MedicationRequest

• dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
  contained.contained.empty()
• dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
  contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
• dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
  contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
• dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
  contained.meta.security.empty()
• dom-6: A resource should have narrative for robust management
  text.`div`.exists()

• rim: Entity, Role, or Act,CombinedMedicationRequest
• workflow: Request
• script10.6: Message/Body/NewRx
• w5: clinical.medication

Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

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 its narrative along with other profiles, value sets, etc.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

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).

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

Contained resources do not have a 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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: Act.text?

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.

• rim: N/A

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: N/A

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: N/A

This is a business identifier, not a resource identifier.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• workflow: Request.identifier
• script10.6: Message/Header/PrescriberOrderNumber
• w5: FiveWs.identifier
• v2: ORC-2-Placer Order Number / ORC-3-Filler Order Number
• rim: .id

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• workflow: Request.basedOn
• rim: .outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• workflow: Request.replaces
• script10.6: not mapped
• rim: .outboundRelationship[typeCode=?RPLC or ?SUCC]/target[classCode=SBADM,moodCode=RQO]

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• workflow: Request.groupIdentifier
• rim: .outboundRelationship(typeCode=COMP].target[classCode=SBADM, moodCode=INT].id

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Clinical decision support systems should take the status into account when determining which medications to include in their algorithms.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• workflow: Request.status
• script10.6: no mapping
• w5: FiveWs.status
• rim: .statusCode

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• workflow: Request.statusReason
• rim: .inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: subjectOf Observation[code = statusChange].value = date

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• workflow: Request.intent
• w5: FiveWs.class
• rim: .moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)

The category can be used to include where the medication is expected to be consumed or other types of requests. The examplar value set represents where the meds are intended to be administered and is just one example of request categorization.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• script10.6: Message/Body/NewRx/MedicationPrescribed/Directions or Message/Body/NewRx/MedicationPrescribed/StructuredSIG
• w5: FiveWs.class
• rim: .inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication usage"].value

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• workflow: Request.priority
• w5: FiveWs.grade
• rim: .priorityCode

If do not perform is not specified, the request is a positive request e.g. "do perform".

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: SubstanceAdministration.actionNegationInd

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• workflow: Request.code
• script10.6: Message/Body/NewRx/MedicationPrescribed Medication.code.coding.code = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCode Medication.code.coding.system = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCodeQualifier Medication.code.coding.display = Message/Body/NewRx/MedicationPrescribed/DrugDescription
• w5: FiveWs.what[x]
• v2: RXE-2-Give Code / RXO-1 Requested Give Code / RXC-2 Component Code
• rim: consumable.administrableMedication

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: N/A

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: N/A

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• workflow: Request.subject
• script10.6: Message/Body/NewRx/Patient (need detail to link to specific patient … Patient.Identification in SCRIPT)
• w5: FiveWs.subject[x]
• v2: PID-3 Patient ID List
• rim: .participation[typeCode=AUT].role

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: .participation[typeCode=INF].role[classCode=PAT, or codes for Practitioner or Related Person or Practitioner Role or Organization

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• workflow: Request.encounter
• script10.6: no mapping
• w5: FiveWs.context
• v2: PV1-19 Visit Number
• rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]

This attribute can be used to reference a MedicationStatement about the patients' medication use.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• workflow: Request.supportingInfo
• w5: FiveWs.context
• rim: .outboundRelationship[typeCode=PERT].target[A_SupportingClinicalStatement CMET minimal with many different choices of classCodes(ORG, ENC, PROC, SPLY, SBADM, OBS) and each of the act class codes draws from one or more of the following moodCodes (EVN, DEF, INT PRMS, RQO, PRP, APT, ARQ, GOL)]

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• workflow: Request.authoredOn
• script10.6: Message/Body/NewRx/MedicationPrescribed/WrittenDate
• w5: FiveWs.recorded
• v2: RXE-32 Original Order Date/Time / ORC-9-Date Time of Transaction
• rim: author.time

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• workflow: Request.requester
• w5: FiveWs.author
• rim: .participation[typeCode=AUT].role

If not populated, then assume that this is the original record and not reported

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: .participation[typeCode=INF].role

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• workflow: Request.performerType
• rim: .participation[typeCode=PRF].role[scoper.determinerCode=KIND].code

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• workflow: Request.performer
• w5: FiveWs.actor
• rim: .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• w5: FiveWs.who
• rim: .participation[typeCode=TRANS].role[classCode=ASSIGNED].code (HealthcareProviderType)

This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• workflow: Request.reason
• script10.6: Message/Body/NewRx/MedicationPrescribed/Diagnosis/Primary/Value
• w5: FiveWs.why[x]
• v2: ORC-16 Order Control Code Reason /RXE-27 Give Indication/RXO-20-Indication / RXD-21 Indication / RXG-22 Indication / RXA-19 Indication
• rim: reason.observation.reasonCode | reason.observation[code=ASSERTION].value

This attribute should not be confused with the protocol of the medication.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: Act.code where classCode = LIST and moodCode = EVN

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• workflow: Request.insurance
• rim: .outboundRelationship[typeCode=COVBY].target

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• workflow: Request.note
• script10.6: Message/Body/NewRx/MedicationPrescribed/Note
• rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=OBS,moodCode=EVN,code="annotation"].value

The content of the renderedDosageInstructions must not be different than the dose represented in the dosageInstruction content.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: SubstanceAdministration.text

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: substanceAdministration.effectiveTime

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. In general, each prescribed drug will be a separate Medication Request.

When drug orders are grouped together at the time of order entry, but each of the drugs can be manipulated independently e.g. changing the status of one order to "completed" or "cancelled", changing another order status to "on-hold", the method to "group" all of the medication requests together is to use MedicationRequest.groupIdentifier element. All of the orders grouped together in this manner will have the same groupIdentifier, and separately, each order in the group may have a unique identifier.

There are cases that require grouping of Medication orders together when it is necessary to specify optionality e.g. order two drugs at one time, but stating either of these drugs may be used to treat the patient. The use of a RequestOrchestration should be used as a parent for the Medication orders that require this type of grouping. An example when it may be necessary to group medication orders together is when you specify timing relationships e.g. order drug "xyz" with dose 123, then taper the same drug to a different dose after some interval of time precedence: e.g. give drug "abc" followed by drug "def" e.g. give drug 30 minutes before some procedure was performed more generically this supports - hierarchical groups of actions, where each specific action references the action to be performed (in terms of a Request resource), and each group describes additional behavior, relationships, and applicable conditions between the actions in the overall group. Note that one should NOT use the List or Composition resource to accomplish the above requirements. You may use List or Composition for other business requirements, but not to address the specific requirements of grouping medication orders.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: see dosageInstruction mapping

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: N/A

If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: TQ1-1
• rim: .text

Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. Additional information about administration or preparation of the medication should be included as text.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: RXO-6; RXE-21
• rim: .text

Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.

Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or take "immediately following drug x") should be populated in dosage.text.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: RXO-7
• rim: .text

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: RXO-7
• rim: .text

The timing schedule for giving the medication to the patient. This data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: .effectiveTime

Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: TQ1-9
• rim: .outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept

Can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be False, then the dose is given according to the schedule and is not "prn" or "as needed".

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: TQ1-9
• rim: .outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept

A coded specification of the anatomic site where the medication first enters the body.

If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension http://hl7.org/fhir/StructureDefinition/bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: RXR-2
• rim: .approachSiteCode

A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: RXR-1
• rim: .routeCode

A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.

Terminologies used often pre-coordinate this term with the route and or form of administration.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: RXR-4
• rim: SubstanceAdministration.methodCode

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: TQ1-2
• rim: SubstanceAdministration.doseQuantity; SubstanceAdministration.RateQuantity

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a

If the type is not populated, assume to be "ordered".

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: RXO-21; RXE-23

The amount of therapeutic or other substance given at one administration event.

Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: RXO-2, RXE-3
• rim: .doseQuantity

Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.

It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammar where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: RXE22, RXE23, RXE-24
• rim: .rateQuantity

The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.

This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• v2: RXO-23, RXE-19
• rim: .maxDoseQuantity

The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.

This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: not supported

The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: not supported

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• script10.6: Message/Body/NewRx/MedicationPrescribed/ExpirationDate
• rim: component.supplyEvent

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: N/A

If populating this element, either the quantity or the duration must be included.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: SubstanceAdministration -> ActRelationship[sequenceNumber = '1'] -> Supply

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: N/A

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: Supply.quantity[moodCode=RQO]

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: Supply.effectivetime[moodCode=RQO]

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: Supply.effectivetime[moodCode=RQO]

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• script10.6: Message/Body/NewRx/MedicationPrescribed/Refills
• rim: effectiveTime

If displaying "number of authorized fills", add 1 to this number.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• script10.6: Message/Body/NewRx/MedicationPrescribed/Quantity
• v2: RXE-12 Number of Refills
• rim: repeatNumber

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• script10.6: Message/Body/NewRx/MedicationPrescribed/DaysSupply
• v2: RXD-4 Actual Dispense Amount / RXD-5.1 Actual Dispense Units.code / RXD-5.3 Actual Dispense Units.name of coding system
• rim: quantity

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• script10.6: Message/Body/NewRx/MedicationPrescribed/Substitutions
• rim: expectedUseTime

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• w5: FiveWs.who
• rim: .outboundRelationship[typeCode=COMP].target[classCode=SPLY, moodCode=RQO] .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: Supply.text

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• rim: Supply.administerableMedication.product.asContent.container.code

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• script10.6: specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions
• rim: subjectOf.substitutionPersmission

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: N/A

This element is labeled as a modifier because whether substitution is allow or not, it cannot be ignored.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• script10.6: specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions
• v2: RXO-9 Allow Substitutions / RXE-9 Substitution Status
• rim: code

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• script10.6: not mapped
• v2: RXE-9 Substition status
• rim: reasonCode

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.).

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())

• workflow: Request.relevantHistory
• rim: .inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]