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This version of the UK Core is a development copy.
This contains BREAKING CHANGES as a result of the C&TA Sprint 7 Review, and STU2 Sequence ballot reconciliation.
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StructureDefinition-UKCore-MedicationAdministration

Canonical_URL	Status	Current_Version	Last_Updated	Description
https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationAdministration	active	2.3.0	2024-07-11	This profile defines the UK constraints and extensions on the International FHIR resource MedicationAdministration.

Profile_Purpose
The purpose of this profile is to describe the event of a patient consuming or otherwise being administered a medication. This may be as simple as swallowing a tablet, or it may be a long-running infusion. Related resources tie this event to the authorizing prescription, and the specific encounter between patient and health care practitioner.

Profile_Purpose

The purpose of this profile is to describe the event of a patient consuming or otherwise being administered a medication. This may be as simple as swallowing a tablet, or it may be a long-running infusion.

Related resources tie this event to the authorizing prescription, and the specific encounter between patient and health care practitioner.

UKCoreMedicationAdministration (MedicationAdministration)	I		MedicationAdministration	There are no (further) constraints on this element Element id MedicationAdministration Short description Administration of medication to a patient Definition Describes the event of a patient consuming or otherwise being administered a medication. This may be as simple as swallowing a tablet or it may be a long running infusion. Related resources tie this event to the authorizing prescription, and the specific encounter between patient and health care practitioner. Data type MedicationAdministration Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim: Entity. Role, or Act workflow: Event rim: SubstanceAdministration
id	Σ	0..1	string	There are no (further) constraints on this element Element id MedicationAdministration.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id MedicationAdministration.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id MedicationAdministration.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Comments Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. 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. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
language		0..1	codeBinding	There are no (further) constraints on this element Element id MedicationAdministration.language Short description Language of the resource content Definition The base language in which the resource is written. Comments Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
text		0..1	Narrative	There are no (further) constraints on this element Element id MedicationAdministration.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource and 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. Comments Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id MedicationAdministration.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. Data type Resource Mappings rim: Entity. Role, or Act rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationAdministration.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. 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. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id MedicationAdministration.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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). Requirements 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. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
identifier	S	0..*	Identifier	Element id MedicationAdministration.identifier Short description Allows the resource to be referenced within / by other resources. Definition Identifiers associated with this Medication Administration 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. Comments This is a business identifier, not a resource identifier. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier workflow: Event.identifier w5: FiveWs.identifier rim: .id
instantiates	Σ	0..*	uri	There are no (further) constraints on this element Element id MedicationAdministration.instantiates Short description Instantiates protocol or definition Definition A protocol, guideline, orderset, or other definition that was adhered to in whole or in part by this event. Comments see http://en.wikipedia.org/wiki/Uniform_resource_identifier Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.instantiates rim: .outboundRelationship[typeCode=DEFN].target[classCode=unspecified]
partOf	Σ I	0..*	Reference(MedicationAdministration \| Procedure)	There are no (further) constraints on this element Element id MedicationAdministration.partOf Short description Part of referenced event Definition A larger event of which this particular event is a component or step. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(MedicationAdministration \| Procedure) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.partOf rim: .outboundRelationship[typeCode=COMP]/target[classCode=SBADM or PROC,moodCode=EVN]
status	S Σ ?!	1..1	codeBinding	Element id MedicationAdministration.status Short description Allows an administration to be marked as in-progress or completed. Definition Will generally be set to show that the administration has been completed. For some long running administrations such as infusions, it is possible for an administration to be started but not completed or it may be paused while some other process is under way. Comments This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. Data type code Binding A set of codes indicating the current status of a MedicationAdministration. MedicationAdministration Status Codes (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.status w5: FiveWs.status v2: RXA-20-Completion Status rim: .statusCode
statusReason		0..*	CodeableConcept	There are no (further) constraints on this element Element id MedicationAdministration.statusReason Short description Reason administration not performed Definition A code indicating why the administration was not performed. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding A set of codes indicating the reason why the MedicationAdministration is negated. SNOMEDCTReasonMedicationNotGivenCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Event.statusReason v2: RXA-9-Administration Notes / RXA-18 Substance/Treatment Refusal Reason rim: .outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="reason not given"].value
category		0..1	CodeableConceptBinding	Element id MedicationAdministration.category Short description Type of medication usage Definition Indicates where the medication is expected to be consumed or administered. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding A coded concept describing where the medication administered is expected to occur. UKCoreMedicationAdministrationCategory (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: .inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication usage"].value
medication[x]	S Σ	1..1	Binding	Element id MedicationAdministration.medication[x] Short description Identifies the medication that was administered. Definition Identifies the medication that was administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications. Comments If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example, if you require form or lot number, then you must reference the Medication resource. Binding Codes identifying substance or product that can be administered. UKCoreMedicationCode (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.code w5: FiveWs.what[x] v2: RXA-5-Administered Code rim: .participation[typeCode=CSM].role[classCode=ADMM]
medicationCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
medicationReference			Reference(Medication)	There are no (further) constraints on this element Data type Reference(Medication)
subject	S Σ I	1..1	Reference(Patient \| Group)	Element id MedicationAdministration.subject Short description Identifies the patient receiving the medication. Definition The person or animal or group receiving the medication. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Patient \| Group) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.subject w5: FiveWs.subject[x] v2: PID-3-Patient ID List rim: .participation[typeCode=SBJ].role[classCode=PAT] w5: FiveWs.subject
context	I	0..1	Reference(Encounter \| EpisodeOfCare)	There are no (further) constraints on this element Element id MedicationAdministration.context Short description Encounter or Episode of Care administered as part of Definition The visit, admission, or other contact between patient and health care provider during which the medication administration was performed. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Encounter \| EpisodeOfCare) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.context w5: FiveWs.context v2: PV1-19-Visit Number rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]
supportingInformation	I	0..*	Reference(Resource)	There are no (further) constraints on this element Element id MedicationAdministration.supportingInformation Short description Additional information to support administration Definition Additional information (for example, patient height and weight) that supports the administration of the medication. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Resource) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.context rim: .outboundRelationship[typeCode=PERT].target[A_SupportingClinicalStatement CMET minimal with many different choices of classCodes(ORG, ENC, PROC, SPLY, SBADM, OBS) and each of the act class codes draws from one or more of the following moodCodes (EVN, DEF, INT PRMS, RQO, PRP, APT, ARQ, GOL)]
effective[x]	S Σ	1..1		Element id MedicationAdministration.effective[x] Short description The start and end time of the administration. Definition A specific date/time or interval of time during which the administration took place (or did not take place, when the 'notGiven' attribute is true). For many administrations, such as swallowing a tablet the use of dateTime is more appropriate. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.occurrence[x] w5: FiveWs.done[x] v2: RXA-3-Date/Time Start of Administration / RXA-4-Date/Time End of Administration rim: .effectiveTime
effectiveDateTime			dateTime	There are no (further) constraints on this element Data type dateTime
effectivePeriod			Period	There are no (further) constraints on this element Data type Period
performer	Σ	0..*	BackboneElement	There are no (further) constraints on this element Element id MedicationAdministration.performer Short description Who performed the medication administration and what they did Definition Indicates who or what performed the medication administration and how they were involved. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.performer w5: FiveWs.actor v2: RXA-10-Administering Provider / PRT-5-Participation Person: PRT-4-Participation='AP' (RXA-10 is deprecated) rim: .participation[typeCode=PRF]
id		0..1	string	There are no (further) constraints on this element Element id MedicationAdministration.performer.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationAdministration.performer.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id MedicationAdministration.performer.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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). Requirements 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. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
function		0..1	CodeableConcept	There are no (further) constraints on this element Element id MedicationAdministration.performer.function Short description Type of performance Definition Distinguishes the type of involvement of the performer in the medication administration. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding A code describing the role an individual played in administering the medication. MedicationAdministration Performer Function Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Event.performer.function rim: participation[typeCode=PRF].functionCode
actor	Σ I	1..1	Reference(Practitioner \| PractitionerRole \| Patient \| RelatedPerson \| Device)	There are no (further) constraints on this element Element id MedicationAdministration.performer.actor Short description Who performed the medication administration Definition Indicates who or what performed the medication administration. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Practitioner \| PractitionerRole \| Patient \| RelatedPerson \| Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.performer.actor rim: .role
reasonCode		0..*	CodeableConcept	There are no (further) constraints on this element Element id MedicationAdministration.reasonCode Short description Reason administration performed Definition A code indicating why the medication was given. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding A set of codes indicating the reason why the MedicationAdministration was made. ReasonMedicationGivenCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Event.reasonCode v2: RXE-27 Give Indication rim: .reasonCode
reasonReference	I	0..*	Reference(Condition \| Observation \| DiagnosticReport)	There are no (further) constraints on this element Element id MedicationAdministration.reasonReference Short description Condition or observation that supports why the medication was administered Definition Condition or observation that supports why the medication was administered. Comments This is a reference to a condition that is the reason for the medication request. If only a code exists, use reasonCode. Data type Reference(Condition \| Observation \| DiagnosticReport) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.reasonReference w5: FiveWs.why[x] rim: .outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="reason for use ASSERTION"].value w3c.prov: no mapping
request	I	0..1	Reference(MedicationRequest)	There are no (further) constraints on this element Element id MedicationAdministration.request Short description Request administration performed against Definition The original request, instruction or authority to perform the administration. Comments This is a reference to the MedicationRequest where the intent is either order or instance-order. It should not reference MedicationRequests where the intent is any other value. Data type Reference(MedicationRequest) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.basedOn v2: ORC-2-Placer Order Number / ORC-3-Filler Order Number rim: InFullfillmentOf->SubstanceAdministration
device	I	0..*	Reference(Device)	There are no (further) constraints on this element Element id MedicationAdministration.device Short description Device used to administer Definition The device used in administering the medication to the patient. For example, a particular infusion pump. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2: PRT-10 Participation Device / RXR-3 Administrative Device rim: device->Access OR device->AssignedDevice
note		0..*	Annotation	There are no (further) constraints on this element Element id MedicationAdministration.note Short description Information about the administration Definition Extra information about the medication administration that is not conveyed by the other attributes. Comments For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible). Data type Annotation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: N/A rim: Act workflow: Event.note rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=OBS,moodCode=EVN,code="annotation"].value
dosage	S I	0..1	BackboneElement	Element id MedicationAdministration.dosage Short description The dosage instruction for the administered medication. Definition Describes the medication dosage information details e.g. dose, rate, site, route, etc. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` mad-1: SHALL have at least one of dosage.dose or dosage.rate[x] `dose.exists() or rate.exists()` Mappings rim: n/a rim: component->SubstanceAdministrationEvent
id		0..1	string	There are no (further) constraints on this element Element id MedicationAdministration.dosage.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationAdministration.dosage.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id MedicationAdministration.dosage.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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). Requirements 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. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
text		0..1	string	There are no (further) constraints on this element Element id MedicationAdministration.dosage.text Short description Free text dosage instructions e.g. SIG Definition Free text dosage can be used for cases where the dosage administered is too complex to code. When coded dosage is present, the free text dosage may still be present for display to humans. The dosage instructions should reflect the dosage of the medication that was administered. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: .text
site		0..1	CodeableConceptBinding	Element id MedicationAdministration.dosage.site Short description Body site administered to Definition A coded specification of the anatomic site where the medication first entered the body. For example, "left arm". Comments 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. Data type CodeableConcept Binding A coded concept describing the site location the medicine enters into or onto the body. UKCoreBodySite (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXR-2 Administration Site / RXR-6 Administration Site Modifier rim: .approachSiteCode
route		0..1	CodeableConceptBinding	Element id MedicationAdministration.dosage.route Short description Path of substance into body Definition A code specifying the route or physiological path of administration of a therapeutic agent into or onto the patient. For example, topical, intravenous, etc. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject. UKCoreSubstanceOrProductAdministrationRoute (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXR-1-Route rim: .routeCode
method		0..1	CodeableConceptBinding	Element id MedicationAdministration.dosage.method Short description How drug was administered Definition A coded value indicating the method by which the medication is intended to be or was introduced into or on the body. This attribute will most often NOT be populated. It is most commonly used for injections. For example, Slow Push, Deep IV. Comments One of the reasons this attribute is not used often, is that the method is often pre-coordinated with the route and/or form of administration. This means the codes used in route or form may pre-coordinate the method in the route code or the form code. The implementation decision about what coding system to use for route or form code will determine how frequently the method code will be populated e.g. if route or form code pre-coordinate method code, then this attribute will not be populated often; if there is no pre-coordination then method code may be used frequently. Data type CodeableConcept Binding A coded concept describing the technique by which the medicine is administered. UKCoreMedicationDosageMethod (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXR-4-Administration Method rim: .methodCode
dose	I	0..1	SimpleQuantity	There are no (further) constraints on this element Element id MedicationAdministration.dosage.dose Short description Amount of medication per dose Definition The amount of the medication given at one administration event. Use this value when the administration is essentially an instantaneous event such as a swallowing a tablet or giving an injection. Comments If the administration is not instantaneous (rate is present), this can be specified to convey the total amount administered over period of time of a single administration. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` sqty-1: The comparator is not used on a SimpleQuantity `comparator.empty()` Mappings rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values v2: RXA-6 Administered Amount / RXA-7 Administered Units rim: .doseQuantity
rate[x]		0..1		There are no (further) constraints on this element Element id MedicationAdministration.dosage.rate[x] Short description Dose quantity per unit of time Definition 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. Comments If the rate changes over time, and you want to capture this in MedicationAdministration, then each change should be captured as a distinct MedicationAdministration, with a specific MedicationAdministration.dosage.rate, and the date time when the rate change occurred. Typically, the MedicationAdministration.dosage.rate element is not used to convey an average rate. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: RXA-12-Administered Per (Time Unit) rim: .rateQuantity
rateRatio			Ratio	There are no (further) constraints on this element Data type Ratio
rateQuantity			SimpleQuantity	There are no (further) constraints on this element Data type SimpleQuantity
eventHistory	I	0..*	Reference(Provenance)	There are no (further) constraints on this element Element id MedicationAdministration.eventHistory Short description A list of events of interest in the lifecycle Definition A summary of the events of interest that have occurred, such as when the administration was verified. Comments 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. Data type Reference(Provenance) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]

Detailed Descriptions

MedicationAdministration
Definition	Describes the event of a patient consuming or otherwise being administered a medication. This may be as simple as swallowing a tablet or it may be a long running infusion. Related resources tie this event to the authorizing prescription, and the specific encounter between patient and health care practitioner.
Cardinality	0...*
Invariants	dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()`
Mappings	rim: Entity. Role, or Act workflow: Event rim: SubstanceAdministration
MedicationAdministration.id
Definition	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality	0...1
Type	string
Summary	True
Comments	The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
MedicationAdministration.meta
Definition	The 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.
Cardinality	0...1
Type	Meta
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
MedicationAdministration.implicitRules
Definition	A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Cardinality	0...1
Type	uri
Modifier	True
Summary	True
Comments	Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. 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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
MedicationAdministration.language
Definition	The base language in which the resource is written.
Cardinality	0...1
Type	code
Binding	A human language. CommonLanguages (preferred)
Comments	Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
MedicationAdministration.text
Definition	A 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.
Cardinality	0...1
Type	Narrative
Alias	narrative, html, xhtml, display
Comments	Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A rim: Act.text?
MedicationAdministration.contained
Definition	These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality	0...*
Type	Resource
Alias	inline resources, anonymous resources, contained resources
Comments	This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Mappings	rim: Entity. Role, or Act rim: N/A
MedicationAdministration.extension
Definition	May 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.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationAdministration.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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).
Cardinality	0...*
Type	Extension
Modifier	True
Alias	extensions, user content
Requirements	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.
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationAdministration.identifier
Definition	Identifiers associated with this Medication Administration 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.
Cardinality	0...*
Type	Identifier
Must Support	True
Comments	This is a business identifier, not a resource identifier.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier workflow: Event.identifier w5: FiveWs.identifier rim: .id
MedicationAdministration.instantiates
Definition	A protocol, guideline, orderset, or other definition that was adhered to in whole or in part by this event.
Cardinality	0...*
Type	uri
Summary	True
Comments	see http://en.wikipedia.org/wiki/Uniform_resource_identifier
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Event.instantiates rim: .outboundRelationship[typeCode=DEFN].target[classCode=unspecified]
MedicationAdministration.partOf
Definition	A larger event of which this particular event is a component or step.
Cardinality	0...*
Type	Reference(MedicationAdministration \| Procedure)
Summary	True
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.partOf rim: .outboundRelationship[typeCode=COMP]/target[classCode=SBADM or PROC,moodCode=EVN]
MedicationAdministration.status
Definition	Will generally be set to show that the administration has been completed. For some long running administrations such as infusions, it is possible for an administration to be started but not completed or it may be paused while some other process is under way.
Cardinality	1...1
Type	code
Binding	A set of codes indicating the current status of a MedicationAdministration. MedicationAdministration Status Codes (required)
Must Support	True
Modifier	True
Summary	True
Comments	This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Event.status w5: FiveWs.status v2: RXA-20-Completion Status rim: .statusCode
MedicationAdministration.statusReason
Definition	A code indicating why the administration was not performed.
Cardinality	0...*
Type	CodeableConcept
Binding	A set of codes indicating the reason why the MedicationAdministration is negated. SNOMEDCTReasonMedicationNotGivenCodes (example)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Event.statusReason v2: RXA-9-Administration Notes / RXA-18 Substance/Treatment Refusal Reason rim: .outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="reason not given"].value
MedicationAdministration.category
Definition	Indicates where the medication is expected to be consumed or administered.
Cardinality	0...1
Type	CodeableConcept
Binding	A coded concept describing where the medication administered is expected to occur. UKCoreMedicationAdministrationCategory (extensible)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: .inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication usage"].value
MedicationAdministration.medication[x]
Definition	Identifies the medication that was administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.
Cardinality	1...1
Type	CodeableConcept
Binding	Codes identifying substance or product that can be administered. UKCoreMedicationCode (preferred)
Must Support	True
Summary	True
Comments	If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example, if you require form or lot number, then you must reference the Medication resource.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Event.code w5: FiveWs.what[x] v2: RXA-5-Administered Code rim: .participation[typeCode=CSM].role[classCode=ADMM]
MedicationAdministration.subject
Definition	The person or animal or group receiving the medication.
Cardinality	1...1
Type	Reference(Patient \| Group)
Must Support	True
Summary	True
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.subject w5: FiveWs.subject[x] v2: PID-3-Patient ID List rim: .participation[typeCode=SBJ].role[classCode=PAT] w5: FiveWs.subject
MedicationAdministration.context
Definition	The visit, admission, or other contact between patient and health care provider during which the medication administration was performed.
Cardinality	0...1
Type	Reference(Encounter \| EpisodeOfCare)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.context w5: FiveWs.context v2: PV1-19-Visit Number rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]
MedicationAdministration.supportingInformation
Definition	Additional information (for example, patient height and weight) that supports the administration of the medication.
Cardinality	0...*
Type	Reference(Resource)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.context rim: .outboundRelationship[typeCode=PERT].target[A_SupportingClinicalStatement CMET minimal with many different choices of classCodes(ORG, ENC, PROC, SPLY, SBADM, OBS) and each of the act class codes draws from one or more of the following moodCodes (EVN, DEF, INT PRMS, RQO, PRP, APT, ARQ, GOL)]
MedicationAdministration.effective[x]
Definition	A specific date/time or interval of time during which the administration took place (or did not take place, when the 'notGiven' attribute is true). For many administrations, such as swallowing a tablet the use of dateTime is more appropriate.
Cardinality	1...1
Type	dateTime
Must Support	True
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Event.occurrence[x] w5: FiveWs.done[x] v2: RXA-3-Date/Time Start of Administration / RXA-4-Date/Time End of Administration rim: .effectiveTime
MedicationAdministration.performer
Definition	Indicates who or what performed the medication administration and how they were involved.
Cardinality	0...*
Type	BackboneElement
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Event.performer w5: FiveWs.actor v2: RXA-10-Administering Provider / PRT-5-Participation Person: PRT-4-Participation='AP' (RXA-10 is deprecated) rim: .participation[typeCode=PRF]
MedicationAdministration.performer.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
MedicationAdministration.performer.extension
Definition	May 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.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationAdministration.performer.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	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.
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationAdministration.performer.function
Definition	Distinguishes the type of involvement of the performer in the medication administration.
Cardinality	0...1
Type	CodeableConcept
Binding	A code describing the role an individual played in administering the medication. MedicationAdministration Performer Function Codes (example)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Event.performer.function rim: participation[typeCode=PRF].functionCode
MedicationAdministration.performer.actor
Definition	Indicates who or what performed the medication administration.
Cardinality	1...1
Type	Reference(Practitioner \| PractitionerRole \| Patient \| RelatedPerson \| Device)
Summary	True
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.performer.actor rim: .role
MedicationAdministration.reasonCode
Definition	A code indicating why the medication was given.
Cardinality	0...*
Type	CodeableConcept
Binding	A set of codes indicating the reason why the MedicationAdministration was made. ReasonMedicationGivenCodes (example)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Event.reasonCode v2: RXE-27 Give Indication rim: .reasonCode
MedicationAdministration.reasonReference
Definition	Condition or observation that supports why the medication was administered.
Cardinality	0...*
Type	Reference(Condition \| Observation \| DiagnosticReport)
Comments	This is a reference to a condition that is the reason for the medication request. If only a code exists, use reasonCode.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.reasonReference w5: FiveWs.why[x] rim: .outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="reason for use ASSERTION"].value w3c.prov: no mapping
MedicationAdministration.request
Definition	The original request, instruction or authority to perform the administration.
Cardinality	0...1
Type	Reference(MedicationRequest)
Comments	This is a reference to the MedicationRequest where the intent is either order or instance-order. It should not reference MedicationRequests where the intent is any other value.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.basedOn v2: ORC-2-Placer Order Number / ORC-3-Filler Order Number rim: InFullfillmentOf->SubstanceAdministration
MedicationAdministration.device
Definition	The device used in administering the medication to the patient. For example, a particular infusion pump.
Cardinality	0...*
Type	Reference(Device)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2: PRT-10 Participation Device / RXR-3 Administrative Device rim: device->Access OR device->AssignedDevice
MedicationAdministration.note
Definition	Extra information about the medication administration that is not conveyed by the other attributes.
Cardinality	0...*
Type	Annotation
Comments	For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: N/A rim: Act workflow: Event.note rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=OBS,moodCode=EVN,code="annotation"].value
MedicationAdministration.dosage
Definition	Describes the medication dosage information details e.g. dose, rate, site, route, etc.
Cardinality	0...1
Type	BackboneElement
Must Support	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` mad-1: SHALL have at least one of dosage.dose or dosage.rate[x] `dose.exists() or rate.exists()`
Mappings	rim: n/a rim: component->SubstanceAdministrationEvent
MedicationAdministration.dosage.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
MedicationAdministration.dosage.extension
Definition	May 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.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationAdministration.dosage.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	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.
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationAdministration.dosage.text
Definition	Free text dosage can be used for cases where the dosage administered is too complex to code. When coded dosage is present, the free text dosage may still be present for display to humans. The dosage instructions should reflect the dosage of the medication that was administered.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings SHALL NOT exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: .text
MedicationAdministration.dosage.site
Definition	A coded specification of the anatomic site where the medication first entered the body. For example, "left arm".
Cardinality	0...1
Type	CodeableConcept
Binding	A coded concept describing the site location the medicine enters into or onto the body. UKCoreBodySite (preferred)
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXR-2 Administration Site / RXR-6 Administration Site Modifier rim: .approachSiteCode
MedicationAdministration.dosage.route
Definition	A code specifying the route or physiological path of administration of a therapeutic agent into or onto the patient. For example, topical, intravenous, etc.
Cardinality	0...1
Type	CodeableConcept
Binding	A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject. UKCoreSubstanceOrProductAdministrationRoute (preferred)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXR-1-Route rim: .routeCode
MedicationAdministration.dosage.method
Definition	A coded value indicating the method by which the medication is intended to be or was introduced into or on the body. This attribute will most often NOT be populated. It is most commonly used for injections. For example, Slow Push, Deep IV.
Cardinality	0...1
Type	CodeableConcept
Binding	A coded concept describing the technique by which the medicine is administered. UKCoreMedicationDosageMethod (preferred)
Comments	One of the reasons this attribute is not used often, is that the method is often pre-coordinated with the route and/or form of administration. This means the codes used in route or form may pre-coordinate the method in the route code or the form code. The implementation decision about what coding system to use for route or form code will determine how frequently the method code will be populated e.g. if route or form code pre-coordinate method code, then this attribute will not be populated often; if there is no pre-coordination then method code may be used frequently.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXR-4-Administration Method rim: .methodCode
MedicationAdministration.dosage.dose
Definition	The amount of the medication given at one administration event. Use this value when the administration is essentially an instantaneous event such as a swallowing a tablet or giving an injection.
Cardinality	0...1
Type	SimpleQuantity
Comments	If the administration is not instantaneous (rate is present), this can be specified to convey the total amount administered over period of time of a single administration.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` sqty-1: The comparator is not used on a SimpleQuantity `comparator.empty()`
Mappings	rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values v2: RXA-6 Administered Amount / RXA-7 Administered Units rim: .doseQuantity
MedicationAdministration.dosage.rate[x]
Definition	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.
Cardinality	0...1
Type	Ratio
Comments	If the rate changes over time, and you want to capture this in MedicationAdministration, then each change should be captured as a distinct MedicationAdministration, with a specific MedicationAdministration.dosage.rate, and the date time when the rate change occurred. Typically, the MedicationAdministration.dosage.rate element is not used to convey an average rate.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: RXA-12-Administered Per (Time Unit) rim: .rateQuantity
MedicationAdministration.eventHistory
Definition	A summary of the events of interest that have occurred, such as when the administration was verified.
Cardinality	0...*
Type	Reference(Provenance)
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]

Table View

MedicationAdministration		..
MedicationAdministration.identifier		..
MedicationAdministration.status		..
MedicationAdministration.category		..
MedicationAdministration.medication[x]		..
MedicationAdministration.subject		..
MedicationAdministration.effective[x]		..
MedicationAdministration.dosage		..
MedicationAdministration.dosage.site		..
MedicationAdministration.dosage.route		..
MedicationAdministration.dosage.method		..

XML View

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="UKCore-MedicationAdministration" />
    <url value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationAdministration" />
    <version value="2.3.0" />
    <name value="UKCoreMedicationAdministration" />
    <title value="UK Core Medication Administration" />
    <status value="active" />
    <date value="2024-07-11" />
    <publisher value="HL7 UK" />
    <contact>
        <name value="HL7 UK" />
        <telecom>
            <system value="email" />
            <value value="ukcore@hl7.org.uk" />
            <use value="work" />
            <rank value="1" />
        </telecom>
    </contact>
    <description value="This profile defines the UK constraints and extensions on the International FHIR resource [MedicationAdministration](https://hl7.org/fhir/R4/MedicationAdministration.html)." />
    <purpose value="The purpose of this profile is to describe the event of a patient consuming or otherwise being administered a medication. This may be as simple as swallowing a tablet, or it may be a long-running infusion. \n\nRelated resources tie this event to the authorizing prescription, and the specific encounter between patient and health care practitioner." />
    <copyright value="Copyright &#169; 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the &quot;License&quot;); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an &quot;AS IS&quot; BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7&#174; FHIR&#174; standard Copyright &#169; 2011+ HL7 The HL7&#174; FHIR&#174; standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html." />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="MedicationAdministration" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration" />
    <derivation value="constraint" />
    <differential>
        <element id="MedicationAdministration.identifier">
            <path value="MedicationAdministration.identifier" />
            <short value="Allows the resource to be referenced within / by other resources." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationAdministration.status">
            <path value="MedicationAdministration.status" />
            <short value="Allows an administration to be marked as in-progress or completed." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationAdministration.category">
            <path value="MedicationAdministration.category" />
            <binding>
                <strength value="extensible" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationAdministrationCategory" />
            </binding>
        </element>
        <element id="MedicationAdministration.medication[x]">
            <path value="MedicationAdministration.medication[x]" />
            <short value="Identifies the medication that was administered." />
            <mustSupport value="true" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationCode" />
            </binding>
        </element>
        <element id="MedicationAdministration.subject">
            <path value="MedicationAdministration.subject" />
            <short value="Identifies the patient receiving the medication." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationAdministration.effective[x]">
            <path value="MedicationAdministration.effective[x]" />
            <short value="The start and end time of the administration." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationAdministration.dosage">
            <path value="MedicationAdministration.dosage" />
            <short value="The dosage instruction for the administered medication." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationAdministration.dosage.site">
            <path value="MedicationAdministration.dosage.site" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-BodySite" />
            </binding>
        </element>
        <element id="MedicationAdministration.dosage.route">
            <path value="MedicationAdministration.dosage.route" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute" />
            </binding>
        </element>
        <element id="MedicationAdministration.dosage.method">
            <path value="MedicationAdministration.dosage.method" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationDosageMethod" />
            </binding>
        </element>
    </differential>
</StructureDefinition>

JSON View

{
    "resourceType": "StructureDefinition",
    "id": "UKCore-MedicationAdministration",
    "url": "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationAdministration",
    "version": "2.3.0",
    "name": "UKCoreMedicationAdministration",
    "title": "UK Core Medication Administration",
    "status": "active",
    "date": "2024-07-11",
    "publisher": "HL7 UK",
    "contact":  [
        {
            "name": "HL7 UK",
            "telecom":  [
                {
                    "system": "email",
                    "value": "ukcore@hl7.org.uk",
                    "use": "work",
                    "rank": 1
                }
            ]
        }
    ],
    "description": "This profile defines the UK constraints and extensions on the International FHIR resource [MedicationAdministration](https://hl7.org/fhir/R4/MedicationAdministration.html).",
    "purpose": "The purpose of this profile is to describe the event of a patient consuming or otherwise being administered a medication. This may be as simple as swallowing a tablet, or it may be a long-running infusion. \n\nRelated resources tie this event to the authorizing prescription, and the specific encounter between patient and health care practitioner.",
    "copyright": "Copyright © 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the \"License\"); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an \"AS IS\" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7® FHIR® standard Copyright © 2011+ HL7 The HL7® FHIR® standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html.",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "MedicationAdministration",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/MedicationAdministration",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "MedicationAdministration.identifier",
                "path": "MedicationAdministration.identifier",
                "short": "Allows the resource to be referenced within / by other resources.",
                "mustSupport": true
            },
            {
                "id": "MedicationAdministration.status",
                "path": "MedicationAdministration.status",
                "short": "Allows an administration to be marked as in-progress or completed.",
                "mustSupport": true
            },
            {
                "id": "MedicationAdministration.category",
                "path": "MedicationAdministration.category",
                "binding": {
                    "strength": "extensible",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationAdministrationCategory"
                }
            },
            {
                "id": "MedicationAdministration.medication[x]",
                "path": "MedicationAdministration.medication[x]",
                "short": "Identifies the medication that was administered.",
                "mustSupport": true,
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationCode"
                }
            },
            {
                "id": "MedicationAdministration.subject",
                "path": "MedicationAdministration.subject",
                "short": "Identifies the patient receiving the medication.",
                "mustSupport": true
            },
            {
                "id": "MedicationAdministration.effective[x]",
                "path": "MedicationAdministration.effective[x]",
                "short": "The start and end time of the administration.",
                "mustSupport": true
            },
            {
                "id": "MedicationAdministration.dosage",
                "path": "MedicationAdministration.dosage",
                "short": "The dosage instruction for the administered medication.",
                "mustSupport": true
            },
            {
                "id": "MedicationAdministration.dosage.site",
                "path": "MedicationAdministration.dosage.site",
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-BodySite"
                }
            },
            {
                "id": "MedicationAdministration.dosage.route",
                "path": "MedicationAdministration.dosage.route",
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute"
                }
            },
            {
                "id": "MedicationAdministration.dosage.method",
                "path": "MedicationAdministration.dosage.method",
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationDosageMethod"
                }
            }
        ]
    }
}

Feedback

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Report issue for UKCore-MedicationAdministration, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Examples

Timoptol Eye Drops - An example to illustrate a medication administration of eye drops.
Example UKCore-MedicationAdministration-TimoptolEyeDrops

Example Usage Scenarios

The following are example usage scenarios for the UK Core Medication Administration profile:

To share inpatient or outpatient non-immunization administrations of medication between clinical systems. Example scenarios include inpatient patient transfer from ward-to-ward or hospital-to-hospital, where different clinical systems are in use. For immunisations use the Profile UKCore-Immunization resource.
To share patient self-administration of medication.
To share home-health reporting from medicines administration and monitoring devices.

Profile Specific Implementation Guidance:

Mandatory and Must Support Data Elements

The following elements are identified as MustSupport, and it is expected that consumers and suppliers SHALL support these as per the MustSupport Guidance.

Element	Reason
`MedicationAdministration.identifier`	Allows the resource to be referenced within / by other resources.
`MedicationAdministration.status`	Allows an administration to be marked as in-progress or completed.
`MedicationAdministration.medication[x]`	Identifies the medication that was administered.
`MedicationAdministration.subject`	Identifies the patient receiving the medication.
`MedicationAdministration.effective[x]`	The start and end time of the administration.
`MedicationAdministration.dosage`	The dosage instruction for the administered medication.

Bindings (differential)

More information about the bindings to UK Core ValueSets can be found below.

Context	Strength	Link
MedicationAdministration.category	extensible	https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationAdministrationCategory
MedicationAdministration.medication[x]	preferred	https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationCode
MedicationAdministration.dosage.site	preferred	https://fhir.hl7.org.uk/ValueSet/UKCore-BodySite
MedicationAdministration.dosage.route	preferred	https://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute
MedicationAdministration.dosage.method	preferred	https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationDosageMethod

`partOf`

An optional reference to a Procedure that could be used for medications given intraoperatively (during an operation / procedure) where there may not be a MedicationRequest resource to reference. A reverse reference could be added as ‘partOf’ of the Procedure resource.

This element can also reference another MedicationAdministration resource. Where several medication administrations relate to the same MedicationRequest, the reference to the MedicationRequest within ‘request’ is sufficient for logical data linkage purposes. It may give additional business benefit to also logically link the MedicationAdministration resources using ‘partOf’.

Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles:

`status`

The MedicationAdministration.status element SHALL be populated with a value from the International FHIR ValueSet medication-admin-status, which is shown expanded here with additional guidance.

Systems consuming the data SHOULD use MedicationAdministration.status to support workflow.

The status can be used to determine the overall status of medication administration events.

It is recommended that the MedicationAdministration.status is used to indicate the status at a high-level so that integrated systems can determine how to represent this information.

Status	FHIR Definition	Implementation Guidance
`in-progress`	The administration has started but has not yet completed.	Would be a suitable status to use, for example, by an infusion pump device which is interoperable with the clinical system to denote an infusion is in progress.
`not-done`	The administration was terminated prior to any impact on the subject (though preparatory actions may have been taken)	Use this when there is not the intention to undertake the administration at a future time.
`on-hold`	Actions implied by the administration have been temporarily halted, but are expected to continue later. May also be called 'suspended'.	Use this when there is the intention to administer the medication at a future time. For example, if the patient is temporarily unavailable.
`completed`	All actions that are implied by the administration have occurred.	This would be a suitable trigger to share the medication administration event with shared records.
`entered-in-error`	The administration was entered in error and therefore nullified.	There is limited value in sharing records that are entered in error.
`stopped`	Actions implied by the administration have been permanently halted, before all of them occurred.	A `MedicationAdministration.statusReason` SHOULD be populated with a coded reason for stopping the medication administration. This is for things like patches and continuous infusions etc. where administration is over a period of time. The `MedicationAdministration.dosage` SHOULD reflect the amount administered (or whatever the source system has recorded).
`unknown`	The authoring system does not know which of the status values currently applies for this request. Note: This concept is not to be used for 'other' - one of the statuses listed is presumed to apply, it's just not known which one.	The patient may have had some encounter with this medication, but the current status is unknown. Avoid the use of this status value where possible.

`statusReason`

A coded reason for why an administration was not performed.

SHOULD only be populated when the MedicationAdministration.status is either stopped, not-done or on-hold.

Example scenarios for the use of `status` and `statusReason`.

Some medication was taken, but not all that was intended, for whatever reason, e.g. an infusion that was started, and finished prematurely.

status = stopped
status reason = 416093006 | Allergic reaction to drug
dosage = Should reflect how much was actually administered, e.g. 150ml (instead of 200ml requested)

Note: For this example it would be expected that the originating MedicationRequest would be updated with a status of stopped which should prevent the system from scheduling an administration or delete any that have been scheduled. Where administration records are retained, use the status of stopped.

Patient refused to take the medication.

status = not-done
statusReason = 182895007 | Drug declined by patient (finding) - or a child concept of the above

Where required use MedicationAdministration.note to capture additional notes for why the patient refused the medication.

Patient not available, e.g. on home leave for a couple of days, moved ward, location unknown, etc. and not recorded as `on-hold`.

status = not-done
statusReason = 398090008 | Patient unavailable (finding)

Medication was taken but patient then vomited all/some of the medication.

status = on-hold or stopped
statusReason = 419219000 | Drug-induced nausea and vomiting

Use MedicationAdministration.note for additional notes for what happened, provided the administration record can be amended after the vomiting episode.

An infusion for the patient is paused for a period based on blood test results. Or, a nutrition feed is paused for clinical reasons, to restart again later.

status = on-hold
statusReason = Optional. Any valid SNOMED term.
dosage = The dosage would either be recorded with a zero rateRatio or rateQuantity or may be fully omitted. Both must be interpreted as a zero medication administration.

`medication[x]`

Medication WITH dm+d code

Where a dm+d code exists it SHALL be used either as MedicationAdministration.medicationCodeableConcept.coding or as MedicationAdministration.medicationReference.Medication.code.

Where CodeableConcept is used, MedicationAdministration.medicationCodeableConcept.coding is the dm+d code and MedicationAdministration.medicationCodeableConcept.text is dm+d concept name/description.

Can be either a dm+d code as a CodeableConcept or reference to a Profile UKCore-Medication.

Using a CodeableConcept is preferred unless additional data is required that would be contained within a Profile UKCore-Medication.

The elements MedicationAdministration.medicationCodeableConcept.coding and MedicationAdministration.medicationReference.Medication.code are both bound to ValueSet UKCore-MedicationCode

Examples where a reference to a Profile UKCore-Medication would be applicable include:

Record a VTM with a specific form
Record manufacturer with a concept as described in ValueSet UKCore-MedicationCode
Record batch number
Record ingredients (for example with a magisterial prescription or an excipient).

Medication WITHOUT dm+d code

Medication not published within the dm+d may be requested in the Acute care setting.

In this scenario it is recommended to use the CodeableConcept variant for this element.

If the prescribing system has both a locally assigned code and description for the medication then;

The MedicationAdministration.medicationCodeableConcept.text SHOULD be the description for the medication.
The MedicationAdministration.medicationCodeableConcept.coding.code SHOULD be the code for the medication.
The MedicationAdministration.medicationCodeableConcept.coding.display SHOULD be the description for the medication, i.e. the same value as MedicationAdministration.medicationCodeableConcept.text.

If the prescribing system only has a description for the medication then;

The MedicationAdministration.medicationCodeableConcept.text SHOULD be the locally assigned description for the medication.

`subject`

A reference to the patient.

Within a FHIR Messaging or FHIR Document implementation, include a Profile UKCore-Patient resource within the Bundle with at least the minimum dataset populated as defined within the UK Core standard. The MedicationAdministration.subject.reference points to the resource in the Bundle.

`context`

Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles:

`supportingInformation`

Where a UK Core profile exists, the resource being referenced SHOULD conform to the profile.

`reasonReference`

Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles:

`request`

In many cases, a Profile UKCore-MedicationRequest resource will exist and can be referenced. Consideration must be made when sharing the records to either also share the MedicationRequest or make it accessible by query, if/when required.

Cases where a MedicationRequest may not exist include administration of medication bought over the counter or via an emergency supply of medication.

`device`

The resource being referenced SHALL conform to the UKCore-Device.

`dosage`

Consider aligning to the Implementation Guide for Digital Medicines, but as a minimum, MedicationAdministration.dosage.text.

A MedicationAdministration resource may be used to describe a period of no administration. The MedicationAdministration.status would be on-hold and either the dosage would be omitted, or a dosage would be recorded with a zero rate or quantity. For example;

Example of `MedicationAdministration.dosage` usage:

Table View

MedicationAdministration.id[0]	UKCore-MedicationAdministration-Sn-ZeroDosage-Example
MedicationAdministration.status[0]	on-hold
MedicationAdministration.medication[0].reference[0]	Medication/UKCore-Medication-TimoptolEyeDrops-Example
MedicationAdministration.subject[0].reference[0]	Patient/UKCore-Patient-RichardSmith-Example
MedicationAdministration.effective[0]	2021-03-25T13:00:00+00:00
MedicationAdministration.dosage[0].text[0]	No administration required.
MedicationAdministration.dosage[0].rate[0].value[0]	0
MedicationAdministration.dosage[0].rate[0].unit[0]	milliliter per hour
MedicationAdministration.dosage[0].rate[0].system[0]	http://unitsofmeasure.org
MedicationAdministration.dosage[0].rate[0].code[0]	mL/h

Tree View

MedicationAdministration

id : UKCore-MedicationAdministration-Sn-ZeroDosage-Example

status : on-hold

medication

reference : Medication/UKCore-Medication-TimoptolEyeDrops-Example

subject

reference : Patient/UKCore-Patient-RichardSmith-Example

effective : 2021-03-25T13:00:00+00:00

dosage

text : No administration required.

rate

value : 0

unit : milliliter per hour

system : http://unitsofmeasure.org

code : mL/h

XML View

<MedicationAdministration xmlns="http://hl7.org/fhir">
    <id value="UKCore-MedicationAdministration-Sn-ZeroDosage-Example" />
    <status value="on-hold" />
    <medicationReference>
        <reference value="Medication/UKCore-Medication-TimoptolEyeDrops-Example" />
    </medicationReference>
    <subject>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
    </subject>
    <effectiveDateTime value="2021-03-25T13:00:00+00:00" />
    <dosage>
        <text value="No administration required." />
        <rateQuantity>
            <value value="0" />
            <unit value="milliliter per hour" />
            <system value="http://unitsofmeasure.org" />
            <code value="mL/h" />
        </rateQuantity>
    </dosage>
</MedicationAdministration>

JSON View

{
    "resourceType": "MedicationAdministration",
    "id": "UKCore-MedicationAdministration-Sn-ZeroDosage-Example",
    "status": "on-hold",
    "medicationReference": {
        "reference": "Medication/UKCore-Medication-TimoptolEyeDrops-Example"
    },
    "subject": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "effectiveDateTime": "2021-03-25T13:00:00+00:00",
    "dosage": {
        "text": "No administration required.",
        "rateQuantity": {
            "value": 0,
            "unit": "milliliter per hour",
            "system": "http://unitsofmeasure.org",
            "code": "mL/h"
        }
    }
}

`eventHistory`

The resource being referenced SHALL conform to UKCore-Provenance (draft).

StructureDefinition-UKCore-MedicationAdministration

Detailed Descriptions

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JSON View

Feedback

Examples

Example Usage Scenarios

Profile Specific Implementation Guidance:

Mandatory and Must Support Data Elements

Bindings (differential)

partOf

status

statusReason

Example scenarios for the use of status and statusReason.

Some medication was taken, but not all that was intended, for whatever reason, e.g. an infusion that was started, and finished prematurely.

Patient refused to take the medication.

Patient not available, e.g. on home leave for a couple of days, moved ward, location unknown, etc. and not recorded as on-hold.

Medication was taken but patient then vomited all/some of the medication.

An infusion for the patient is paused for a period based on blood test results. Or, a nutrition feed is paused for clinical reasons, to restart again later.

medication[x]

Medication WITH dm+d code

Medication WITHOUT dm+d code

subject

context

supportingInformation

reasonReference

request

device

dosage

Example of MedicationAdministration.dosage usage:

Table View

Tree View

XML View

JSON View

eventHistory

`partOf`

`status`

`statusReason`

Example scenarios for the use of `status` and `statusReason`.

Patient not available, e.g. on home leave for a couple of days, moved ward, location unknown, etc. and not recorded as `on-hold`.

`medication[x]`

`subject`

`context`

`supportingInformation`

`reasonReference`

`request`

`device`

`dosage`

Example of `MedicationAdministration.dosage` usage:

`eventHistory`