Element idMedicationRequest.detectedIssue.type Type the reference refers to (e.g. "Patient") DefinitionThe expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Aa resource (or, for logical models, the URI of the logical model).
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| identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationRequest.detectedIssue.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents 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. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
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| display | S Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.detectedIssue.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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| eventHistory | I | 0..* | Reference(Provenance) | There are no (further) constraints on this element Element idMedicationRequest.eventHistory A list of events of interest in the lifecycle DefinitionLinks to Provenance records for past versions of this resource or fulfilling request or event resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resource. This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).
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Usage note
extension.DispenserInstructions - For EMR's that have this information available this extension provides any additional instructions for the pharmacist about the prescription.
extension.NoRenewalsFlag - Reflects the EMR instruction to the pharmacist that the prescription should not be renewed.
extension.StatusChanged - This is a pre-adoption of an R5 data element, and reflects the dateTime that the status was changed https://build.fhir.org/medicationrequest-definitions.html#MedicationRequest.statusChanged
extension.RenderedDosageInstruction - Complete rendered dosage instructions for a medication as displayed on the EMR prescription.
reported - In EMR's where the "external" prescription indicator is selected this will be considered as reported and value = true.
medication - Non-drug prescriptions such as prescriptions for devices will be provided as a medication codeableConcept. Medications will be provided as a Medication Reference.
supportingInformation For EMR's that reference the latest observations in the prescribing moduele. This will provide references to the supporting observations for weight, height, creatinine, eGFR.
medication In the case where the prescriber wants to send an Indication for Use that is not included in the value set the prescriber must be able to send a text value without a code.
reasonCode This could be a diagnosis code. If a full condition record exists it will be provided via reasonCode.
dosageInstruction.extension.effectivePeriod - The timeline or period for a specific dosage instruction applies to prescriptions for medications with tapering dose. In some cases, it could be same as a prescription.
dosageInstruction.sequence - This indicates the relationship between instruction line. If the sequence number of multiple dosages is the same, then it is implied that the instructions are to be treated as concurrent. This carries the meaning of AND. If the sequence number is different, then the Dosages are intended to be sequential. and carries a meaning of "THEN"..
dosageInstruction.patientInstruction - When the dosage is not populated in the discrete template in the EMR then text dosage instructions are provided as patientInstruction.
dispenseRequest.extension.TotalQuantity - It represents the total quantity prescribed
dispenseRequest.extension.DispenseTrial - Where an EMR has the ability to identify that the prescription is a trial supply.
Bundle
Example
{
"resource": {
"resourceType": "MedicationRequest",
"id": "ma-labtestsk1-MedicationRequest-2302754",
"meta": {
"lastUpdated": "2024-01-10T12:28:39+00:00",
"source": "urn:telus:emr:ma:labtestsk1",
"security": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-Confidentiality",
"code": "N",
"display": "normal"
}
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"> "Text summary for human interpretation" </div>"
},
"extension": [
{
"url": "https://simplifier.net/telusdwgenericemrextract/rendereddosageinstruction",
"valueString": "AURO-CIPROFLOXACIN 500 MG TAB 35.0 Tablet(s) Once daily 10 Day"
},
{
"url": "https://simplifier.net/telusdwgenericemrextract/effectiveperiod",
"valuePeriod": {
"start": "2023-11-15T00:00:00+00:00",
"end": "2023-12-05T00:00:00+00:00"
}
}
],
"identifier": [
{
"system": "urn:telus:emr:ma:labtestsk1:MedicationRequest",
"value": "2302754"
}
],
"status": "completed",
"intent": "order",
"category": [
{
"coding": [
{
"system": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptiontype",
"code": "medication",
"display": "Medication",
"userSelected": true
}
],
"text": "Simple Rx"
}
],
"reportedBoolean": false,
"medicationReference": {
"reference": "Medication/ma-labtestsk1-Medication-DIN-02381923",
"type": "Medication",
"display": "AURO-CIPROFLOXACIN 500 MG TAB"
},
"subject": {
"reference": "Patient/ma-labtestsk1-Patient-17938",
"type": "Patient"
},
"authoredOn": "2023-10-12T03:31:42+00:00",
"requester": {
"reference": "Practitioner/ma-labtestsk1-Practitioner-594",
"type": "Practitioner",
"display": "Evan EVB Blue"
},
"courseOfTherapyType": {
"coding": [
{
"system": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptiontreatmentcategory",
"code": "CHRON",
"display": "Continuous/chronic"
}
],
"text": "Continuous"
},
"dosageInstruction": [
{
"sequence": 0,
"text": "AURO-CIPROFLOXACIN 500 MG TAB 35.0 Tablet(s) Once daily 10 Day",
"timing": {
"repeat": {
"frequency": 1,
"period": 1.0,
"periodUnit": "d"
},
"code": {
"coding": [
{
"system": "http://hl7.org/fhir/v3/GTSAbbreviation",
"code": "QD",
"display": "Once daily"
}
],
"text": "Once daily"
}
},
"asNeededBoolean": false,
"route": {
"coding": [
{
"system": "urn:telus:emr:ma:*:medication-route",
"code": "PO",
"display": "Oral",
"userSelected": true
},
{
"system": "http://snomed.info/sct",
"version": "20220930",
"code": "26643006",
"display": "Oral route",
"_display": {
"extension": [
{
"extension": [
{
"url": "lang",
"valueCode": "fr"
},
{
"url": "content",
"valueString": "voie orale"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/translation"
}
]
},
"userSelected": false
},
{
"system": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionrouteofadministration",
"version": "20190415",
"code": "26643006",
"display": "Oral route",
"userSelected": false
}
],
"text": "Oral"
},
"doseAndRate": [
{
"doseQuantity": {
"value": 35.0,
"unit": "Tablet(s)",
"system": "urn:telus:emr:ma:*:medication-dose-unit",
"code": "TAB"
}
}
]
}
],
"dispenseRequest": {
"extension": [
{
"url": "https://simplifier.net/telusdwgenericemrextract/totalquantity",
"valueQuantity": {
"value": 350.0
}
},
{
"url": "https://simplifier.net/telusdwgenericemrextract/dispensetrial",
"valueBoolean": false
}
],
"initialFill": {
"quantity": {
"value": 350.0,
"unit": "TAB"
},
"duration": {
"value": 0.0
}
},
"dispenseInterval": {
"value": 0.0
},
"validityPeriod": {
"start": "2023-10-11T00:00:00+00:00",
"end": "2024-10-10T00:00:00+00:00"
},
"numberOfRepeatsAllowed": 1,
"quantity": {
"value": 0.0
},
"expectedSupplyDuration": {
"value": 10.0,
"unit": "days",
"system": "http://unitsofmeasure.org",
"code": "d"
}
},
"substitution": {
"allowedBoolean": true
}
},
"fullUrl": "https://telus.com/MedicationRequest/ma-labtestsk1-MedicationRequest-2302754",
"request": {
"method": "PUT",
"url": "MedicationRequest/ma-labtestsk1-MedicationRequest-2302754"
}
}