MedicationAdministration
CareConnect-MedicationAdministration-1 (MedicationAdministration) | I | MedicationAdministration | |
id | Σ | 0..1 | id |
meta | Σ | 0..1 | Meta |
implicitRules | Σ ?! | 0..1 | uri |
language | 0..1 | codeBinding | |
text | I | 0..1 | Narrative |
contained | 0..* | Resource | |
extension | I | 0..* | Extension |
modifierExtension | ?! I | 0..* | Extension |
identifier | 0..* | Identifier | |
id | 0..1 | string | |
extension | I | 0..* | Extension |
use | Σ ?! | 0..1 | codeBinding |
type | Σ | 0..1 | CodeableConceptBinding |
system | Σ | 0..1 | uri |
value | Σ | 0..1 | string |
period | Σ I | 0..1 | Period |
assigner | Σ I | 0..1 | Reference() |
definition | Σ I | 0..* | Reference(PlanDefinition | ActivityDefinition) |
partOf | Σ I | 0..* | Reference( | ) |
status | Σ ?! | 1..1 | codeBinding |
category | 0..1 | CodeableConceptBinding | |
medication[x] | Σ | 1..1 | |
medicationCodeableConcept | CodeableConcept | ||
medicationReference | Reference() | ||
subject | Σ I | 1..1 | Reference(Group | ) |
context | I | 0..1 | Reference(https://fhir.hl7.org.uk/STU3/StructureDefinition/CareConnect-Encounter-1 | ) |
supportingInformation | I | 0..* | Reference(Resource) |
effective[x] | Σ | 1..1 | |
effectiveDateTime | dateTime | ||
effectivePeriod | Period | ||
performer | Σ | 0..* | BackboneElement |
id | 0..1 | string | |
extension | I | 0..* | Extension |
modifierExtension | Σ ?! I | 0..* | Extension |
actor | Σ I | 1..1 | Reference(Device | | | ) |
onBehalfOf | I | 0..1 | Reference() |
notGiven | Σ ?! | 0..1 | boolean |
reasonNotGiven | I | 0..* | CodeableConcept |
reasonCode | I | 0..* | CodeableConcept |
reasonReference | I | 0..* | Reference( | ) |
prescription | I | 0..1 | Reference() |
device | I | 0..* | Reference(Device) |
note | 0..* | Annotation | |
id | 0..1 | string | |
extension | I | 0..* | Extension |
author[x] | Σ | 0..1 | |
authorString | string | ||
authorReference | Reference( | | ) | ||
time | Σ | 0..1 | dateTime |
text | 1..1 | string | |
dosage | I | 0..1 | BackboneElement |
id | 0..1 | string | |
extension | I | 0..* | Extension |
modifierExtension | Σ ?! I | 0..* | Extension |
text | 0..1 | string | |
site | 0..1 | CodeableConcept | |
route | 0..1 | CodeableConcept | |
id | 0..1 | string | |
extension | I | 0..* | Extension |
coding | Σ | 0..* | Coding |
snomedCT | Σ | 0..1 | Coding |
id | 0..1 | string | |
extension | I | 0..* | Extension |
SnomedCTDescriptionId | I | 0..1 | Extension(Complex) |
system | Σ | 1..1 | uriFixed Value |
version | Σ | 0..1 | string |
code | Σ | 1..1 | code |
display | Σ | 1..1 | string |
userSelected | Σ | 0..1 | boolean |
text | Σ | 0..1 | string |
method | 0..1 | CodeableConcept | |
dose | I | 0..1 | SimpleQuantity |
rate[x] | 0..1 | ||
rateRatio | Ratio | ||
rateQuantity | SimpleQuantity | ||
eventHistory | I | 0..* | Reference(Provenance) |
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...* |
Comments | The WG will be updating the MedicationAdministration resource to adjust each affected resource to align with the workflow pattern (see workflow.html). |
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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 | id |
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. |
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MedicationAdministration.meta | |
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource. |
Cardinality | 0...1 |
Type | Meta |
Summary | True |
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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. |
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. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation. |
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MedicationAdministration.language | |
Definition | The base language in which the resource is written. |
Cardinality | 0...1 |
Type | code |
Binding | A human language. Common Languages (extensible) |
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). |
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MedicationAdministration.text | |
Definition | A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. |
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 in formation is added later. |
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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. |
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MedicationAdministration.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
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) |
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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. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. |
Cardinality | 0...* |
Type | Extension |
Modifier | True |
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) |
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MedicationAdministration.identifier | |
Definition | External identifier - FHIR will generate its own internal identifiers (probably URLs) which do not need to be explicitly managed by the resource. The identifier here is one that would be used by another non-FHIR system - for example an automated medication pump would provide a record each time it operated; an administration while the patient was off the ward might be made with a different system and entered after the event. Particularly important if these records have to be updated. |
Cardinality | 0...* |
Type | Identifier |
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MedicationAdministration.identifier.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 |
Comments | Note that FHIR strings may not exceed 1MB in size |
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MedicationAdministration.identifier.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
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) |
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MedicationAdministration.identifier.use | |
Definition | The purpose of this identifier. |
Cardinality | 0...1 |
Type | code |
Binding | Identifies the purpose for this identifier, if known . IdentifierUse (required) |
Modifier | True |
Summary | True |
Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. |
Comments | This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. |
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MedicationAdministration.identifier.type | |
Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. |
Cardinality | 0...1 |
Type | CodeableConcept |
Binding | A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible) |
Summary | True |
Requirements | Allows users to make use of identifiers when the identifier system is not known. |
Comments | This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. |
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MedicationAdministration.identifier.system | |
Definition | Establishes the namespace for the value - that is, a URL that describes a set values that are unique. |
Cardinality | 0...1 |
Type | uri |
Summary | True |
Requirements | There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. |
Comments | see http://en.wikipedia.org/wiki/Uniform_resource_identifier |
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Examples | General http://www.acme.com/identifiers/patient |
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MedicationAdministration.identifier.value | |
Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system. |
Cardinality | 0...1 |
Type | string |
Summary | True |
Comments | If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. |
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Examples | General 123456 |
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MedicationAdministration.identifier.period | |
Definition | Time period during which identifier is/was valid for use. |
Cardinality | 0...1 |
Type | Period |
Summary | True |
Comments | This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval|Duration. |
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MedicationAdministration.identifier.assigner | |
Definition | Organization that issued/manages the identifier. |
Cardinality | 0...1 |
Type | Reference() |
Summary | True |
Comments | The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. |
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MedicationAdministration.definition | |
Definition | A protocol, guideline, orderset or other definition that was adhered to in whole or in part by this event. |
Cardinality | 0...* |
Type | Reference(PlanDefinition | ActivityDefinition) |
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. |
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MedicationAdministration.partOf | |
Definition | A larger event of which this particular event is a component or step. |
Cardinality | 0...* |
Type | Reference( | ) |
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. |
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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. MedicationAdministrationStatus (required) |
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. |
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MedicationAdministration.category | |
Definition | Indicates the type of medication administration and 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 MedicationAdministrationCategory (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. |
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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 | Reference(), CodeableConcept |
Binding | Codes identifying substance or product that can be administered. SNOMED CT Medication Codes (example) |
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. . |
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MedicationAdministration.subject | |
Definition | The person or animal or group receiving the medication. |
Cardinality | 1...1 |
Type | Reference(Group | ) |
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. |
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MedicationAdministration.context | |
Definition | The visit, admission or other contact between patient and health care provider the medication administration was performed as part of. |
Cardinality | 0...1 |
Type | Reference(https://fhir.hl7.org.uk/STU3/StructureDefinition/CareConnect-Encounter-1 | ) |
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. |
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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. |
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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, Period |
Summary | True |
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MedicationAdministration.performer | |
Definition | The individual who was responsible for giving the medication to the patient. |
Cardinality | 0...* |
Type | BackboneElement |
Summary | True |
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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 |
Comments | Note that FHIR strings may not exceed 1MB in size |
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MedicationAdministration.performer.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
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) |
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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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. |
Cardinality | 0...* |
Type | Extension |
Modifier | True |
Summary | True |
Alias | extensions, user content, modifiers |
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. |
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MedicationAdministration.performer.actor | |
Definition | The device, practitioner, etc. who performed the action. |
Cardinality | 1...1 |
Type | Reference(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. |
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MedicationAdministration.performer.onBehalfOf | |
Definition | The organization the device or practitioner was acting on behalf of. |
Cardinality | 0...1 |
Type | Reference() |
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. |
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MedicationAdministration.notGiven | |
Definition | Set this to true if the record is saying that the medication was NOT administered. |
Cardinality | 0...1 |
Type | boolean |
Modifier | True |
Summary | True |
Comments | This element is labeled as a modifier because it indicates that a administration didn't happen. |
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MedicationAdministration.reasonNotGiven | |
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. SNOMED CT Reason Medication Not Given 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. |
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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. Reason Medication Given 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. |
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MedicationAdministration.reasonReference | |
Definition | Condition or observation that supports why the medication was administered. |
Cardinality | 0...* |
Type | Reference( | ) |
Comments | This is a reference to a condition that is the reason for the medication request. If only a code exists, use reasonCode. |
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MedicationAdministration.prescription | |
Definition | The original request, instruction or authority to perform the administration. |
Cardinality | 0...1 |
Type | Reference() |
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. |
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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. |
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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). |
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MedicationAdministration.note.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 |
Comments | Note that FHIR strings may not exceed 1MB in size |
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MedicationAdministration.note.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
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) |
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MedicationAdministration.note.author[x] | |
Definition | The individual responsible for making the annotation. |
Cardinality | 0...1 |
Type | Reference( | | ), string |
Summary | True |
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MedicationAdministration.note.time | |
Definition | Indicates when this particular annotation was made. |
Cardinality | 0...1 |
Type | dateTime |
Summary | True |
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MedicationAdministration.note.text | |
Definition | The text of the annotation. |
Cardinality | 1...1 |
Type | string |
Comments | Note that FHIR strings may not exceed 1MB in size |
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MedicationAdministration.dosage | |
Definition | Describes the medication dosage information details e.g. dose, rate, site, route, etc. |
Cardinality | 0...1 |
Type | BackboneElement |
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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 |
Comments | Note that FHIR strings may not exceed 1MB in size |
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MedicationAdministration.dosage.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
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) |
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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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. |
Cardinality | 0...* |
Type | Extension |
Modifier | True |
Summary | True |
Alias | extensions, user content, modifiers |
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. |
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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 may not exceed 1MB in size |
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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. SNOMED CT Anatomical Structure for Administration Site Codes (example) |
Comments | If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension body-site-instance. May be a summary code, or a reference to a very precise definition of the location, or both. |
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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. SNOMED CT Route 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. |
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MedicationAdministration.dosage.route.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 |
Comments | Note that FHIR strings may not exceed 1MB in size |
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MedicationAdministration.dosage.route.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
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) |
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MedicationAdministration.dosage.route.coding | |
Definition | A reference to a code defined by a terminology system. |
Cardinality | 0...* |
Type | Coding |
Summary | True |
Requirements | Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. |
Comments | Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. |
Slicing | Unordered, Open, by system(Value) |
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MedicationAdministration.dosage.route.coding:snomedCT | |
Definition | A reference to a code defined by a terminology system. |
Cardinality | 0...1 |
Type | Coding |
Binding | A code from the SNOMED Clinical Terminology UK coding system that describes the e-Prescribing route of administration. (example) |
Summary | True |
Requirements | Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. |
Comments | Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. |
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MedicationAdministration.dosage.route.coding:snomedCT.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 |
Comments | Note that FHIR strings may not exceed 1MB in size |
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MedicationAdministration.dosage.route.coding:snomedCT.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
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) |
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MedicationAdministration.dosage.route.coding:snomedCT.extension:SnomedCTDescriptionId | |
Definition | The SNOMED CT Description ID for the display. |
Cardinality | 0...1 |
Type | Extension(Complex) |
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. |
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MedicationAdministration.dosage.route.coding:snomedCT.system | |
Definition | The identification of the code system that defines the meaning of the symbol in the code. |
Cardinality | 1...1 |
Type | uri |
Summary | True |
Requirements | Need to be unambiguous about the source of the definition of the symbol. |
Comments | The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously. |
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Fixed Value | http://snomed.info/sct |
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MedicationAdministration.dosage.route.coding:snomedCT.version | |
Definition | The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. |
Cardinality | 0...1 |
Type | string |
Summary | True |
Comments | Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. |
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MedicationAdministration.dosage.route.coding:snomedCT.code | |
Definition | A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). |
Cardinality | 1...1 |
Type | code |
Summary | True |
Requirements | Need to refer to a particular code in the system. |
Comments | Note that FHIR strings may not exceed 1MB in size |
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MedicationAdministration.dosage.route.coding:snomedCT.display | |
Definition | A representation of the meaning of the code in the system, following the rules of the system. |
Cardinality | 1...1 |
Type | string |
Summary | True |
Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system. |
Comments | Note that FHIR strings may not exceed 1MB in size |
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MedicationAdministration.dosage.route.coding:snomedCT.userSelected | |
Definition | Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). |
Cardinality | 0...1 |
Type | boolean |
Summary | True |
Requirements | This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. |
Comments | Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. |
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MedicationAdministration.dosage.route.text | |
Definition | A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. |
Cardinality | 0...1 |
Type | string |
Summary | True |
Requirements | The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. |
Comments | Very often the text is the same as a displayName of one of the codings. |
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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. SNOMED CT Administration Method Codes (example) |
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. |
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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. |
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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, SimpleQuantity |
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. |
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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 may not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject. |
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Minimum Viable Product
Element: identifier
This MUST be populated with a globally unique and persistent identifier (that is, it doesn’t change between requests and therefore stored with the source data). This MUST be scoped by a provider specific namespace for the identifier.
Where consuming systems are integrating data from this resource to their local system, they MUST also persist this identifier at the same time.
Element: definition
TBC
Element: partOf
TBC
Element: status
TBC
Element: category
TBC
Element: medication[x]
Populating the element
Can be either a dm+d code as a CodeableConcept or reference to UK Medication. CodeableConcept is preferred where no more information would be provided by reference to UK Core Medication.
Where a dm+d code exists it MUST be used either as CodeableConcept.coding
or as Medication.Medication.code
Where CodeableConcept is used CodeableConcept.coding
is dm+d code and CodeableConcept.text
is dm+d text. Where no dm+d code is available drug name can be provided as text as CodeableConcept.text
A Reference to UK Core Medication should only be used when there is additional information to record which is not explicit in CodeableConcept for example where:
- To specify a VTM with a specific form
- To record manufacture against VTM, VMP and VMP
- To record batch number
Element: subject
Normally this is provided by reference to a CareConnect Patient which must include the following if available:
Patient.Patient.identifier:nhsNumber
Patient.Patient.name
Patient.birthDate
Some use cases do not require the full detail provided by a reference to a CareConnect Patient when this is the case the patient may be identified using the child elements of MedicationStatement.subject
.
For example:
- Name
- NHS Number Hospital Number.
Developers should ensure that in the context of use that clinical safety issues are not created where multiple identifiers are not provided.
Element: context
TBC
Element: supportingInformation
TBC
Element: effective[x]
TBC
Element: performer
TBC
Element: notGiven
TBC
Element: reasonNotGiven
TBC
Element: reasonCode
TBC
Element: reasonReference
TBC
Element: prescription
TBC
Element: device
TBC
Element: note
TBC
Element: dosage
Preferable as a structured dosage according to FHIR dose Syntax Guidance but as a minimum MedicationStatement.dosage.text
.
View the R4 FHIR Dose Syntax Guidance
Element: eventHistory
TBC