Medication Administration
The resource TrustcenterMedicationAdministration is a modified resource of the profile MedicationAdministration and represents e.g. the administration of a medication. It consists of the elements identifier, status, medication, subject and effective. If a summary is requested with the command summary=true, all these elements are displayed.
Properties and constraints
There must be at least one (1..*) identifier of type Identifier. This can and must be specialized in this case by specifying exactly one (1..1) officialIdentifier (fixed values: use = official). However, other identifiers can be defined, e.g. with the use usual, temp, secondary or old. In addition, the officialIdentifier is marked as must support, therefore the later implementation should be able to process this meaningfully.
The attributes status, medication, subject and effective are already stipulated by the super resource and must be specified exactly once. Thereby, status and subject are of the type code and Reference (data type that references an existing resource, e.g. patient), whereas medication and effective can have two different data types or even a composite data type.
status specifies the status of the medication, where its values must come from a specific value set (binding-strength = required). Here, they come from the set medication-admin-status. subject specifies who receives the medication (person, animal, group, etc.). The instance also has different possibilities to be specified here, e.g. as reference, type or identifier.
medication specifies the medication that was administered. This can be instantiated either as a code of type CodeableConcept or/and as a reference to the resource Medication.
effective specifies the time at which the medication was administered. This can be instantiated either as dateTime or/and as Period.
| MedicationAdministration | I | MedicationAdministration | There are no (further) constraints on this element Element idMedicationAdministration Administration of medication to a patient DefinitionDescribes 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.
| |
| id | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationAdministration.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 idMedicationAdministration.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.
|
| implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idMedicationAdministration.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.
|
| language | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationAdministration.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.
| |
| text | 0..1 | Narrative | There are no (further) constraints on this element Element idMedicationAdministration.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.
| |
| contained | 0..* | Resource | There are no (further) constraints on this element Element idMedicationAdministration.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.
| |
| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationAdministration.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
| modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationAdministration.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
|
| identifier | 1..* | Identifier | Element idMedicationAdministration.identifier External identifier DefinitionIdentifiers associated with this Medication Administration that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server. This is a business identifier, not a resource identifier. Unordered, Open, by use(Value) Constraints
| |
| officialIdentifier | S | 1..1 | Identifier | There are no (further) constraints on this element Element idMedicationAdministration.identifier:officialIdentifier External identifier DefinitionIdentifiers associated with this Medication Administration that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server. This is a business identifier, not a resource identifier.
|
| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationAdministration.identifier:officialIdentifier.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.
| |
| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationAdministration.identifier:officialIdentifier.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
|
| use | Σ ?! | 1..1 | codeBindingFixed Value | Element idMedicationAdministration.identifier:officialIdentifier.use usual | official | temp | secondary | old (If known) DefinitionThe purpose of this identifier. Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Identifies the purpose for this identifier, if known .
official
|
| type | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationAdministration.identifier:officialIdentifier.type Description of identifier DefinitionA coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Allows users to make use of identifiers when the identifier system is not known. This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
|
| system | Σ | 0..1 | uri | There are no (further) constraints on this element Element idMedicationAdministration.identifier:officialIdentifier.system The namespace for the identifier value DefinitionEstablishes the namespace for the value - that is, a URL that describes a set values that are unique. There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. Identifier.system is always case sensitive.
General http://www.acme.com/identifiers/patient Mappings
|
| value | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationAdministration.identifier:officialIdentifier.value The value that is unique DefinitionThe portion of the identifier typically relevant to the user and which is unique within the context of the system. If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
General 123456 Mappings
|
| period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element idMedicationAdministration.identifier:officialIdentifier.period Time period when id is/was valid for use DefinitionTime period during which identifier is/was valid for use. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration.
|
| assigner | Σ I | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element idMedicationAdministration.identifier:officialIdentifier.assigner Organization that issued id (may be just text) DefinitionOrganization that issued/manages the identifier. The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
|
| instantiates | Σ | 0..0 | uri | There are no (further) constraints on this element Element idMedicationAdministration.instantiates Instantiates protocol or definition DefinitionA protocol, guideline, orderset, or other definition that was adhered to in whole or in part by this event. see http://en.wikipedia.org/wiki/Uniform_resource_identifier
|
| partOf | Σ I | 0..0 | Reference(MedicationAdministration | Procedure) | There are no (further) constraints on this element Element idMedicationAdministration.partOf Part of referenced event DefinitionA larger event of which this particular event is a component or step. 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(MedicationAdministration | Procedure) Constraints
|
| status | Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idMedicationAdministration.status in-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown DefinitionWill 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. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. A set of codes indicating the current status of a MedicationAdministration.
|
| statusReason | 0..0 | CodeableConcept | There are no (further) constraints on this element Element idMedicationAdministration.statusReason Reason administration not performed DefinitionA code indicating why the administration was not 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 set of codes indicating the reason why the MedicationAdministration is negated.
| |
| category | 0..0 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationAdministration.category Type of medication usage DefinitionIndicates where the medication is expected to be consumed or administered. 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 where the medication administered is expected to occur.
| |
| medication[x] | Σ | 1..1 | There are no (further) constraints on this element Element idMedicationAdministration.medication[x] What was administered DefinitionIdentifies 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. 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. Codes identifying substance or product that can be administered.
| |
| medicationCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||
| medicationReference | Reference(Medication) | There are no (further) constraints on this element Data type | ||
| subject | Σ I | 1..1 | Reference(Patient | Group) | There are no (further) constraints on this element Element idMedicationAdministration.subject Who received medication DefinitionThe person or animal or group receiving 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.
|
| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationAdministration.subject.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
| |
| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedicationAdministration.subject.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
| reference | Σ I | 0..1 | string | There are no (further) constraints on this element Element idMedicationAdministration.subject.reference Literal reference, Relative, internal or absolute URL DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
|
| type | Σ | 0..1 | uriBinding | There are no (further) constraints on this element Element idMedicationAdministration.subject.type Type the reference refers to (e.g. "Patient") DefinitionThe expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Aa resource (or, for logical models, the URI of the logical model).
|
| identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationAdministration.subject.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
|
| display | Σ | 0..0 | string | There are no (further) constraints on this element Element idMedicationAdministration.subject.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
|
| context | I | 0..0 | Reference(Encounter | EpisodeOfCare) | There are no (further) constraints on this element Element idMedicationAdministration.context Encounter or Episode of Care administered as part of DefinitionThe visit, admission, or other contact between patient and health care provider during which the medication administration was performed. 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(Encounter | EpisodeOfCare) Constraints
|
| supportingInformation | I | 0..0 | Reference(Resource) | There are no (further) constraints on this element Element idMedicationAdministration.supportingInformation Additional information to support administration DefinitionAdditional information (for example, patient height and weight) that supports the administration 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.
|
| effective[x] | Σ | 1..1 | There are no (further) constraints on this element Element idMedicationAdministration.effective[x] Start and end time of administration DefinitionA 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.
| |
| effectiveDateTime | dateTime | There are no (further) constraints on this element Data type | ||
| effectivePeriod | Period | There are no (further) constraints on this element Data type | ||
| performer | Σ | 0..0 | BackboneElement | There are no (further) constraints on this element Element idMedicationAdministration.performer Who performed the medication administration and what they did DefinitionIndicates who or what performed the medication administration and how they were involved.
|
| reasonCode | 0..0 | CodeableConcept | There are no (further) constraints on this element Element idMedicationAdministration.reasonCode Reason administration performed DefinitionA code indicating why the medication was given. 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 set of codes indicating the reason why the MedicationAdministration was made.
| |
| reasonReference | I | 0..0 | Reference(Condition | Observation | DiagnosticReport) | There are no (further) constraints on this element Element idMedicationAdministration.reasonReference Condition or observation that supports why the medication was administered DefinitionCondition or observation that supports why the medication was administered. This is a reference to a condition that is the reason for the medication request. If only a code exists, use reasonCode. Reference(Condition | Observation | DiagnosticReport) Constraints
|
| request | I | 0..0 | Reference(MedicationRequest) | There are no (further) constraints on this element Element idMedicationAdministration.request Request administration performed against DefinitionThe original request, instruction or authority to perform the administration. This is a reference to the MedicationRequest where the intent is either order or instance-order. It should not reference MedicationRequests where the intent is any other value.
|
| device | I | 0..0 | Reference(Device) | There are no (further) constraints on this element Element idMedicationAdministration.device Device used to administer DefinitionThe device used in administering the medication to the patient. For example, a particular infusion pump. 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.
|
| note | 0..0 | Annotation | There are no (further) constraints on this element Element idMedicationAdministration.note Information about the administration DefinitionExtra information about the medication administration that is not 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).
| |
| dosage | I | 0..0 | BackboneElement | There are no (further) constraints on this element Element idMedicationAdministration.dosage Details of how medication was taken DefinitionDescribes the medication dosage information details e.g. dose, rate, site, route, etc.
|
| eventHistory | I | 0..0 | Reference(Provenance) | There are no (further) constraints on this element Element idMedicationAdministration.eventHistory A list of events of interest in the lifecycle DefinitionA summary of the events of interest that have occurred, such as when the administration was verified. 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.
|