Angefragte Medikation (MedicationRequest)
Motivation
Als Anfragender möchte ich angeben können, welche Medikation ich für einen Patienten anfragen möchte. Eine Einrichtung/ Person, die eine Verordnung anfragt nutzt dieses Profil, um strukturiert anzugeben, welche Medikation benötigt wird.
Hierzu muss in einem ERPServiceRequestPrescriptionRequest ein ERPServiceRequestMedicationRequest mit angegeben werden. Dieser enthält die medizinische Information, die der Verordnende benötigt, um ein entsprechendes Rezept auszustellen.
Die anzugebende Medication entspricht dabei den KBV Medication's, damit das PVS daraus eine Verordnung erstellen kann.
Da die KBV_PR_ERP_Prescription Informationen voraussetzt, die u.U. im Moment der Anfrage nicht bekannt sind, wurde dieses Profil spezifiziert. Es lehnt sich an die Spezifikation der KBV_PR_ERP_Prescription an, ist aber offener, erlaubt also auch dass die fehlenden Informationen nicht angegeben werden müssen.
Das PS der verordnenden LEI sollte die Informationen aus diesem Profil extrahieren und dann eine eigene KBV_PR_ERP_Prescription erstellen, die es dann in der Antwort nutzen kann.
Kompatibilität
Dieses Profil basiert auf dem Profil MedicationRequest der FHIR-Core Spezifikation (R4).
Profil
Die folgende FHIR Ressource stellt eine Ressource bereit, die als Trägerobjekt für medizinische Informationen dient. Sie ist an die KBV_PR_ERP_Prescription Profilierung angelehnt, um Informationen so einfach wie möglich in die Verordnung zu übernehmen.
Die Profilierung ist allerdings nicht so eng, da in der anfragenden Pflegeeinrichtung möglicherweise nicht alle Informationen vorliegen.
Das schreibende System übermittelt mit dieser Medikationsanfrage dem Verordnenden die Informationen zur gewünschten Medikation.
| ERPServiceRequestMedicationRequest (MedicationRequest) | I | MedicationRequest | Element idMedicationRequest Ordering of medication for patient or group Alternate namesPrescription, Order DefinitionAn order or request for both supply of the medication and the instructions for administration of the medication to a patient. The resource is called "MedicationRequest" rather than "MedicationPrescription" or "MedicationOrder" to generalize the use across inpatient and outpatient settings, including care plans, etc., and to harmonize with workflow patterns.
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| id | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. |
| meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idMedicationRequest.meta Metadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
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| implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idMedicationRequest.implicitRules A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
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| language | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.language Language of the resource content DefinitionThe base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). A human language.
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| text | 0..1 | Narrative | There are no (further) constraints on this element Element idMedicationRequest.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
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| contained | 0..* | Resource | There are no (further) constraints on this element Element idMedicationRequest.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
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| extension | S I | 0..* | Extension | Element idMedicationRequest.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. If the previous recipe ID is known, it can be named here Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| PriorPrescriptionID | S I | 0..1 | Extension(Identifier Profile for Prescription IDs (GEM_ERP_PR_PrescriptionId)) | Element idMedicationRequest.extension:PriorPrescriptionID Provide a previous PrescriptionID that corresponds to the requested medication. Alternate namesextensions, user content DefinitionThe MedicationRequest can contain a PrescriptionId of a prescription that has already been issued. If a previous prescription ID is known, the writing system MAY indicate this in the medication request. If this ID is available, the receiving system MUST be able to search for the previous regulation and give the user the opportunity to display and compare the content. Must be given in the form xxx.xxx.xxx.xxx.xxx.xx. Extension(Identifier Profile for Prescription IDs (GEM_ERP_PR_PrescriptionId)) Extension URLhttps://gematik.de/fhir/erp-servicerequest/StructureDefinition/prescription-id-ex Constraints
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| requestMVO | S ?! I | 0..1 | Extension(Complex) | Element idMedicationRequest.extension:requestMVO Multiple prescription order Alternate namesextensions, user content DefinitionAbbildung der Informationen im Rahmen einer Mehrfachverordnung If the prescription is should be a multiple prescription order. Only the 'Kennzeichen' should be stated, indicating that the prescription is requested to be a multiple prescription order. Extension(Complex) Extension URLhttps://fhir.kbv.de/StructureDefinition/KBV_EX_ERP_Multiple_Prescription Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.extension:requestMVO.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 1..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.extension:requestMVO.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Closed, by url(Value) Extensions are always sliced by (at least) url Constraints
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| Kennzeichen | S I | 1..1 | Extension | There are no (further) constraints on this element Element idMedicationRequest.extension:requestMVO.extension:Kennzeichen Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.extension:requestMVO.extension:Kennzeichen.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.extension:requestMVO.extension:Kennzeichen.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| url | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idMedicationRequest.extension:requestMVO.extension:Kennzeichen.url identifies the meaning of the extension DefinitionSource of the definition for the extension code - a logical name or a URL. The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Kennzeichen
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| value[x] | 1..1 | There are no (further) constraints on this element Element idMedicationRequest.extension:requestMVO.extension:Kennzeichen.value[x] Value of extension DefinitionValue of extension - must be one of a constrained set of the data types (see Extensibility for a list). Unordered, Closed, by $this(Type) Constraints
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| valueBoolean | 1..1 | boolean | There are no (further) constraints on this element Element idMedicationRequest.extension:requestMVO.extension:Kennzeichen.value[x]:valueBoolean Kennzeichen Mehrfachverordnung DefinitionAbbildung, ob die aktuelle Verordnung Teil einer Mehrfachverordnung ist true - die aktuelle Verordnung ist Teil einer Mehrfachverordnung false - die aktuelle Verordnung ist kein Teil einer Mehrfachverordnung
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| Nummerierung | I | 0..0 | Extension | There are no (further) constraints on this element Element idMedicationRequest.extension:requestMVO.extension:Nummerierung Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| Zeitraum | I | 0..0 | Extension | There are no (further) constraints on this element Element idMedicationRequest.extension:requestMVO.extension:Zeitraum Zeitraum der Einlösefrist Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| ID | I | 0..0 | Extension | There are no (further) constraints on this element Element idMedicationRequest.extension:requestMVO.extension:ID Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| url | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idMedicationRequest.extension:requestMVO.url identifies the meaning of the extension DefinitionSource of the definition for the extension code - a logical name or a URL. The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. https://fhir.kbv.de/StructureDefinition/KBV_EX_ERP_Multiple_Prescription
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| value[x] | 0..0 | There are no (further) constraints on this element Element idMedicationRequest.extension:requestMVO.value[x] Value of extension DefinitionValue of extension - must be one of a constrained set of the data types (see Extensibility for a list).
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| redeemByPatient | S ?! I | 0..1 | Extension(Identifier Profile for Prescription IDs (GEM_ERP_PR_PrescriptionId)) | Element idMedicationRequest.extension:redeemByPatient Redeem By Patient Alternate namesextensions, user content DefinitionOptional Extension Element - found in all resources. Indicates whether the prescription should be redeemed by the patient. Extension(Identifier Profile for Prescription IDs (GEM_ERP_PR_PrescriptionId)) Extension URLhttps://gematik.de/fhir/erp-servicerequest/StructureDefinition/prescription-id-ex Constraints
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| modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| identifier | 0..* | Identifier | There are no (further) constraints on this element Element idMedicationRequest.identifier External ids for this request DefinitionIdentifiers associated with this medication request that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server. This is a business identifier, not a resource identifier.
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| status | Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.status active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown DefinitionA code specifying the current state of the order. Generally, this will be active or completed state. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.
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| statusReason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idMedicationRequest.statusReason Reason for current status DefinitionCaptures the reason for the current state of the MedicationRequest. This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the MedicationRequest was created at all is captured in reasonCode, not here. Identifies the reasons for a given status.
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| intent | Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.intent proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option DefinitionWhether the request is a proposal, plan, or an original order. It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only. An instance-order is an instantiation of a request or order and may be used to populate Medication Administration Record. This element is labeled as a modifier because the intent alters when and how the resource is actually applicable. The kind of medication order.
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| category | 0..* | CodeableConcept | There are no (further) constraints on this element Element idMedicationRequest.category Type of medication usage DefinitionIndicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)). The category can be used to include where the medication is expected to be consumed or other types of requests. A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.
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| priority | Σ | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.priority routine | urgent | asap | stat DefinitionIndicates how quickly the Medication Request should be addressed with respect to other requests. Note that FHIR strings SHALL NOT exceed 1MB in size Identifies the level of importance to be assigned to actioning the request.
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| doNotPerform | Σ ?! | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationRequest.doNotPerform True if request is prohibiting action DefinitionIf true indicates that the provider is asking for the medication request not to occur. If do not perform is not specified, the request is a positive request e.g. "do perform".
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| reported[x] | Σ | 0..1 | There are no (further) constraints on this element Element idMedicationRequest.reported[x] Reported rather than primary record DefinitionIndicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the report.
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| reportedBoolean | boolean | There are no (further) constraints on this element Data type | ||
| reportedReference | Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization) | There are no (further) constraints on this element Data type Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization) | ||
| medication[x] | S Σ | 1..1 | Element idMedicationRequest.medication[x] Medication to be taken DefinitionIdentifies the medication being requested. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medications. If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the Medication resource is recommended. For example, if you require form or lot number or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource.
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| medicationReference | Reference(KBV_PR_ERP_Medication_PZN | KBV_PR_ERP_Medication_Compounding | KBV_PR_ERP_Medication_Ingredient | KBV_PR_ERP_Medication_FreeText) | Data type Reference(KBV_PR_ERP_Medication_PZN | KBV_PR_ERP_Medication_Compounding | KBV_PR_ERP_Medication_Ingredient | KBV_PR_ERP_Medication_FreeText) | ||
| subject | Σ I | 1..1 | Reference(Patient | Group) | There are no (further) constraints on this element Element idMedicationRequest.subject Who or group medication request is for DefinitionA link to a resource representing the person or set of individuals to whom the medication will be given. The subject on a medication request is mandatory. For the secondary use case where the actual subject is not provided, there still must be an anonymized subject specified.
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| encounter | I | 0..1 | Reference(Encounter) | There are no (further) constraints on this element Element idMedicationRequest.encounter Encounter created as part of encounter/admission/stay DefinitionThe Encounter during which this [x] was created or to which the creation of this record is tightly associated. This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter." If there is a need to link to episodes of care they will be handled with an extension.
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| supportingInformation | I | 0..* | Reference(Resource) | There are no (further) constraints on this element Element idMedicationRequest.supportingInformation Information to support ordering of the medication DefinitionInclude additional information (for example, patient height and weight) that supports the ordering of the medication. 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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| authoredOn | Σ | 0..1 | dateTime | There are no (further) constraints on this element Element idMedicationRequest.authoredOn When request was initially authored DefinitionThe date (and perhaps time) when the prescription was initially written or authored on.
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| requester | Σ I | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device) | There are no (further) constraints on this element Element idMedicationRequest.requester Who/What requested the Request DefinitionThe individual, organization, or device that initiated the request and has responsibility for its activation. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device) Constraints
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| performer | I | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam) | There are no (further) constraints on this element Element idMedicationRequest.performer Intended performer of administration DefinitionThe specified desired performer of the medication treatment (e.g. the performer of the medication administration). References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam) Constraints
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| performerType | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idMedicationRequest.performerType Desired kind of performer of the medication administration DefinitionIndicates the type of performer of the administration of the medication. If specified without indicating a performer, this indicates that the performer must be of the specified type. If specified with a performer then it indicates the requirements of the performer if the designated performer is not available. Identifies the type of individual that is desired to administer the medication.
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| recorder | I | 0..1 | Reference(Practitioner | PractitionerRole) | There are no (further) constraints on this element Element idMedicationRequest.recorder Person who entered the request DefinitionThe person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Practitioner | PractitionerRole) Constraints
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| reasonCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element idMedicationRequest.reasonCode Reason or indication for ordering or not ordering the medication DefinitionThe reason or the indication for ordering or not ordering the medication. This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference. A coded concept indicating why the medication was ordered.
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| reasonReference | I | 0..* | Reference(Condition | Observation) | There are no (further) constraints on this element Element idMedicationRequest.reasonReference Condition or observation that supports why the prescription is being written DefinitionCondition or observation that supports why the medication was ordered. This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode. Reference(Condition | Observation) Constraints
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| instantiatesCanonical | Σ | 0..* | canonical() | There are no (further) constraints on this element Element idMedicationRequest.instantiatesCanonical Instantiates FHIR protocol or definition DefinitionThe URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest.
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| instantiatesUri | Σ | 0..* | uri | There are no (further) constraints on this element Element idMedicationRequest.instantiatesUri Instantiates external protocol or definition DefinitionThe URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this MedicationRequest. see http://en.wikipedia.org/wiki/Uniform_resource_identifier
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| basedOn | Σ I | 0..* | Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation) | There are no (further) constraints on this element Element idMedicationRequest.basedOn What request fulfills DefinitionA plan or request that is fulfilled in whole or in part by this medication request. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation) Constraints
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| groupIdentifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationRequest.groupIdentifier Composite request this is part of DefinitionA shared identifier common to all requests that were authorized more or less simultaneously by a single author, representing the identifier of the requisition or prescription. Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.
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| courseOfTherapyType | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idMedicationRequest.courseOfTherapyType Overall pattern of medication administration DefinitionThe description of the overall patte3rn of the administration of the medication to the patient. This attribute should not be confused with the protocol of the medication. Identifies the overall pattern of medication administratio.
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| insurance | I | 0..* | Reference(Coverage | ClaimResponse) | There are no (further) constraints on this element Element idMedicationRequest.insurance Associated insurance coverage DefinitionInsurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Coverage | ClaimResponse) Constraints
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| note | 0..* | Annotation | There are no (further) constraints on this element Element idMedicationRequest.note Information about the prescription DefinitionExtra information about the prescription that could not be conveyed by the other attributes. For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).
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| dosageInstruction | 0..* | Dosage | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction How the medication should be taken DefinitionIndicates how the medication is to be used by the patient. There are examples where a medication request may include the option of an oral dose or an Intravenous or Intramuscular dose. For example, "Ondansetron 8mg orally or IV twice a day as needed for nausea" or "Compazine® (prochlorperazine) 5-10mg PO or 25mg PR bid prn nausea or vomiting". In these cases, two medication requests would be created that could be grouped together. The decision on which dose and route of administration to use is based on the patient's condition at the time the dose is needed.
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| dispenseRequest | S | 0..1 | BackboneElement | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest Medication supply authorization DefinitionIndicates the specific details for the dispense or medication supply part of a medication request (also known as a Medication Prescription or Medication Order). Note that this information is not always sent with the order. There may be in some settings (e.g. hospitals) institutional or system support for completing the dispense details in the pharmacy department.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| initialFill | 0..1 | BackboneElement | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill First fill details DefinitionIndicates the quantity or duration for the first dispense of the medication. If populating this element, either the quantity or the duration must be included.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| quantity | I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.quantity First fill quantity DefinitionThe amount or quantity to provide as part of the first dispense. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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| duration | I | 0..1 | Duration | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.duration First fill duration DefinitionThe length of time that the first dispense is expected to last. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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| dispenseInterval | I | 0..1 | Duration | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.dispenseInterval Minimum period of time between dispenses DefinitionThe minimum period of time that must occur between dispenses of the medication. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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| validityPeriod | I | 0..1 | Period | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.validityPeriod Time period supply is authorized for DefinitionThis indicates the validity period of a prescription (stale dating the Prescription). Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription. It reflects the prescribers' perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations.
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| numberOfRepeatsAllowed | 0..1 | unsignedInt | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.numberOfRepeatsAllowed Number of refills authorized DefinitionAn integer indicating the number of times, in addition to the original dispense, (aka refills or repeats) that the patient can receive the prescribed medication. Usage Notes: This integer does not include the original order dispense. This means that if an order indicates dispense 30 tablets plus "3 repeats", then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets. A prescriber may explicitly say that zero refills are permitted after the initial dispense. If displaying "number of authorized fills", add 1 to this number.
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| quantity | S I | 1..1 | SimpleQuantity | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.quantity Amount of medication to supply per dispense DefinitionThe amount that is to be dispensed for one fill. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.quantity.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.quantity.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| value | S Σ | 1..1 | decimal | Element idMedicationRequest.dispenseRequest.quantity.value Number of packs prescribed DefinitionNumber of packs prescribed Precision is handled implicitly in almost all cases of measurement. The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).
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| comparator | Σ ?! | 0..0 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.quantity.comparator < | <= | >= | > - how to understand the value DefinitionNot allowed to be used in this context Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. Note that FHIR strings SHALL NOT exceed 1MB in size If there is no comparator, then there is no modification of the value How the Quantity should be understood and represented.
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| unit | Σ | 0..0 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.quantity.unit Unit representation DefinitionA human-readable form of the unit. There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms. Note that FHIR strings SHALL NOT exceed 1MB in size
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| system | S Σ I | 1..1 | uriFixed Value | Element idMedicationRequest.dispenseRequest.quantity.system System that defines coded unit form DefinitionThe identification of the system that provides the coded form of the unit. Need to know the system that defines the coded form of the unit. see http://en.wikipedia.org/wiki/Uniform_resource_identifier
http://unitsofmeasure.org
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| code | S Σ | 1..1 | codeFixed Value | Element idMedicationRequest.dispenseRequest.quantity.code Coded form of the unit DefinitionA computer processable form of the unit in some unit representation system. Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.
{Package}
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| expectedSupplyDuration | I | 0..1 | Duration | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.expectedSupplyDuration Number of days supply per dispense DefinitionIdentifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last. In some situations, this attribute may be used instead of quantity to identify the amount supplied by how long it is expected to last, rather than the physical quantity issued, e.g. 90 days supply of medication (based on an ordered dosage). When possible, it is always better to specify quantity, as this tends to be more precise. expectedSupplyDuration will always be an estimate that can be influenced by external factors.
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| performer | I | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.performer Intended dispenser DefinitionIndicates the intended dispensing Organization specified by the prescriber. 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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| substitution | 0..1 | BackboneElement | There are no (further) constraints on this element Element idMedicationRequest.substitution Any restrictions on medication substitution DefinitionIndicates whether or not substitution can or should be part of the dispense. In some cases, substitution must happen, in other cases substitution must not happen. This block explains the prescriber's intent. If nothing is specified substitution may be done.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.substitution.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.substitution.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.substitution.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| allowed[x] | 1..1 | There are no (further) constraints on this element Element idMedicationRequest.substitution.allowed[x] Whether substitution is allowed or not DefinitionTrue if the prescriber allows a different drug to be dispensed from what was prescribed. This element is labeled as a modifier because whether substitution is allow or not, it cannot be ignored. Identifies the type of substitution allowed.
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| allowedBoolean | boolean | There are no (further) constraints on this element Data type | ||
| allowedCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||
| reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idMedicationRequest.substitution.reason Why should (not) substitution be made DefinitionIndicates the reason for the substitution, or why substitution must or must not be performed. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
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| priorPrescription | I | 0..1 | Reference(MedicationRequest) | There are no (further) constraints on this element Element idMedicationRequest.priorPrescription An order/prescription that is being replaced DefinitionA link to a resource representing an earlier order related order or prescription. 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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| detectedIssue | I | 0..* | Reference(DetectedIssue) | There are no (further) constraints on this element Element idMedicationRequest.detectedIssue Clinical Issue with action Alternate namesContraindication, Drug Utilization Review (DUR), Alert DefinitionIndicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etc. This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.
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| eventHistory | I | 0..* | Reference(Provenance) | There are no (further) constraints on this element Element idMedicationRequest.eventHistory A list of events of interest in the lifecycle DefinitionLinks to Provenance records for past versions of this resource or fulfilling request or event resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resource. This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).
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Folgende Felder sind entsprechend zu befüllen, bzw. können befüllt werden:
| id | short | comment |
|---|---|---|
| MedicationRequest | ||
| MedicationRequest.extension | If the previous recipe ID is known, it can be named here | |
| MedicationRequest.extension:PriorPrescriptionID | Provide a previous PrescriptionID that corresponds to the requested medication. | Must be given in the form xxx.xxx.xxx.xxx.xxx.xx. |
| MedicationRequest.extension:requestMVO | Multiple prescription order | If the prescription is should be a multiple prescription order. Only the 'Kennzeichen' should be stated, indicating that the prescription is requested to be a multiple prescription order. |
| MedicationRequest.extension:requestMVO.extension:Kennzeichen | ||
| MedicationRequest.extension:requestMVO.extension:Nummerierung | ||
| MedicationRequest.extension:requestMVO.extension:Zeitraum | ||
| MedicationRequest.extension:requestMVO.extension:ID | ||
| MedicationRequest.extension:redeemByPatient | Redeem By Patient | Indicates whether the prescription should be redeemed by the patient. |
| MedicationRequest.medication[x] | ||
| MedicationRequest.dispenseRequest | ||
| MedicationRequest.dispenseRequest.quantity | ||
| MedicationRequest.dispenseRequest.quantity.value | Number of packs prescribed | |
| MedicationRequest.dispenseRequest.quantity.unit | ||
| MedicationRequest.dispenseRequest.quantity.system | ||
| MedicationRequest.dispenseRequest.quantity.code |
Use-Case spezifische Anforderungen
- Für
medicationReferenceMUSS das Profil KBV_PR_ERP_Medication_FreeText, KBV_PR_ERP_Medication_Compounding, KBV_PR_ERP_Medication_PZN oder KBV_PR_ERP_Medication_Ingredient verwendet werden. - Für
subjectMUSS das Profil KBV_PR_FOR_Patient verwendet werden. - Für
requesterMUSS das Profil KBV_PR_FOR_Practitioner oder ERPServiceRequestOrganization verwendet werden. - Für
insuranceMUSS das Profil KBV_PR_FOR_Coverage verwendet werden.
Beispiel
Valides Beispiel einer Verordnungsanfrage:
{ "resourceType": "MedicationRequest", "id": "Example-Initial-Medication-Request", "meta": { "profile": [ "https://gematik.de/fhir/erp-servicerequest/StructureDefinition/erp-service-request-medication-request" ] }, "extension": [ { "valueIdentifier": { "system": "https://gematik.de/fhir/erp/NamingSystem/GEM_ERP_NS_PrescriptionId", "value": "160.100.000.000.001.36" }, "url": "https://gematik.de/fhir/erp-servicerequest/StructureDefinition/prescription-id-ex" } ], "dispenseRequest": { "quantity": { "system": "http://unitsofmeasure.org", "code": "{Package}", "value": 1 } }, "status": "active", "intent": "order", "medicationReference": { "reference": "Medication/Example-Initial-Medication" }, "subject": { "reference": "Patient/Example-Patient" }, "authoredOn": "2022-05-20", "dosageInstruction": [ { "text": "2mal tägl. 5ml" } ], "substitution": { "allowedBoolean": true } }