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Pan-Canadian Patient Summary (2.2.0-ti-ballot)

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    1. Index
    2. FHIR Artifacts
    3. MedicationRequest (PS-CA)

ti-ballot - For a full list of available versions, see the Directory of published versions

Releases of the PS-CA Implementation Guide may be found on a table on the Home Page of this Project.

MedicationRequest (PS-CA)

Links

Profile

medicationrequest-ca-ps

Derived from

http://hl7.org/fhir/StructureDefinition/MedicationRequest

Examples

nystatinCCDD-request-example, simvastatin-request-example

Description

This profile represents the constraints applied to the MedicationRequest resource by the PS-CA project and allows for cross-border and cross-jurisdiction sharing of information record of a medication request information in the patient summary.

References to this resource

CompositionPSCA

Resource Content

  • Tree view
  • Overview
  • XML
  • JSON
MedicationRequestPSCA (MedicationRequest)CMedicationRequestElement id
MedicationRequest
Short description

Ordering of medication for patient or group

Alternate names

Prescription, Order

Definition

An 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.

Comments

Jurisdictions mapping prescription data into FHIR profiles for the patient summary should support the MedicationRequest resource. Use of the MedicationStatement profile should be reserved for communicating a statement about the patient's usage of the medication that is ultimately provided by a patient, significant other, or a clinician.

The MedicationRequest resource is not included in the current (as of November 2021) published release of IPS (release 1.0.0, STU1), but is in the development preview of the next release.

Data type

MedicationRequest

Constraints
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.empty()
  • dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
  • dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim: Entity. Role, or Act
  • workflow: Request
  • script10.6: Message/Body/NewRx
  • rim: CombinedMedicationRequest
idΣ0..1string
There are no (further) constraints on this element
Element id
MedicationRequest.id
Short description

Logical id of this artifact

Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

Data type

string

metaΣ0..1Meta
There are no (further) constraints on this element
Element id
MedicationRequest.meta
Short description

Metadata about the resource

Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Data type

Meta

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
implicitRulesΣ ?!0..1uri
There are no (further) constraints on this element
Element id
MedicationRequest.implicitRules
Short description

A set of rules under which this content was created

Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Data type

uri

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
language0..1codeBinding
There are no (further) constraints on this element
Element id
MedicationRequest.language
Short description

Language of the resource content

Definition

The base language in which the resource is written.

Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Data type

code

Binding

A human language.

CommonLanguages (preferred)

Binding extensions
maxValueSetAllLanguages
Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
text0..1Narrative
There are no (further) constraints on this element
Element id
MedicationRequest.text
Short description

Text summary of the resource, for human interpretation

Alternate names

narrative, html, xhtml, display

Definition

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

Data type

Narrative

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
contained0..*Resource
There are no (further) constraints on this element
Element id
MedicationRequest.contained
Short description

Contained, inline Resources

Alternate names

inline resources, anonymous resources, contained resources

Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Data type

Resource

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
extensionC0..*ExtensionElement id
MedicationRequest.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
RenderedDosageInstructionC0..1Extension(string)Element id
MedicationRequest.extension:RenderedDosageInstruction
Short description

Extension for representing rendered dosage instruction.

Alternate names

extensions, user content

Definition

A free form textual specification generated from the input specifications as created by the provider. This is made up of either an 'Ad-hoc instruction' or 'Textual rendition of the structured dosage lines', plus route, dosage unit, and other pertinent administration information specified by the provider.

Comments

Use of structured fields for dosage instructions is heavily encouraged by this specification to promote interoperability of patient summaries. However, this extension is provided to make implementers aware that legacy medication data may come from some systems in this format. This extension is used by PrescribeIT implementations when the system has difficulty sending very complex dosage instructions in the form of structured data. Implementers are encouraged to read the PrescribeIT Specification (https://specs.prescribeit.ca/R5.0/erx/extension-ext-medication-rendered-dosage.html) to understand the context around its use.

Data type

Extension(string)

Extension URL

http://prescribeit.ca/fhir/StructureDefinition/ext-rendered-dosage-instruction

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
modifierExtension?! C0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.modifierExtension
Short description

Extensions that cannot be ignored

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
identifier0..*Identifier
There are no (further) constraints on this element
Element id
MedicationRequest.identifier
Short description

External ids for this request

Definition

Identifiers 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.

Comments

This is a business identifier, not a resource identifier.

Data type

Identifier

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Request.identifier
  • script10.6: Message/Header/PrescriberOrderNumber
  • w5: FiveWs.identifier
  • v2: ORC-2-Placer Order Number / ORC-3-Filler Order Number
  • rim: .id
statusSO Σ ?!1..1codeBindingElement id
MedicationRequest.status
Short description

active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown

Definition

A code specifying the current state of the order. Generally, this will be active or completed state.

Comments

In the scope of the IPS the entered-in-error concept is not allowed.

Data type

code

Binding

A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.

medicationrequest Status (required)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.status
  • script10.6: no mapping
  • w5: FiveWs.status
  • rim: .statusCode
Obligations
CodeActor
SHALL:populatehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer
SHALL:no-errorhttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
SHALL:handlehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
SHOULD:displayhttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
statusReason0..1CodeableConcept
There are no (further) constraints on this element
Element id
MedicationRequest.statusReason
Short description

Reason for current status

Definition

Captures the reason for the current state of the MedicationRequest.

Comments

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.

Data type

CodeableConcept

Binding

Identifies the reasons for a given status.

medicationRequest Status Reason Codes (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Request.statusReason
  • rim: .inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde
intentΣ ?!1..1codeBindingElement id
MedicationRequest.intent
Short description

proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option

Definition

Whether the request is a proposal, plan, or an original order.

Comments

This element is considered mandatory in the Base FHIR R4 Specification.

Base R4 Note: 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.

Data type

code

Binding

The kind of medication order.

medicationRequest Intent (required)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.intent
  • w5: FiveWs.class
  • rim: .moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)
category0..*CodeableConcept
There are no (further) constraints on this element
Element id
MedicationRequest.category
Short description

Type of medication usage

Definition

Indicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).

Comments

The category can be used to include where the medication is expected to be consumed or other types of requests.

Data type

CodeableConcept

Binding

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.

medicationRequest Category Codes (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • 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
priorityΣ0..1codeBinding
There are no (further) constraints on this element
Element id
MedicationRequest.priority
Short description

routine | urgent | asap | stat

Definition

Indicates how quickly the Medication Request should be addressed with respect to other requests.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data type

code

Binding

Identifies the level of importance to be assigned to actioning the request.

RequestPriority (required)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.priority
  • w5: FiveWs.grade
  • rim: .priorityCode
doNotPerformΣ ?!0..1booleanPatternElement id
MedicationRequest.doNotPerform
Short description

True if request is prohibiting action

Definition

If true indicates that the provider is asking for the medication request not to occur.

Comments

In the scope of the PSCA MedicationRequest, the doNotPerform concept is not allowed to be set to true. Other sections may be used to convey medications that a patient should or will not take.

Data type

boolean

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Pattern
false
Mappings
  • rim: n/a
  • rim: SubstanceAdministration.actionNegationInd
reported[x]Σ0..1
There are no (further) constraints on this element
Element id
MedicationRequest.reported[x]
Short description

Reported rather than primary record

Definition

Indicates 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.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .participation[typeCode=INF].role
reportedBooleanboolean
There are no (further) constraints on this element
Data type

boolean

reportedReferenceReference(Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
There are no (further) constraints on this element
Data type

Reference(Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)

medication[x]SO Σ1..1BindingElement id
MedicationRequest.medication[x]
Short description

Medication to be taken

Definition

Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code. To improve global interoperability is strongly encouraged that the reference to a medication resource is used, limiting the usage of the medicationCodeableConcept only to the cases in which no other information than a simple code is available.

Comments

If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the Medication resource is recommended. For example, if you require form or lot number or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource.

Binding

A coded concept identifying substance or product that can be ordered.

PrescriptionMedicinalProduct (preferred)

Additional bindings
  • LicensedNaturalHealthProducts (candidate)

    All Natural Product Number (NPN) and Homeopathic Medicine Number (DIN-HM) codes that are licensed by Health Canada and present in the Licensed Natural Health Products Database.

  • WhoAtcUvIps (candidate)

    WHO ATC classification.

  • MedicationsUvIps (candidate)

    SNOMED CT medications (Medicinal product)

  • DIN (candidate)

    Health Canada Drug Identification Number set.

  • PharmaceuticalBiologicProductAndSubstanceCode (candidate)

    per PCHDCF: The alternate value set can be used for the international use case where the medication is not available in Canada and therefore does not appear in the recommended pan-Canadian value sets

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • 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
Obligations
CodeActor
SHALL:populatehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer
SHALL:no-errorhttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
SHALL:handlehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
SHOULD:displayhttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
medicationCodeableConceptCodeableConceptMedicationPSCAData type

CodeableConceptMedicationPSCA

medicationReferenceReference(MedicationPSCA)Data type

Reference(MedicationPSCA)

subjectSO Σ C1..1Reference(PatientPSCA)Element id
MedicationRequest.subject
Short description

Who or group medication request is for

Definition

A link to a resource representing the person or set of individuals to whom the medication will be given.

Comments

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.

Data type

Reference(PatientPSCA)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: 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
  • w5: FiveWs.subject
Obligations
CodeActor
SHALL:populatehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer
SHALL:no-errorhttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
SHALL:handlehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
SHOULD:displayhttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
id0..1string
There are no (further) constraints on this element
Element id
MedicationRequest.subject.id
Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings
  • rim: n/a
extensionC0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.subject.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
referenceSO Σ C1..1stringElement id
MedicationRequest.subject.reference
Short description

Literal reference, Relative, internal or absolute URL

Definition

A 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.

Comments

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.

Data type

string

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1, ref-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Obligations
CodeActor
SHALL:populatehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer
SHALL:no-errorhttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
SHALL:handlehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
SHOULD:displayhttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
typeΣ0..1uriBinding
There are no (further) constraints on this element
Element id
MedicationRequest.subject.type
Short description

Type the reference refers to (e.g. "Patient")

Definition

The 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).

Comments

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.

Data type

uri

Binding

Aa resource (or, for logical models, the URI of the logical model).

ResourceType (extensible)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
identifierΣ0..1Identifier
There are no (further) constraints on this element
Element id
MedicationRequest.subject.identifier
Short description

Logical reference, when literal reference is not known

Definition

An 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.

Comments

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).

Data type

Identifier

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • rim: .identifier
displayΣ0..1string
There are no (further) constraints on this element
Element id
MedicationRequest.subject.display
Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

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.

Data type

string

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
encounterC0..1Reference(Encounter)
There are no (further) constraints on this element
Element id
MedicationRequest.encounter
Short description

Encounter created as part of encounter/admission/stay

Definition

The Encounter during which this [x] was created or to which the creation of this record is tightly associated.

Comments

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.

Data type

Reference(Encounter)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.context
  • 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"]
supportingInformationC0..*Reference(Resource)
There are no (further) constraints on this element
Element id
MedicationRequest.supportingInformation
Short description

Information to support ordering of the medication

Definition

Include additional information (for example, patient height and weight) that supports the ordering of the medication.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Data type

Reference(Resource)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: 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)]
authoredOnSO Σ0..1dateTimeElement id
MedicationRequest.authoredOn
Short description

When request was initially authored

Definition

The date (and perhaps time) when the prescription was initially written or authored on.

Data type

dateTime

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • 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
Obligations
CodeActor
SHALL:able-to-populatehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer
SHALL:no-errorhttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
SHOULD:handlehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
requesterΣ C0..1Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
There are no (further) constraints on this element
Element id
MedicationRequest.requester
Short description

Who/What requested the Request

Definition

The individual, organization, or device that initiated the request and has responsibility for its activation.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Data type

Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.requester
  • w5: FiveWs.author
  • rim: .participation[typeCode=AUT].role
performerC0..1Reference(CareTeam | Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
There are no (further) constraints on this element
Element id
MedicationRequest.performer
Short description

Intended performer of administration

Definition

The specified desired performer of the medication treatment (e.g. the performer of the medication administration).

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Data type

Reference(CareTeam | Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.performer
  • w5: FiveWs.actor
  • rim: .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]
performerTypeΣ0..1CodeableConcept
There are no (further) constraints on this element
Element id
MedicationRequest.performerType
Short description

Desired kind of performer of the medication administration

Definition

Indicates the type of performer of the administration of the medication.

Comments

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.

Data type

CodeableConcept

Binding

Identifies the type of individual that is desired to administer the medication.

ProcedurePerformerRoleCodes (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Request.performerType
  • rim: .participation[typeCode=PRF].role[scoper.determinerCode=KIND].code
recorderC0..1Reference(Practitioner | PractitionerRole)
There are no (further) constraints on this element
Element id
MedicationRequest.recorder
Short description

Person who entered the request

Definition

The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Data type

Reference(Practitioner | PractitionerRole)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.who
  • rim: .participation[typeCode=TRANS].role[classCode=ASSIGNED].code (HealthcareProviderType)
reasonCode0..*CodeableConceptBindingElement id
MedicationRequest.reasonCode
Short description

Reason or indication for ordering or not ordering the medication

Definition

The reason or the indication for ordering or not ordering the medication.

Comments

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

Data type

CodeableConcept

Binding

A coded concept indicating why the medication was ordered.

MedicationReasonCode (preferred)

Additional bindings
  • PrescriptionIndicationForUse (candidate)

    Commonly used reason for which a medication is being ordered reference set (foundation metadata concept)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Request.reasonCode
  • 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
reasonReferenceC0..*Reference(Condition | Observation)
There are no (further) constraints on this element
Element id
MedicationRequest.reasonReference
Short description

Condition or observation that supports why the prescription is being written

Definition

Condition or observation that supports why the medication was ordered.

Comments

This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode.

Data type

Reference(Condition | Observation)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.reasonReference
  • script10.6: no mapping
  • w5: FiveWs.why[x]
  • rim: reason.observation[code=ASSERTION].value
instantiatesCanonicalΣ0..*canonical
There are no (further) constraints on this element
Element id
MedicationRequest.instantiatesCanonical
Short description

Instantiates FHIR protocol or definition

Definition

The URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest.

Comments

see Canonical References

Data type

canonical

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.instantiates
  • rim: .outboundRelationship[typeCode=DEFN].target
instantiatesUriΣ0..*uri
There are no (further) constraints on this element
Element id
MedicationRequest.instantiatesUri
Short description

Instantiates external protocol or definition

Definition

The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this MedicationRequest.

Comments

see http://en.wikipedia.org/wiki/Uniform_resource_identifier

Data type

uri

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .outboundRelationship[typeCode=DEFN].target
basedOnΣ C0..*Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | ServiceRequest)
There are no (further) constraints on this element
Element id
MedicationRequest.basedOn
Short description

What request fulfills

Definition

A plan or request that is fulfilled in whole or in part by this medication request.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Data type

Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | ServiceRequest)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.basedOn
  • rim: .outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]
groupIdentifierΣ0..1Identifier
There are no (further) constraints on this element
Element id
MedicationRequest.groupIdentifier
Short description

Composite request this is part of

Definition

A 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.

Requirements

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.

Data type

Identifier

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Request.groupIdentifier
  • rim: .outboundRelationship(typeCode=COMP].target[classCode=SBADM, moodCode=INT].id
courseOfTherapyType0..1CodeableConcept
There are no (further) constraints on this element
Element id
MedicationRequest.courseOfTherapyType
Short description

Overall pattern of medication administration

Definition

The description of the overall patte3rn of the administration of the medication to the patient.

Comments

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

Data type

CodeableConcept

Binding

Identifies the overall pattern of medication administratio.

medicationRequest Course of Therapy Codes (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: Act.code where classCode = LIST and moodCode = EVN
insuranceC0..*Reference(ClaimResponse | Coverage)
There are no (further) constraints on this element
Element id
MedicationRequest.insurance
Short description

Associated insurance coverage

Definition

Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Data type

Reference(ClaimResponse | Coverage)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.insurance
  • rim: .outboundRelationship[typeCode=COVBY].target
note0..*Annotation
There are no (further) constraints on this element
Element id
MedicationRequest.note
Short description

Information about the prescription

Definition

Extra information about the prescription that could not be conveyed by the other attributes.

Comments

For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).

Data type

Annotation

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: Act
  • workflow: Request.note
  • script10.6: Message/Body/NewRx/MedicationPrescribed/Note
  • rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=OBS,moodCode=EVN,code="annotation"].value
dosageInstruction0..*Dosage
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction
Short description

How the medication should be taken

Definition

Indicates how the medication is to be used by the patient.

Comments

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.

Data type

Dosage

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT]
  • workflow: Request.occurrence[x]
  • rim: see dosageInstruction mapping
id0..1string
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.id
Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings
  • rim: n/a
extensionC0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
modifierExtensionΣ ?! C0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.modifierExtension
Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
sequenceΣ0..1integer
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.sequence
Short description

The order of the dosage instructions

Definition

Indicates the order in which the dosage instructions should be applied or interpreted.

Requirements

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.

Comments

32 bit number; for values larger than this, use decimal

Data type

integer

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: TQ1-1
  • rim: .text
textSO Σ0..1stringElement id
MedicationRequest.dosageInstruction.text
Short description

Free text dosage instructions e.g. SIG

Definition

Free text dosage instructions e.g. SIG.

Requirements

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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data type

string

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: RXO-6; RXE-21
  • rim: .text
Obligations
CodeActor
SHALL:able-to-populatehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer
SHALL:no-errorhttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
SHOULD:handlehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
additionalInstructionΣ0..*CodeableConcept
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.additionalInstruction
Short description

Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"

Definition

Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").

Requirements

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.

Comments

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

Data type

CodeableConcept

Binding

A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

SNOMEDCTAdditionalDosageInstructions (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: RXO-7
  • rim: .text
patientInstructionΣ0..1string
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.patientInstruction
Short description

Patient or consumer oriented instructions

Definition

Instructions in terms that are understood by the patient or consumer.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data type

string

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: RXO-7
  • rim: .text
timingΣ0..1TimingElement id
MedicationRequest.dosageInstruction.timing
Short description

When medication should be administered

Definition

When medication should be administered.

Requirements

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.

Comments

IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content.

Data type

Timing

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: QSET<TS> (GTS)
  • rim: .effectiveTime
asNeeded[x]Σ0..1
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.asNeeded[x]
Short description

Take "as needed" (for x)

Definition

Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).

Comments

Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".

Binding

A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.

SNOMEDCTMedicationAsNeededReasonCodes (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: TQ1-9
  • rim: .outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept
asNeededBooleanboolean
There are no (further) constraints on this element
Data type

boolean

asNeededCodeableConceptCodeableConcept
There are no (further) constraints on this element
Data type

CodeableConcept

siteΣ0..1CodeableConcept
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.site
Short description

Body site to administer to

Definition

Body site to administer to.

Requirements

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

Comments

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

Data type

CodeableConcept

Binding

A coded concept describing the site location the medicine enters into or onto the body.

SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: RXR-2
  • rim: .approachSiteCode
routeΣ0..1CodeableConceptBindingElement id
MedicationRequest.dosageInstruction.route
Short description

How drug should enter body

Definition

How drug should enter body.

Requirements

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

Comments

See additionalBinding extension.

IPS-UV no longer flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received..

Data type

CodeableConcept

Binding

SCTCA Route of Administration

RouteOfAdministration (preferred)

Additional bindings
  • MedicineRouteOfAdministrationUvIps (candidate)

    EDQM Standards Terms for route.

  • PrescriptionRouteOfAdministration (candidate)

    Route of administration for the prescription from the PrescribeIT value set. Implementers should anticipate that data collected and or exchanged in the context of ePrescribing may contain concepts from this valueSet. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: RXR-1
  • rim: .routeCode
methodΣ0..1CodeableConcept
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.method
Short description

Technique for administering medication

Definition

Technique for administering medication.

Requirements

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.

Comments

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

Data type

CodeableConcept

Binding

A coded concept describing the technique by which the medicine is administered.

SNOMEDCTAdministrationMethodCodes (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: RXR-4
  • rim: .doseQuantity
doseAndRateΣ0..*Element
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.doseAndRate
Short description

Amount of medication administered

Definition

The amount of medication administered.

Data type

Element

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: TQ1-2
id0..1string
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.doseAndRate.id
Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings
  • rim: n/a
extensionC0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.doseAndRate.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
typeΣ0..1CodeableConcept
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.doseAndRate.type
Short description

The kind of dose or rate specified

Definition

The kind of dose or rate specified, for example, ordered or calculated.

Requirements

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

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Data type

CodeableConcept

Binding

The kind of dose or rate specified.

DoseAndRateType (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: RXO-21; RXE-23
dose[x]Σ0..1
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.doseAndRate.dose[x]
Short description

Amount of medication per dose

Definition

Amount of medication per dose.

Requirements

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

Comments

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.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: RXO-2, RXE-3
  • rim: .doseQuantity
doseQuantitySimpleQuantity
There are no (further) constraints on this element
Data type

SimpleQuantity

doseRangeRange
There are no (further) constraints on this element
Data type

Range

rate[x]Σ0..1
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.doseAndRate.rate[x]
Short description

Amount of medication per unit of time

Definition

Amount of medication per unit of time.

Requirements

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.

Comments

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 grammer 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.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: RXE22, RXE23, RXE-24
  • rim: .rateQuantity
rateQuantitySimpleQuantity
There are no (further) constraints on this element
Data type

SimpleQuantity

rateRangeRange
There are no (further) constraints on this element
Data type

Range

rateRatioRatio
There are no (further) constraints on this element
Data type

Ratio

maxDosePerPeriodΣ C0..1Ratio
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.maxDosePerPeriod
Short description

Upper limit on medication per unit of time

Definition

Upper limit on medication per unit of time.

Requirements

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.

Comments

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".

Data type

Ratio

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • rat-1: Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present
    (numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: RTO
  • v2: RXO-23, RXE-19
  • rim: .maxDoseQuantity
maxDosePerAdministrationΣ C0..1SimpleQuantity
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.maxDosePerAdministration
Short description

Upper limit on medication per administration

Definition

Upper limit on medication per administration.

Requirements

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

Comments

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.

Data type

SimpleQuantity

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • sqty-1: The comparator is not used on a SimpleQuantity
    comparator.empty()
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • rim: not supported
maxDosePerLifetimeΣ C0..1SimpleQuantity
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.maxDosePerLifetime
Short description

Upper limit on medication per lifetime of the patient

Definition

Upper limit on medication per lifetime of the patient.

Requirements

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

Comments

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.

Data type

SimpleQuantity

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • sqty-1: The comparator is not used on a SimpleQuantity
    comparator.empty()
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • rim: not supported
dispenseRequest0..1BackboneElement
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest
Short description

Medication supply authorization

Definition

Indicates 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.

Data type

BackboneElement

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • script10.6: Message/Body/NewRx/MedicationPrescribed/ExpirationDate
  • rim: component.supplyEvent
id0..1string
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.id
Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings
  • rim: n/a
extensionC0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
modifierExtensionΣ ?! C0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.modifierExtension
Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
initialFill0..1BackboneElement
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.initialFill
Short description

First fill details

Definition

Indicates the quantity or duration for the first dispense of the medication.

Comments

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

Data type

BackboneElement

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: SubstanceAdministration -> ActRelationship[sequenceNumber = '1'] -> Supply
id0..1string
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.initialFill.id
Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings
  • rim: n/a
extensionC0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.initialFill.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
modifierExtensionΣ ?! C0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.initialFill.modifierExtension
Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
quantityC0..1SimpleQuantity
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.initialFill.quantity
Short description

First fill quantity

Definition

The amount or quantity to provide as part of the first dispense.

Comments

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.

Data type

SimpleQuantity

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • sqty-1: The comparator is not used on a SimpleQuantity
    comparator.empty()
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • rim: Supply.quantity[moodCode=RQO]
durationC0..1Duration
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.initialFill.duration
Short description

First fill duration

Definition

The length of time that the first dispense is expected to last.

Comments

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.

Data type

Duration

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM.
    code.exists() implies ((system = %ucum) and value.exists())
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • rim: PQ, IVL<PQ> depending on the values
  • rim: Supply.effectivetime[moodCode=RQO]
dispenseIntervalC0..1Duration
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.dispenseInterval
Short description

Minimum period of time between dispenses

Definition

The minimum period of time that must occur between dispenses of the medication.

Comments

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.

Data type

Duration

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM.
    code.exists() implies ((system = %ucum) and value.exists())
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • rim: PQ, IVL<PQ> depending on the values
  • rim: Supply.effectivetime[moodCode=RQO]
validityPeriodC0..1Period
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.validityPeriod
Short description

Time period supply is authorized for

Definition

This indicates the validity period of a prescription (stale dating the Prescription).

Requirements

Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.

Comments

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.

Data type

Period

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • script10.6: Message/Body/NewRx/MedicationPrescribed/Refills
  • rim: effectiveTime
numberOfRepeatsAllowed0..1unsignedInt
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
Short description

Number of refills authorized

Definition

An 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.

Comments

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

Data type

unsignedInt

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • script10.6: Message/Body/NewRx/MedicationPrescribed/Quantity
  • v2: RXE-12-Number of Refills
  • rim: repeatNumber
quantityC0..1SimpleQuantity
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.quantity
Short description

Amount of medication to supply per dispense

Definition

The amount that is to be dispensed for one fill.

Comments

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.

Data type

SimpleQuantity

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • sqty-1: The comparator is not used on a SimpleQuantity
    comparator.empty()
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • 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
expectedSupplyDurationC0..1Duration
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.expectedSupplyDuration
Short description

Number of days supply per dispense

Definition

Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last.

Comments

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.

Data type

Duration

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM.
    code.exists() implies ((system = %ucum) and value.exists())
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • rim: PQ, IVL<PQ> depending on the values
  • script10.6: Message/Body/NewRx/MedicationPrescribed/Substitutions
  • rim: expectedUseTime
performerC0..1Reference(Organization)
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.performer
Short description

Intended dispenser

Definition

Indicates the intended dispensing Organization specified by the prescriber.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Data type

Reference(Organization)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.who
  • rim: .outboundRelationship[typeCode=COMP].target[classCode=SPLY, moodCode=RQO] .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]
substitution0..1BackboneElement
There are no (further) constraints on this element
Element id
MedicationRequest.substitution
Short description

Any restrictions on medication substitution

Definition

Indicates 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.

Data type

BackboneElement

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • script10.6: specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions
  • rim: subjectOf.substitutionPersmission
id0..1string
There are no (further) constraints on this element
Element id
MedicationRequest.substitution.id
Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings
  • rim: n/a
extensionC0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.substitution.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
modifierExtensionΣ ?! C0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.substitution.modifierExtension
Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
allowed[x]1..1
There are no (further) constraints on this element
Element id
MedicationRequest.substitution.allowed[x]
Short description

Whether substitution is allowed or not

Definition

True if the prescriber allows a different drug to be dispensed from what was prescribed.

Comments

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

Binding

Identifies the type of substitution allowed.

v3.ActSubstanceAdminSubstitutionCode (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • script10.6: specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions
  • v2: RXO-9-Allow Substitutions / RXE-9-Substitution Status
  • rim: code
allowedBooleanboolean
There are no (further) constraints on this element
Data type

boolean

allowedCodeableConceptCodeableConcept
There are no (further) constraints on this element
Data type

CodeableConcept

reason0..1CodeableConcept
There are no (further) constraints on this element
Element id
MedicationRequest.substitution.reason
Short description

Why should (not) substitution be made

Definition

Indicates the reason for the substitution, or why substitution must or must not be performed.

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Data type

CodeableConcept

Binding

A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.

v3.SubstanceAdminSubstitutionReason (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • script10.6: not mapped
  • v2: RXE-9 Substition status
  • rim: reasonCode
priorPrescriptionC0..1Reference(MedicationRequest)
There are no (further) constraints on this element
Element id
MedicationRequest.priorPrescription
Short description

An order/prescription that is being replaced

Definition

A link to a resource representing an earlier order related order or prescription.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Data type

Reference(MedicationRequest)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.replaces
  • script10.6: not mapped
  • rim: .outboundRelationship[typeCode=?RPLC or ?SUCC]/target[classCode=SBADM,moodCode=RQO]
detectedIssueC0..*Reference(DetectedIssue)
There are no (further) constraints on this element
Element id
MedicationRequest.detectedIssue
Short description

Clinical Issue with action

Alternate names

Contraindication, Drug Utilization Review (DUR), Alert

Definition

Indicates 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.

Comments

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.

Data type

Reference(DetectedIssue)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=ALRT,moodCode=EVN].value
eventHistoryC0..*Reference(Provenance)
There are no (further) constraints on this element
Element id
MedicationRequest.eventHistory
Short description

A list of events of interest in the lifecycle

Definition

Links 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.

Comments

This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).

Data type

Reference(Provenance)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.relevantHistory
  • rim: .inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]
MedicationRequestPSCA (MedicationRequest)CMedicationRequest
There are no (further) constraints on this element
Element id
MedicationRequest
Short description

Ordering of medication for patient or group

Alternate names

Prescription, Order

Definition

An 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.

Comments

Jurisdictions mapping prescription data into FHIR profiles for the patient summary should support the MedicationRequest resource. Use of the MedicationStatement profile should be reserved for communicating a statement about the patient's usage of the medication that is ultimately provided by a patient, significant other, or a clinician.

The MedicationRequest resource is not included in the current (as of November 2021) published release of IPS (release 1.0.0, STU1), but is in the development preview of the next release.

Data type

MedicationRequest

Constraints
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.empty()
  • dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
  • dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim: Entity. Role, or Act
  • workflow: Request
  • script10.6: Message/Body/NewRx
  • rim: CombinedMedicationRequest
idΣ0..1string
There are no (further) constraints on this element
Element id
MedicationRequest.id
Short description

Logical id of this artifact

Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

Data type

string

metaΣ0..1Meta
There are no (further) constraints on this element
Element id
MedicationRequest.meta
Short description

Metadata about the resource

Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Data type

Meta

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
implicitRulesΣ ?!0..1uri
There are no (further) constraints on this element
Element id
MedicationRequest.implicitRules
Short description

A set of rules under which this content was created

Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Data type

uri

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
language0..1codeBinding
There are no (further) constraints on this element
Element id
MedicationRequest.language
Short description

Language of the resource content

Definition

The base language in which the resource is written.

Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Data type

code

Binding

A human language.

CommonLanguages (preferred)

Binding extensions
maxValueSetAllLanguages
Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
text0..1Narrative
There are no (further) constraints on this element
Element id
MedicationRequest.text
Short description

Text summary of the resource, for human interpretation

Alternate names

narrative, html, xhtml, display

Definition

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

Data type

Narrative

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
contained0..*Resource
There are no (further) constraints on this element
Element id
MedicationRequest.contained
Short description

Contained, inline Resources

Alternate names

inline resources, anonymous resources, contained resources

Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Data type

Resource

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
extensionC0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
RenderedDosageInstructionC0..1Extension(string)
There are no (further) constraints on this element
Element id
MedicationRequest.extension:RenderedDosageInstruction
Short description

Extension for representing rendered dosage instruction.

Alternate names

extensions, user content

Definition

A free form textual specification generated from the input specifications as created by the provider. This is made up of either an 'Ad-hoc instruction' or 'Textual rendition of the structured dosage lines', plus route, dosage unit, and other pertinent administration information specified by the provider.

Comments

Use of structured fields for dosage instructions is heavily encouraged by this specification to promote interoperability of patient summaries. However, this extension is provided to make implementers aware that legacy medication data may come from some systems in this format. This extension is used by PrescribeIT implementations when the system has difficulty sending very complex dosage instructions in the form of structured data. Implementers are encouraged to read the PrescribeIT Specification (https://specs.prescribeit.ca/R5.0/erx/extension-ext-medication-rendered-dosage.html) to understand the context around its use.

Data type

Extension(string)

Extension URL

http://prescribeit.ca/fhir/StructureDefinition/ext-rendered-dosage-instruction

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
modifierExtension?! C0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.modifierExtension
Short description

Extensions that cannot be ignored

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
identifier0..*Identifier
There are no (further) constraints on this element
Element id
MedicationRequest.identifier
Short description

External ids for this request

Definition

Identifiers 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.

Comments

This is a business identifier, not a resource identifier.

Data type

Identifier

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Request.identifier
  • script10.6: Message/Header/PrescriberOrderNumber
  • w5: FiveWs.identifier
  • v2: ORC-2-Placer Order Number / ORC-3-Filler Order Number
  • rim: .id
statusSO Σ ?!1..1codeBinding
There are no (further) constraints on this element
Element id
MedicationRequest.status
Short description

active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown

Definition

A code specifying the current state of the order. Generally, this will be active or completed state.

Comments

In the scope of the IPS the entered-in-error concept is not allowed.

Data type

code

Binding

A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.

medicationrequest Status (required)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.status
  • script10.6: no mapping
  • w5: FiveWs.status
  • rim: .statusCode
Obligations
CodeActor
SHALL:populatehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer
SHALL:no-errorhttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
SHALL:handlehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
SHOULD:displayhttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
statusReason0..1CodeableConcept
There are no (further) constraints on this element
Element id
MedicationRequest.statusReason
Short description

Reason for current status

Definition

Captures the reason for the current state of the MedicationRequest.

Comments

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.

Data type

CodeableConcept

Binding

Identifies the reasons for a given status.

medicationRequest Status Reason Codes (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Request.statusReason
  • rim: .inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde
intentΣ ?!1..1codeBinding
There are no (further) constraints on this element
Element id
MedicationRequest.intent
Short description

proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option

Definition

Whether the request is a proposal, plan, or an original order.

Comments

This element is considered mandatory in the Base FHIR R4 Specification.

Base R4 Note: 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.

Data type

code

Binding

The kind of medication order.

medicationRequest Intent (required)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.intent
  • w5: FiveWs.class
  • rim: .moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)
category0..*CodeableConcept
There are no (further) constraints on this element
Element id
MedicationRequest.category
Short description

Type of medication usage

Definition

Indicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).

Comments

The category can be used to include where the medication is expected to be consumed or other types of requests.

Data type

CodeableConcept

Binding

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.

medicationRequest Category Codes (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • 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
priorityΣ0..1codeBinding
There are no (further) constraints on this element
Element id
MedicationRequest.priority
Short description

routine | urgent | asap | stat

Definition

Indicates how quickly the Medication Request should be addressed with respect to other requests.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data type

code

Binding

Identifies the level of importance to be assigned to actioning the request.

RequestPriority (required)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.priority
  • w5: FiveWs.grade
  • rim: .priorityCode
doNotPerformΣ ?!0..1booleanPattern
There are no (further) constraints on this element
Element id
MedicationRequest.doNotPerform
Short description

True if request is prohibiting action

Definition

If true indicates that the provider is asking for the medication request not to occur.

Comments

In the scope of the PSCA MedicationRequest, the doNotPerform concept is not allowed to be set to true. Other sections may be used to convey medications that a patient should or will not take.

Data type

boolean

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Pattern
false
Mappings
  • rim: n/a
  • rim: SubstanceAdministration.actionNegationInd
reported[x]Σ0..1
There are no (further) constraints on this element
Element id
MedicationRequest.reported[x]
Short description

Reported rather than primary record

Definition

Indicates 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.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .participation[typeCode=INF].role
reportedBooleanboolean
There are no (further) constraints on this element
Data type

boolean

reportedReferenceReference(Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
There are no (further) constraints on this element
Data type

Reference(Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)

medication[x]SO Σ1..1Binding
There are no (further) constraints on this element
Element id
MedicationRequest.medication[x]
Short description

Medication to be taken

Definition

Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code. To improve global interoperability is strongly encouraged that the reference to a medication resource is used, limiting the usage of the medicationCodeableConcept only to the cases in which no other information than a simple code is available.

Comments

If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the Medication resource is recommended. For example, if you require form or lot number or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource.

Binding

A coded concept identifying substance or product that can be ordered.

PrescriptionMedicinalProduct (preferred)

Additional bindings
  • LicensedNaturalHealthProducts (candidate)

    All Natural Product Number (NPN) and Homeopathic Medicine Number (DIN-HM) codes that are licensed by Health Canada and present in the Licensed Natural Health Products Database.

  • WhoAtcUvIps (candidate)

    WHO ATC classification.

  • MedicationsUvIps (candidate)

    SNOMED CT medications (Medicinal product)

  • DIN (candidate)

    Health Canada Drug Identification Number set.

  • PharmaceuticalBiologicProductAndSubstanceCode (candidate)

    per PCHDCF: The alternate value set can be used for the international use case where the medication is not available in Canada and therefore does not appear in the recommended pan-Canadian value sets

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • 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
Obligations
CodeActor
SHALL:populatehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer
SHALL:no-errorhttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
SHALL:handlehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
SHOULD:displayhttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
medicationCodeableConceptCodeableConceptMedicationPSCA
There are no (further) constraints on this element
Data type

CodeableConceptMedicationPSCA

medicationReferenceReference(MedicationPSCA)
There are no (further) constraints on this element
Data type

Reference(MedicationPSCA)

subjectSO Σ C1..1Reference(PatientPSCA)
There are no (further) constraints on this element
Element id
MedicationRequest.subject
Short description

Who or group medication request is for

Definition

A link to a resource representing the person or set of individuals to whom the medication will be given.

Comments

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.

Data type

Reference(PatientPSCA)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: 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
  • w5: FiveWs.subject
Obligations
CodeActor
SHALL:populatehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer
SHALL:no-errorhttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
SHALL:handlehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
SHOULD:displayhttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
id0..1string
There are no (further) constraints on this element
Element id
MedicationRequest.subject.id
Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings
  • rim: n/a
extensionC0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.subject.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
referenceSO Σ C1..1string
There are no (further) constraints on this element
Element id
MedicationRequest.subject.reference
Short description

Literal reference, Relative, internal or absolute URL

Definition

A 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.

Comments

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.

Data type

string

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1, ref-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Obligations
CodeActor
SHALL:populatehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer
SHALL:no-errorhttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
SHALL:handlehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
SHOULD:displayhttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
typeΣ0..1uriBinding
There are no (further) constraints on this element
Element id
MedicationRequest.subject.type
Short description

Type the reference refers to (e.g. "Patient")

Definition

The 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).

Comments

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.

Data type

uri

Binding

Aa resource (or, for logical models, the URI of the logical model).

ResourceType (extensible)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
identifierΣ0..1Identifier
There are no (further) constraints on this element
Element id
MedicationRequest.subject.identifier
Short description

Logical reference, when literal reference is not known

Definition

An 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.

Comments

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).

Data type

Identifier

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • rim: .identifier
displayΣ0..1string
There are no (further) constraints on this element
Element id
MedicationRequest.subject.display
Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

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.

Data type

string

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
encounterC0..1Reference(Encounter)
There are no (further) constraints on this element
Element id
MedicationRequest.encounter
Short description

Encounter created as part of encounter/admission/stay

Definition

The Encounter during which this [x] was created or to which the creation of this record is tightly associated.

Comments

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.

Data type

Reference(Encounter)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.context
  • 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"]
supportingInformationC0..*Reference(Resource)
There are no (further) constraints on this element
Element id
MedicationRequest.supportingInformation
Short description

Information to support ordering of the medication

Definition

Include additional information (for example, patient height and weight) that supports the ordering of the medication.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Data type

Reference(Resource)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: 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)]
authoredOnSO Σ0..1dateTime
There are no (further) constraints on this element
Element id
MedicationRequest.authoredOn
Short description

When request was initially authored

Definition

The date (and perhaps time) when the prescription was initially written or authored on.

Data type

dateTime

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • 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
Obligations
CodeActor
SHALL:able-to-populatehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer
SHALL:no-errorhttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
SHOULD:handlehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
requesterΣ C0..1Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
There are no (further) constraints on this element
Element id
MedicationRequest.requester
Short description

Who/What requested the Request

Definition

The individual, organization, or device that initiated the request and has responsibility for its activation.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Data type

Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.requester
  • w5: FiveWs.author
  • rim: .participation[typeCode=AUT].role
performerC0..1Reference(CareTeam | Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
There are no (further) constraints on this element
Element id
MedicationRequest.performer
Short description

Intended performer of administration

Definition

The specified desired performer of the medication treatment (e.g. the performer of the medication administration).

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Data type

Reference(CareTeam | Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.performer
  • w5: FiveWs.actor
  • rim: .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]
performerTypeΣ0..1CodeableConcept
There are no (further) constraints on this element
Element id
MedicationRequest.performerType
Short description

Desired kind of performer of the medication administration

Definition

Indicates the type of performer of the administration of the medication.

Comments

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.

Data type

CodeableConcept

Binding

Identifies the type of individual that is desired to administer the medication.

ProcedurePerformerRoleCodes (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Request.performerType
  • rim: .participation[typeCode=PRF].role[scoper.determinerCode=KIND].code
recorderC0..1Reference(Practitioner | PractitionerRole)
There are no (further) constraints on this element
Element id
MedicationRequest.recorder
Short description

Person who entered the request

Definition

The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Data type

Reference(Practitioner | PractitionerRole)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.who
  • rim: .participation[typeCode=TRANS].role[classCode=ASSIGNED].code (HealthcareProviderType)
reasonCode0..*CodeableConceptBinding
There are no (further) constraints on this element
Element id
MedicationRequest.reasonCode
Short description

Reason or indication for ordering or not ordering the medication

Definition

The reason or the indication for ordering or not ordering the medication.

Comments

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

Data type

CodeableConcept

Binding

A coded concept indicating why the medication was ordered.

MedicationReasonCode (preferred)

Additional bindings
  • PrescriptionIndicationForUse (candidate)

    Commonly used reason for which a medication is being ordered reference set (foundation metadata concept)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Request.reasonCode
  • 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
reasonReferenceC0..*Reference(Condition | Observation)
There are no (further) constraints on this element
Element id
MedicationRequest.reasonReference
Short description

Condition or observation that supports why the prescription is being written

Definition

Condition or observation that supports why the medication was ordered.

Comments

This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode.

Data type

Reference(Condition | Observation)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.reasonReference
  • script10.6: no mapping
  • w5: FiveWs.why[x]
  • rim: reason.observation[code=ASSERTION].value
instantiatesCanonicalΣ0..*canonical
There are no (further) constraints on this element
Element id
MedicationRequest.instantiatesCanonical
Short description

Instantiates FHIR protocol or definition

Definition

The URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest.

Comments

see Canonical References

Data type

canonical

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.instantiates
  • rim: .outboundRelationship[typeCode=DEFN].target
instantiatesUriΣ0..*uri
There are no (further) constraints on this element
Element id
MedicationRequest.instantiatesUri
Short description

Instantiates external protocol or definition

Definition

The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this MedicationRequest.

Comments

see http://en.wikipedia.org/wiki/Uniform_resource_identifier

Data type

uri

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .outboundRelationship[typeCode=DEFN].target
basedOnΣ C0..*Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | ServiceRequest)
There are no (further) constraints on this element
Element id
MedicationRequest.basedOn
Short description

What request fulfills

Definition

A plan or request that is fulfilled in whole or in part by this medication request.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Data type

Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | ServiceRequest)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.basedOn
  • rim: .outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]
groupIdentifierΣ0..1Identifier
There are no (further) constraints on this element
Element id
MedicationRequest.groupIdentifier
Short description

Composite request this is part of

Definition

A 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.

Requirements

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.

Data type

Identifier

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Request.groupIdentifier
  • rim: .outboundRelationship(typeCode=COMP].target[classCode=SBADM, moodCode=INT].id
courseOfTherapyType0..1CodeableConcept
There are no (further) constraints on this element
Element id
MedicationRequest.courseOfTherapyType
Short description

Overall pattern of medication administration

Definition

The description of the overall patte3rn of the administration of the medication to the patient.

Comments

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

Data type

CodeableConcept

Binding

Identifies the overall pattern of medication administratio.

medicationRequest Course of Therapy Codes (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: Act.code where classCode = LIST and moodCode = EVN
insuranceC0..*Reference(ClaimResponse | Coverage)
There are no (further) constraints on this element
Element id
MedicationRequest.insurance
Short description

Associated insurance coverage

Definition

Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Data type

Reference(ClaimResponse | Coverage)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.insurance
  • rim: .outboundRelationship[typeCode=COVBY].target
note0..*Annotation
There are no (further) constraints on this element
Element id
MedicationRequest.note
Short description

Information about the prescription

Definition

Extra information about the prescription that could not be conveyed by the other attributes.

Comments

For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).

Data type

Annotation

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: Act
  • workflow: Request.note
  • script10.6: Message/Body/NewRx/MedicationPrescribed/Note
  • rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=OBS,moodCode=EVN,code="annotation"].value
dosageInstruction0..*Dosage
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction
Short description

How the medication should be taken

Definition

Indicates how the medication is to be used by the patient.

Comments

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.

Data type

Dosage

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT]
  • workflow: Request.occurrence[x]
  • rim: see dosageInstruction mapping
id0..1string
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.id
Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings
  • rim: n/a
extensionC0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
modifierExtensionΣ ?! C0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.modifierExtension
Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
sequenceΣ0..1integer
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.sequence
Short description

The order of the dosage instructions

Definition

Indicates the order in which the dosage instructions should be applied or interpreted.

Requirements

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.

Comments

32 bit number; for values larger than this, use decimal

Data type

integer

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: TQ1-1
  • rim: .text
textSO Σ0..1string
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.text
Short description

Free text dosage instructions e.g. SIG

Definition

Free text dosage instructions e.g. SIG.

Requirements

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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data type

string

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: RXO-6; RXE-21
  • rim: .text
Obligations
CodeActor
SHALL:able-to-populatehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer
SHALL:no-errorhttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
SHOULD:handlehttp://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer
additionalInstructionΣ0..*CodeableConcept
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.additionalInstruction
Short description

Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"

Definition

Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").

Requirements

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.

Comments

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

Data type

CodeableConcept

Binding

A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

SNOMEDCTAdditionalDosageInstructions (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: RXO-7
  • rim: .text
patientInstructionΣ0..1string
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.patientInstruction
Short description

Patient or consumer oriented instructions

Definition

Instructions in terms that are understood by the patient or consumer.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data type

string

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: RXO-7
  • rim: .text
timingΣ0..1Timing
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.timing
Short description

When medication should be administered

Definition

When medication should be administered.

Requirements

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.

Comments

IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content.

Data type

Timing

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: QSET<TS> (GTS)
  • rim: .effectiveTime
asNeeded[x]Σ0..1
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.asNeeded[x]
Short description

Take "as needed" (for x)

Definition

Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).

Comments

Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".

Binding

A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.

SNOMEDCTMedicationAsNeededReasonCodes (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: TQ1-9
  • rim: .outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept
asNeededBooleanboolean
There are no (further) constraints on this element
Data type

boolean

asNeededCodeableConceptCodeableConcept
There are no (further) constraints on this element
Data type

CodeableConcept

siteΣ0..1CodeableConcept
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.site
Short description

Body site to administer to

Definition

Body site to administer to.

Requirements

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

Comments

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

Data type

CodeableConcept

Binding

A coded concept describing the site location the medicine enters into or onto the body.

SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: RXR-2
  • rim: .approachSiteCode
routeΣ0..1CodeableConceptBinding
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.route
Short description

How drug should enter body

Definition

How drug should enter body.

Requirements

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

Comments

See additionalBinding extension.

IPS-UV no longer flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received..

Data type

CodeableConcept

Binding

SCTCA Route of Administration

RouteOfAdministration (preferred)

Additional bindings
  • MedicineRouteOfAdministrationUvIps (candidate)

    EDQM Standards Terms for route.

  • PrescriptionRouteOfAdministration (candidate)

    Route of administration for the prescription from the PrescribeIT value set. Implementers should anticipate that data collected and or exchanged in the context of ePrescribing may contain concepts from this valueSet. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: RXR-1
  • rim: .routeCode
methodΣ0..1CodeableConcept
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.method
Short description

Technique for administering medication

Definition

Technique for administering medication.

Requirements

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.

Comments

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

Data type

CodeableConcept

Binding

A coded concept describing the technique by which the medicine is administered.

SNOMEDCTAdministrationMethodCodes (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: RXR-4
  • rim: .doseQuantity
doseAndRateΣ0..*Element
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.doseAndRate
Short description

Amount of medication administered

Definition

The amount of medication administered.

Data type

Element

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: TQ1-2
id0..1string
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.doseAndRate.id
Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings
  • rim: n/a
extensionC0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.doseAndRate.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
typeΣ0..1CodeableConcept
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.doseAndRate.type
Short description

The kind of dose or rate specified

Definition

The kind of dose or rate specified, for example, ordered or calculated.

Requirements

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

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Data type

CodeableConcept

Binding

The kind of dose or rate specified.

DoseAndRateType (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: RXO-21; RXE-23
dose[x]Σ0..1
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.doseAndRate.dose[x]
Short description

Amount of medication per dose

Definition

Amount of medication per dose.

Requirements

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

Comments

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.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: RXO-2, RXE-3
  • rim: .doseQuantity
doseQuantitySimpleQuantity
There are no (further) constraints on this element
Data type

SimpleQuantity

doseRangeRange
There are no (further) constraints on this element
Data type

Range

rate[x]Σ0..1
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.doseAndRate.rate[x]
Short description

Amount of medication per unit of time

Definition

Amount of medication per unit of time.

Requirements

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.

Comments

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 grammer 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.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: RXE22, RXE23, RXE-24
  • rim: .rateQuantity
rateQuantitySimpleQuantity
There are no (further) constraints on this element
Data type

SimpleQuantity

rateRangeRange
There are no (further) constraints on this element
Data type

Range

rateRatioRatio
There are no (further) constraints on this element
Data type

Ratio

maxDosePerPeriodΣ C0..1Ratio
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.maxDosePerPeriod
Short description

Upper limit on medication per unit of time

Definition

Upper limit on medication per unit of time.

Requirements

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.

Comments

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".

Data type

Ratio

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • rat-1: Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present
    (numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: RTO
  • v2: RXO-23, RXE-19
  • rim: .maxDoseQuantity
maxDosePerAdministrationΣ C0..1SimpleQuantity
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.maxDosePerAdministration
Short description

Upper limit on medication per administration

Definition

Upper limit on medication per administration.

Requirements

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

Comments

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.

Data type

SimpleQuantity

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • sqty-1: The comparator is not used on a SimpleQuantity
    comparator.empty()
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • rim: not supported
maxDosePerLifetimeΣ C0..1SimpleQuantity
There are no (further) constraints on this element
Element id
MedicationRequest.dosageInstruction.maxDosePerLifetime
Short description

Upper limit on medication per lifetime of the patient

Definition

Upper limit on medication per lifetime of the patient.

Requirements

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

Comments

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.

Data type

SimpleQuantity

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • sqty-1: The comparator is not used on a SimpleQuantity
    comparator.empty()
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • rim: not supported
dispenseRequest0..1BackboneElement
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest
Short description

Medication supply authorization

Definition

Indicates 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.

Data type

BackboneElement

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • script10.6: Message/Body/NewRx/MedicationPrescribed/ExpirationDate
  • rim: component.supplyEvent
id0..1string
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.id
Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings
  • rim: n/a
extensionC0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
modifierExtensionΣ ?! C0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.modifierExtension
Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
initialFill0..1BackboneElement
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.initialFill
Short description

First fill details

Definition

Indicates the quantity or duration for the first dispense of the medication.

Comments

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

Data type

BackboneElement

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: SubstanceAdministration -> ActRelationship[sequenceNumber = '1'] -> Supply
id0..1string
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.initialFill.id
Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings
  • rim: n/a
extensionC0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.initialFill.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
modifierExtensionΣ ?! C0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.initialFill.modifierExtension
Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
quantityC0..1SimpleQuantity
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.initialFill.quantity
Short description

First fill quantity

Definition

The amount or quantity to provide as part of the first dispense.

Comments

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.

Data type

SimpleQuantity

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • sqty-1: The comparator is not used on a SimpleQuantity
    comparator.empty()
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • rim: Supply.quantity[moodCode=RQO]
durationC0..1Duration
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.initialFill.duration
Short description

First fill duration

Definition

The length of time that the first dispense is expected to last.

Comments

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.

Data type

Duration

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM.
    code.exists() implies ((system = %ucum) and value.exists())
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • rim: PQ, IVL<PQ> depending on the values
  • rim: Supply.effectivetime[moodCode=RQO]
dispenseIntervalC0..1Duration
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.dispenseInterval
Short description

Minimum period of time between dispenses

Definition

The minimum period of time that must occur between dispenses of the medication.

Comments

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.

Data type

Duration

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM.
    code.exists() implies ((system = %ucum) and value.exists())
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • rim: PQ, IVL<PQ> depending on the values
  • rim: Supply.effectivetime[moodCode=RQO]
validityPeriodC0..1Period
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.validityPeriod
Short description

Time period supply is authorized for

Definition

This indicates the validity period of a prescription (stale dating the Prescription).

Requirements

Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.

Comments

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.

Data type

Period

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • script10.6: Message/Body/NewRx/MedicationPrescribed/Refills
  • rim: effectiveTime
numberOfRepeatsAllowed0..1unsignedInt
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
Short description

Number of refills authorized

Definition

An 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.

Comments

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

Data type

unsignedInt

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • script10.6: Message/Body/NewRx/MedicationPrescribed/Quantity
  • v2: RXE-12-Number of Refills
  • rim: repeatNumber
quantityC0..1SimpleQuantity
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.quantity
Short description

Amount of medication to supply per dispense

Definition

The amount that is to be dispensed for one fill.

Comments

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.

Data type

SimpleQuantity

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • sqty-1: The comparator is not used on a SimpleQuantity
    comparator.empty()
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • 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
expectedSupplyDurationC0..1Duration
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.expectedSupplyDuration
Short description

Number of days supply per dispense

Definition

Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last.

Comments

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.

Data type

Duration

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM.
    code.exists() implies ((system = %ucum) and value.exists())
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • rim: PQ, IVL<PQ> depending on the values
  • script10.6: Message/Body/NewRx/MedicationPrescribed/Substitutions
  • rim: expectedUseTime
performerC0..1Reference(Organization)
There are no (further) constraints on this element
Element id
MedicationRequest.dispenseRequest.performer
Short description

Intended dispenser

Definition

Indicates the intended dispensing Organization specified by the prescriber.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Data type

Reference(Organization)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.who
  • rim: .outboundRelationship[typeCode=COMP].target[classCode=SPLY, moodCode=RQO] .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]
substitution0..1BackboneElement
There are no (further) constraints on this element
Element id
MedicationRequest.substitution
Short description

Any restrictions on medication substitution

Definition

Indicates 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.

Data type

BackboneElement

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • script10.6: specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions
  • rim: subjectOf.substitutionPersmission
id0..1string
There are no (further) constraints on this element
Element id
MedicationRequest.substitution.id
Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings
  • rim: n/a
extensionC0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.substitution.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
modifierExtensionΣ ?! C0..*Extension
There are no (further) constraints on this element
Element id
MedicationRequest.substitution.modifierExtension
Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Extension

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
allowed[x]1..1
There are no (further) constraints on this element
Element id
MedicationRequest.substitution.allowed[x]
Short description

Whether substitution is allowed or not

Definition

True if the prescriber allows a different drug to be dispensed from what was prescribed.

Comments

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

Binding

Identifies the type of substitution allowed.

v3.ActSubstanceAdminSubstitutionCode (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • script10.6: specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions
  • v2: RXO-9-Allow Substitutions / RXE-9-Substitution Status
  • rim: code
allowedBooleanboolean
There are no (further) constraints on this element
Data type

boolean

allowedCodeableConceptCodeableConcept
There are no (further) constraints on this element
Data type

CodeableConcept

reason0..1CodeableConcept
There are no (further) constraints on this element
Element id
MedicationRequest.substitution.reason
Short description

Why should (not) substitution be made

Definition

Indicates the reason for the substitution, or why substitution must or must not be performed.

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Data type

CodeableConcept

Binding

A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.

v3.SubstanceAdminSubstitutionReason (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • script10.6: not mapped
  • v2: RXE-9 Substition status
  • rim: reasonCode
priorPrescriptionC0..1Reference(MedicationRequest)
There are no (further) constraints on this element
Element id
MedicationRequest.priorPrescription
Short description

An order/prescription that is being replaced

Definition

A link to a resource representing an earlier order related order or prescription.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Data type

Reference(MedicationRequest)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.replaces
  • script10.6: not mapped
  • rim: .outboundRelationship[typeCode=?RPLC or ?SUCC]/target[classCode=SBADM,moodCode=RQO]
detectedIssueC0..*Reference(DetectedIssue)
There are no (further) constraints on this element
Element id
MedicationRequest.detectedIssue
Short description

Clinical Issue with action

Alternate names

Contraindication, Drug Utilization Review (DUR), Alert

Definition

Indicates 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.

Comments

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.

Data type

Reference(DetectedIssue)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=ALRT,moodCode=EVN].value
eventHistoryC0..*Reference(Provenance)
There are no (further) constraints on this element
Element id
MedicationRequest.eventHistory
Short description

A list of events of interest in the lifecycle

Definition

Links 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.

Comments

This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).

Data type

Reference(Provenance)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.relevantHistory
  • rim: .inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]
<StructureDefinition xmlns="http://hl7.org/fhir">
<id value="medicationrequest-ca-ps" />
<url value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/medicationrequest-ca-ps" />
<version value="2.2.0" />
<name value="MedicationRequestPSCA" />
<title value="Medication Request (PS-CA)" />
<status value="draft" />
<experimental value="false" />
<date value="2024-04-09T00:00:00-08:00" />
<description value="This profile represents the constraints applied to the MedicationRequest resource by the PS-CA project and allows for cross-border and cross-jurisdiction sharing of information record of a medication request information in the patient summary." />
<copyright value="Copyright © 2024+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy)." />
<fhirVersion value="4.0.1" />
<kind value="resource" />
<abstract value="false" />
<type value="MedicationRequest" />
<baseDefinition value="http://hl7.org/fhir/StructureDefinition/MedicationRequest" />
<derivation value="constraint" />
<snapshot>
<element id="MedicationRequest">
<path value="MedicationRequest" />
<short value="Ordering of medication for patient or group" />
<definition value="An 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." />
<comment value="Jurisdictions mapping prescription data into FHIR profiles for the patient summary should support the MedicationRequest resource. Use of the MedicationStatement profile should be reserved for communicating a statement about the patient's usage of the medication that is ultimately provided by a patient, significant other, or a clinician.\n\nThe MedicationRequest resource is not included in the [current](https://hl7.org/fhir/uv/ips/history.html) (as of November 2021) published release of IPS ([release 1.0.0, STU1](https://hl7.org/fhir/uv/ips/STU1/)), but is in the [development](http://build.fhir.org/ig/HL7/fhir-ips) preview of the next release." />
<alias value="Prescription" />
<alias value="Order" />
<min value="0" />
<max value="*" />
<base>
<path value="MedicationRequest" />
<min value="0" />
<max value="*" />
</base>
<constraint>
<key value="dom-2" />
<severity value="error" />
<human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources" />
<expression value="contained.contained.empty()" />
<xpath value="not(parent::f:contained and f:contained)" />
<source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
</constraint>
<constraint>
<key value="dom-4" />
<severity value="error" />
<human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated" />
<expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()" />
<xpath value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))" />
<source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
</constraint>
<constraint>
<key value="dom-3" />
<severity value="error" />
<human value="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" />
<expression value="contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()" />
<xpath value="not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))" />
<source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
</constraint>
<constraint>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice">
<valueBoolean value="true" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
<valueMarkdown value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." />
</extension>
<key value="dom-6" />
<severity value="warning" />
<human value="A resource should have narrative for robust management" />
<expression value="text.`div`.exists()" />
<xpath value="exists(f:text/h:div)" />
<source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
</constraint>
<constraint>
<key value="dom-5" />
<severity value="error" />
<human value="If a resource is contained in another resource, it SHALL NOT have a security label" />
<expression value="contained.meta.security.empty()" />
<xpath value="not(exists(f:contained/*/f:meta/f:security))" />
<source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
</constraint>
<mapping>
<identity value="rim" />
<map value="Entity. Role, or Act" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request" />
</mapping>
<mapping>
<identity value="script10.6" />
<map value="Message/Body/NewRx" />
</mapping>
<mapping>
<identity value="rim" />
<map value="CombinedMedicationRequest" />
</mapping>
</element>
<element id="MedicationRequest.id">
<path value="MedicationRequest.id" />
<short value="Logical id of this artifact" />
<definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes." />
<comment value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation." />
<min value="0" />
<max value="1" />
<base>
<path value="Resource.id" />
<min value="0" />
<max value="1" />
</base>
<type>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string" />
</extension>
<code value="http://hl7.org/fhirpath/System.String" />
</type>
<isSummary value="true" />
</element>
<element id="MedicationRequest.meta">
<path value="MedicationRequest.meta" />
<short value="Metadata about the resource" />
<definition value="The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource." />
<min value="0" />
<max value="1" />
<base>
<path value="Resource.meta" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Meta" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="MedicationRequest.implicitRules">
<path value="MedicationRequest.implicitRules" />
<short value="A set of rules under which this content was created" />
<definition value="A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="Resource.implicitRules" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="uri" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="true" />
<isModifierReason value="This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
</element>
<element id="MedicationRequest.language">
<path value="MedicationRequest.language" />
<short value="Language of the resource content" />
<definition value="The base language in which the resource is written." />
<comment value="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)." />
<min value="0" />
<max value="1" />
<base>
<path value="Resource.language" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="code" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
<valueCanonical value="http://hl7.org/fhir/ValueSet/all-languages" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Language" />
</extension>
<strength value="preferred" />
<description value="A human language." />
<valueSet value="http://hl7.org/fhir/ValueSet/languages" />
</binding>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
</element>
<element id="MedicationRequest.text">
<path value="MedicationRequest.text" />
<short value="Text summary of the resource, for human interpretation" />
<definition value="A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety." />
<comment value="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." />
<alias value="narrative" />
<alias value="html" />
<alias value="xhtml" />
<alias value="display" />
<min value="0" />
<max value="1" />
<base>
<path value="DomainResource.text" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Narrative" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
<mapping>
<identity value="rim" />
<map value="Act.text?" />
</mapping>
</element>
<element id="MedicationRequest.contained">
<path value="MedicationRequest.contained" />
<short value="Contained, inline Resources" />
<definition value="These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope." />
<comment value="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." />
<alias value="inline resources" />
<alias value="anonymous resources" />
<alias value="contained resources" />
<min value="0" />
<max value="*" />
<base>
<path value="DomainResource.contained" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Resource" />
</type>
<mapping>
<identity value="rim" />
<map value="Entity. Role, or Act" />
</mapping>
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="MedicationRequest.extension">
<path value="MedicationRequest.extension" />
<slicing>
<discriminator>
<type value="value" />
<path value="url" />
</discriminator>
<description value="Extensions are always sliced by (at least) url" />
<ordered value="false" />
<rules value="open" />
</slicing>
<short value="Additional content defined by implementations" />
<definition value="May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
<comment value="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." />
<alias value="extensions" />
<alias value="user content" />
<min value="0" />
<max value="*" />
<base>
<path value="DomainResource.extension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="MedicationRequest.extension:RenderedDosageInstruction">
<path value="MedicationRequest.extension" />
<sliceName value="RenderedDosageInstruction" />
<short value="Extension for representing rendered dosage instruction." />
<definition value="A free form textual specification generated from the input specifications as created by the provider. This is made up of either an 'Ad-hoc instruction' or 'Textual rendition of the structured dosage lines', plus route, dosage unit, and other pertinent administration information specified by the provider." />
<comment value="Use of structured fields for dosage instructions is heavily encouraged by this specification to promote interoperability of patient summaries. However, this extension is provided to make implementers aware that legacy medication data may come from some systems in this format. This extension is used by PrescribeIT implementations when the system has difficulty sending very complex dosage instructions in the form of structured data. Implementers are encouraged to read the PrescribeIT Specification (https://specs.prescribeit.ca/R5.0/erx/extension-ext-medication-rendered-dosage.html) to understand the context around its use." />
<alias value="extensions" />
<alias value="user content" />
<min value="0" />
<max value="1" />
<base>
<path value="DomainResource.extension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
<profile value="http://prescribeit.ca/fhir/StructureDefinition/ext-rendered-dosage-instruction" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="MedicationRequest.modifierExtension">
<path value="MedicationRequest.modifierExtension" />
<slicing>
<discriminator>
<type value="value" />
<path value="url" />
</discriminator>
<description value="Extensions are always sliced by (at least) url" />
<rules value="open" />
</slicing>
<short value="Extensions that cannot be ignored" />
<definition value="May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="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." />
<requirements value="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](extensibility.html#modifierExtension)." />
<alias value="extensions" />
<alias value="user content" />
<min value="0" />
<max value="*" />
<base>
<path value="DomainResource.modifierExtension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<isModifier value="true" />
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="MedicationRequest.identifier">
<path value="MedicationRequest.identifier" />
<short value="External ids for this request" />
<definition value="Identifiers 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." />
<comment value="This is a business identifier, not a resource identifier." />
<min value="0" />
<max value="*" />
<base>
<path value="MedicationRequest.identifier" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Identifier" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="CX / EI (occasionally, more often EI maps to a resource id or a URL)" />
</mapping>
<mapping>
<identity value="rim" />
<map value="II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" />
</mapping>
<mapping>
<identity value="servd" />
<map value="Identifier" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.identifier" />
</mapping>
<mapping>
<identity value="script10.6" />
<map value="Message/Header/PrescriberOrderNumber" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.identifier" />
</mapping>
<mapping>
<identity value="v2" />
<map value="ORC-2-Placer Order Number / ORC-3-Filler Order Number" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".id" />
</mapping>
</element>
<element id="MedicationRequest.status">
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:populate" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:no-error" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:handle" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHOULD:display" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<path value="MedicationRequest.status" />
<short value="active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown" />
<definition value="A code specifying the current state of the order. Generally, this will be active or completed state." />
<comment value="In the scope of the IPS the entered-in-error concept is not allowed." />
<min value="1" />
<max value="1" />
<base>
<path value="MedicationRequest.status" />
<min value="1" />
<max value="1" />
</base>
<type>
<code value="code" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<mustSupport value="true" />
<isModifier value="true" />
<isModifierReason value="This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid" />
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MedicationRequestStatus" />
</extension>
<strength value="required" />
<description value="A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription." />
<valueSet value="http://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1" />
</binding>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.status" />
</mapping>
<mapping>
<identity value="script10.6" />
<map value="no mapping" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.status" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".statusCode" />
</mapping>
</element>
<element id="MedicationRequest.statusReason">
<path value="MedicationRequest.statusReason" />
<short value="Reason for current status" />
<definition value="Captures the reason for the current state of the MedicationRequest." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.statusReason" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MedicationRequestStatusReason" />
</extension>
<strength value="example" />
<description value="Identifies the reasons for a given status." />
<valueSet value="http://hl7.org/fhir/ValueSet/medicationrequest-status-reason" />
</binding>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="CE/CNE/CWE" />
</mapping>
<mapping>
<identity value="rim" />
<map value="CD" />
</mapping>
<mapping>
<identity value="orim" />
<map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.statusReason" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde" />
</mapping>
</element>
<element id="MedicationRequest.intent">
<path value="MedicationRequest.intent" />
<short value="proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option" />
<definition value="Whether the request is a proposal, plan, or an original order." />
<comment value="This element is considered mandatory in the Base FHIR R4 Specification. \n\nBase R4 Note: 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." />
<min value="1" />
<max value="1" />
<base>
<path value="MedicationRequest.intent" />
<min value="1" />
<max value="1" />
</base>
<type>
<code value="code" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="true" />
<isModifierReason value="This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request" />
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MedicationRequestIntent" />
</extension>
<strength value="required" />
<description value="The kind of medication order." />
<valueSet value="http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1" />
</binding>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.intent" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.class" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)" />
</mapping>
</element>
<element id="MedicationRequest.category">
<path value="MedicationRequest.category" />
<short value="Type of medication usage" />
<definition value="Indicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient))." />
<comment value="The category can be used to include where the medication is expected to be consumed or other types of requests." />
<min value="0" />
<max value="*" />
<base>
<path value="MedicationRequest.category" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MedicationRequestCategory" />
</extension>
<strength value="example" />
<description value="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." />
<valueSet value="http://hl7.org/fhir/ValueSet/medicationrequest-category" />
</binding>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="CE/CNE/CWE" />
</mapping>
<mapping>
<identity value="rim" />
<map value="CD" />
</mapping>
<mapping>
<identity value="orim" />
<map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
</mapping>
<mapping>
<identity value="script10.6" />
<map value="Message/Body/NewRx/MedicationPrescribed/Directions\n\nor \n\nMessage/Body/NewRx/MedicationPrescribed/StructuredSIG" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.class" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication usage"].value" />
</mapping>
</element>
<element id="MedicationRequest.priority">
<path value="MedicationRequest.priority" />
<short value="routine | urgent | asap | stat" />
<definition value="Indicates how quickly the Medication Request should be addressed with respect to other requests." />
<comment value="Note that FHIR strings SHALL NOT exceed 1MB in size" />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.priority" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="code" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MedicationRequestPriority" />
</extension>
<strength value="required" />
<description value="Identifies the level of importance to be assigned to actioning the request." />
<valueSet value="http://hl7.org/fhir/ValueSet/request-priority|4.0.1" />
</binding>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.priority" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.grade" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".priorityCode" />
</mapping>
</element>
<element id="MedicationRequest.doNotPerform">
<path value="MedicationRequest.doNotPerform" />
<short value="True if request is prohibiting action" />
<definition value="If true indicates that the provider is asking for the medication request not to occur." />
<comment value="In the scope of the PSCA MedicationRequest, the doNotPerform concept is not allowed to be set to true. Other sections may be used to convey medications that a patient should or will not take." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.doNotPerform" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="boolean" />
</type>
<patternBoolean value="false" />
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="true" />
<isModifierReason value="This element is labeled as a modifier because this element negates the request to occur (ie, this is a request for the medication not to be ordered or prescribed, etc)" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="SubstanceAdministration.actionNegationInd" />
</mapping>
</element>
<element id="MedicationRequest.reported[x]">
<path value="MedicationRequest.reported[x]" />
<short value="Reported rather than primary record" />
<definition value="Indicates 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." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.reported[x]" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="boolean" />
</type>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".participation[typeCode=INF].role" />
</mapping>
</element>
<element id="MedicationRequest.medication[x]">
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:populate" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:no-error" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:handle" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHOULD:display" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<path value="MedicationRequest.medication[x]" />
<short value="Medication to be taken" />
<definition value="Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code. To improve global interoperability is strongly encouraged that the reference to a medication resource is used, limiting the usage of the medicationCodeableConcept only to the cases in which no other information than a simple code is available." />
<comment value="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." />
<min value="1" />
<max value="1" />
<base>
<path value="MedicationRequest.medication[x]" />
<min value="1" />
<max value="1" />
</base>
<type>
<code value="CodeableConcept" />
<profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-medication-ca-ps" />
</type>
<type>
<code value="Reference" />
<targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/medication-ca-ps" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<mustSupport value="true" />
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MedicationCode" />
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ValueSet/LicensedNaturalHealthProducts" />
</extension>
<extension url="documentation">
<valueMarkdown value="All Natural Product Number (NPN) and Homeopathic Medicine Number (DIN-HM) codes that are licensed by Health Canada and present in the Licensed Natural Health Products Database." />
</extension>
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://hl7.org/fhir/uv/ips/ValueSet/whoatc-uv-ips" />
</extension>
<extension url="documentation">
<valueMarkdown value="WHO ATC classification." />
</extension>
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://hl7.org/fhir/uv/ips/ValueSet/medication-uv-ips" />
</extension>
<extension url="documentation">
<valueMarkdown value="SNOMED CT medications (Medicinal product)" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ValueSet/DIN" />
</extension>
<extension url="documentation">
<valueMarkdown value="Health Canada Drug Identification Number set." />
</extension>
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticalbiologicproductandsubstancecode" />
</extension>
<extension url="documentation">
<valueMarkdown value="per PCHDCF: The alternate value set can be used for the international use case where the medication is not available in Canada and therefore does not appear in the recommended pan-Canadian value sets" />
</extension>
</extension>
<strength value="preferred" />
<description value="A coded concept identifying substance or product that can be ordered." />
<valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct" />
</binding>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.code" />
</mapping>
<mapping>
<identity value="script10.6" />
<map value="Message/Body/NewRx/MedicationPrescribed\n\nMedication.code.coding.code = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCode\n\nMedication.code.coding.system = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCodeQualifier\n\nMedication.code.coding.display = Message/Body/NewRx/MedicationPrescribed/DrugDescription" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.what[x]" />
</mapping>
<mapping>
<identity value="v2" />
<map value="RXE-2-Give Code / RXO-1-Requested Give Code / RXC-2-Component Code" />
</mapping>
<mapping>
<identity value="rim" />
<map value="consumable.administrableMedication" />
</mapping>
</element>
<element id="MedicationRequest.subject">
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:populate" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:no-error" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:handle" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHOULD:display" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<path value="MedicationRequest.subject" />
<short value="Who or group medication request is for" />
<definition value="A link to a resource representing the person or set of individuals to whom the medication will be given." />
<comment value="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." />
<min value="1" />
<max value="1" />
<base>
<path value="MedicationRequest.subject" />
<min value="1" />
<max value="1" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ref-1" />
<severity value="error" />
<human value="SHALL have a contained resource if a local reference is provided" />
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Reference" />
</constraint>
<mustSupport value="true" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.subject" />
</mapping>
<mapping>
<identity value="script10.6" />
<map value="Message/Body/NewRx/Patient\n\n(need detail to link to specific patient … Patient.Identification in SCRIPT)" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.subject[x]" />
</mapping>
<mapping>
<identity value="v2" />
<map value="PID-3-Patient ID List" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".participation[typeCode=AUT].role" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.subject" />
</mapping>
</element>
<element id="MedicationRequest.subject.id">
<path value="MedicationRequest.subject.id" />
<representation value="xmlAttr" />
<short value="Unique id for inter-element referencing" />
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
<min value="0" />
<max value="1" />
<base>
<path value="Element.id" />
<min value="0" />
<max value="1" />
</base>
<type>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string" />
</extension>
<code value="http://hl7.org/fhirpath/System.String" />
</type>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
</element>
<element id="MedicationRequest.subject.extension">
<path value="MedicationRequest.subject.extension" />
<slicing>
<discriminator>
<type value="value" />
<path value="url" />
</discriminator>
<description value="Extensions are always sliced by (at least) url" />
<rules value="open" />
</slicing>
<short value="Additional content defined by implementations" />
<definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
<comment value="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." />
<alias value="extensions" />
<alias value="user content" />
<min value="0" />
<max value="*" />
<base>
<path value="Element.extension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="MedicationRequest.subject.reference">
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:populate" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:no-error" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:handle" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHOULD:display" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<path value="MedicationRequest.subject.reference" />
<short value="Literal reference, Relative, internal or absolute URL" />
<definition value="A 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." />
<comment value="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." />
<min value="1" />
<max value="1" />
<base>
<path value="Reference.reference" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="string" />
</type>
<condition value="ele-1" />
<condition value="ref-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<mustSupport value="true" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="MedicationRequest.subject.type">
<path value="MedicationRequest.subject.type" />
<short value="Type the reference refers to (e.g. "Patient")" />
<definition value="The 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.\n\nThe 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)." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="Reference.type" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="uri" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="FHIRResourceTypeExt" />
</extension>
<strength value="extensible" />
<description value="Aa resource (or, for logical models, the URI of the logical model)." />
<valueSet value="http://hl7.org/fhir/ValueSet/resource-types" />
</binding>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="MedicationRequest.subject.identifier">
<path value="MedicationRequest.subject.identifier" />
<short value="Logical reference, when literal reference is not known" />
<definition value="An 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." />
<comment value="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. \n\nWhen 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\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.\n\nReference 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)." />
<min value="0" />
<max value="1" />
<base>
<path value="Reference.identifier" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Identifier" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="CX / EI (occasionally, more often EI maps to a resource id or a URL)" />
</mapping>
<mapping>
<identity value="rim" />
<map value="II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" />
</mapping>
<mapping>
<identity value="servd" />
<map value="Identifier" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".identifier" />
</mapping>
</element>
<element id="MedicationRequest.subject.display">
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
<valueBoolean value="true" />
</extension>
<path value="MedicationRequest.subject.display" />
<short value="Text alternative for the resource" />
<definition value="Plain text narrative that identifies the resource in addition to the resource reference." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="Reference.display" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="string" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="MedicationRequest.encounter">
<path value="MedicationRequest.encounter" />
<short value="Encounter created as part of encounter/admission/stay" />
<definition value="The Encounter during which this [x] was created or to which the creation of this record is tightly associated." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.encounter" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Encounter" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ref-1" />
<severity value="error" />
<human value="SHALL have a contained resource if a local reference is provided" />
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Reference" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.context" />
</mapping>
<mapping>
<identity value="script10.6" />
<map value="no mapping" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.context" />
</mapping>
<mapping>
<identity value="v2" />
<map value="PV1-19-Visit Number" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]" />
</mapping>
</element>
<element id="MedicationRequest.supportingInformation">
<path value="MedicationRequest.supportingInformation" />
<short value="Information to support ordering of the medication" />
<definition value="Include additional information (for example, patient height and weight) that supports the ordering of the medication." />
<comment value="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." />
<min value="0" />
<max value="*" />
<base>
<path value="MedicationRequest.supportingInformation" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ref-1" />
<severity value="error" />
<human value="SHALL have a contained resource if a local reference is provided" />
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Reference" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.supportingInfo" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.context" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".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)]" />
</mapping>
</element>
<element id="MedicationRequest.authoredOn">
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:able-to-populate" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:no-error" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHOULD:handle" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<path value="MedicationRequest.authoredOn" />
<short value="When request was initially authored" />
<definition value="The date (and perhaps time) when the prescription was initially written or authored on." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.authoredOn" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="dateTime" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<mustSupport value="true" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.authoredOn" />
</mapping>
<mapping>
<identity value="script10.6" />
<map value="Message/Body/NewRx/MedicationPrescribed/WrittenDate" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.recorded" />
</mapping>
<mapping>
<identity value="v2" />
<map value="RXE-32-Original Order Date/Time / ORC-9-Date/Time of Transaction" />
</mapping>
<mapping>
<identity value="rim" />
<map value="author.time" />
</mapping>
</element>
<element id="MedicationRequest.requester">
<path value="MedicationRequest.requester" />
<short value="Who/What requested the Request" />
<definition value="The individual, organization, or device that initiated the request and has responsibility for its activation." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.requester" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Device" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ref-1" />
<severity value="error" />
<human value="SHALL have a contained resource if a local reference is provided" />
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Reference" />
</constraint>
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.requester" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.author" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".participation[typeCode=AUT].role" />
</mapping>
</element>
<element id="MedicationRequest.performer">
<path value="MedicationRequest.performer" />
<short value="Intended performer of administration" />
<definition value="The specified desired performer of the medication treatment (e.g. the performer of the medication administration)." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.performer" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Device" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/CareTeam" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ref-1" />
<severity value="error" />
<human value="SHALL have a contained resource if a local reference is provided" />
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Reference" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.performer" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.actor" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]" />
</mapping>
</element>
<element id="MedicationRequest.performerType">
<path value="MedicationRequest.performerType" />
<short value="Desired kind of performer of the medication administration" />
<definition value="Indicates the type of performer of the administration of the medication." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.performerType" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MedicationRequestPerformerType" />
</extension>
<strength value="example" />
<description value="Identifies the type of individual that is desired to administer the medication." />
<valueSet value="http://hl7.org/fhir/ValueSet/performer-role" />
</binding>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="CE/CNE/CWE" />
</mapping>
<mapping>
<identity value="rim" />
<map value="CD" />
</mapping>
<mapping>
<identity value="orim" />
<map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.performerType" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".participation[typeCode=PRF].role[scoper.determinerCode=KIND].code" />
</mapping>
</element>
<element id="MedicationRequest.recorder">
<path value="MedicationRequest.recorder" />
<short value="Person who entered the request" />
<definition value="The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.recorder" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ref-1" />
<severity value="error" />
<human value="SHALL have a contained resource if a local reference is provided" />
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Reference" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.who" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".participation[typeCode=TRANS].role[classCode=ASSIGNED].code (HealthcareProviderType)" />
</mapping>
</element>
<element id="MedicationRequest.reasonCode">
<path value="MedicationRequest.reasonCode" />
<short value="Reason or indication for ordering or not ordering the medication" />
<definition value="The reason or the indication for ordering or not ordering the medication." />
<comment value="This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference." />
<min value="0" />
<max value="*" />
<base>
<path value="MedicationRequest.reasonCode" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MedicationRequestReason" />
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="https://fhir.infoway-inforoute.ca/ValueSet/prescriptionindicationforuse" />
</extension>
<extension url="documentation">
<valueMarkdown value="Commonly used reason for which a medication is being ordered reference set (foundation metadata concept)" />
</extension>
</extension>
<strength value="preferred" />
<description value="A coded concept indicating why the medication was ordered." />
<valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/medicationreasoncode" />
</binding>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="CE/CNE/CWE" />
</mapping>
<mapping>
<identity value="rim" />
<map value="CD" />
</mapping>
<mapping>
<identity value="orim" />
<map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.reasonCode" />
</mapping>
<mapping>
<identity value="script10.6" />
<map value="Message/Body/NewRx/MedicationPrescribed/Diagnosis/Primary/Value" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.why[x]" />
</mapping>
<mapping>
<identity value="v2" />
<map value="ORC-16-Order Control Code Reason /RXE-27-Give Indication/RXO-20-Indication / RXD-21-Indication / RXG-22-Indication / RXA-19-Indication" />
</mapping>
<mapping>
<identity value="rim" />
<map value="reason.observation.reasonCode" />
</mapping>
</element>
<element id="MedicationRequest.reasonReference">
<path value="MedicationRequest.reasonReference" />
<short value="Condition or observation that supports why the prescription is being written" />
<definition value="Condition or observation that supports why the medication was ordered." />
<comment value="This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode." />
<min value="0" />
<max value="*" />
<base>
<path value="MedicationRequest.reasonReference" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Condition" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Observation" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ref-1" />
<severity value="error" />
<human value="SHALL have a contained resource if a local reference is provided" />
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Reference" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.reasonReference" />
</mapping>
<mapping>
<identity value="script10.6" />
<map value="no mapping" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.why[x]" />
</mapping>
<mapping>
<identity value="rim" />
<map value="reason.observation[code=ASSERTION].value" />
</mapping>
</element>
<element id="MedicationRequest.instantiatesCanonical">
<path value="MedicationRequest.instantiatesCanonical" />
<short value="Instantiates FHIR protocol or definition" />
<definition value="The URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest." />
<comment value="see [Canonical References](references.html#canonical)" />
<min value="0" />
<max value="*" />
<base>
<path value="MedicationRequest.instantiatesCanonical" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="canonical" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.instantiates" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".outboundRelationship[typeCode=DEFN].target" />
</mapping>
</element>
<element id="MedicationRequest.instantiatesUri">
<path value="MedicationRequest.instantiatesUri" />
<short value="Instantiates external protocol or definition" />
<definition value="The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this MedicationRequest." />
<comment value="see http://en.wikipedia.org/wiki/Uniform_resource_identifier" />
<min value="0" />
<max value="*" />
<base>
<path value="MedicationRequest.instantiatesUri" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="uri" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".outboundRelationship[typeCode=DEFN].target" />
</mapping>
</element>
<element id="MedicationRequest.basedOn">
<path value="MedicationRequest.basedOn" />
<short value="What request fulfills" />
<definition value="A plan or request that is fulfilled in whole or in part by this medication request." />
<comment value="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." />
<min value="0" />
<max value="*" />
<base>
<path value="MedicationRequest.basedOn" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/CarePlan" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationRequest" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/ServiceRequest" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ref-1" />
<severity value="error" />
<human value="SHALL have a contained resource if a local reference is provided" />
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Reference" />
</constraint>
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.basedOn" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]" />
</mapping>
</element>
<element id="MedicationRequest.groupIdentifier">
<path value="MedicationRequest.groupIdentifier" />
<short value="Composite request this is part of" />
<definition value="A 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." />
<requirements value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.groupIdentifier" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Identifier" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="CX / EI (occasionally, more often EI maps to a resource id or a URL)" />
</mapping>
<mapping>
<identity value="rim" />
<map value="II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" />
</mapping>
<mapping>
<identity value="servd" />
<map value="Identifier" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.groupIdentifier" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".outboundRelationship(typeCode=COMP].target[classCode=SBADM, moodCode=INT].id" />
</mapping>
</element>
<element id="MedicationRequest.courseOfTherapyType">
<path value="MedicationRequest.courseOfTherapyType" />
<short value="Overall pattern of medication administration" />
<definition value="The description of the overall patte3rn of the administration of the medication to the patient." />
<comment value="This attribute should not be confused with the protocol of the medication." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.courseOfTherapyType" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MedicationRequestCourseOfTherapy" />
</extension>
<strength value="example" />
<description value="Identifies the overall pattern of medication administratio." />
<valueSet value="http://hl7.org/fhir/ValueSet/medicationrequest-course-of-therapy" />
</binding>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="CE/CNE/CWE" />
</mapping>
<mapping>
<identity value="rim" />
<map value="CD" />
</mapping>
<mapping>
<identity value="orim" />
<map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
</mapping>
<mapping>
<identity value="rim" />
<map value="Act.code where classCode = LIST and moodCode = EVN" />
</mapping>
</element>
<element id="MedicationRequest.insurance">
<path value="MedicationRequest.insurance" />
<short value="Associated insurance coverage" />
<definition value="Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service." />
<comment value="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." />
<min value="0" />
<max value="*" />
<base>
<path value="MedicationRequest.insurance" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Coverage" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/ClaimResponse" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ref-1" />
<severity value="error" />
<human value="SHALL have a contained resource if a local reference is provided" />
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Reference" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.insurance" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".outboundRelationship[typeCode=COVBY].target" />
</mapping>
</element>
<element id="MedicationRequest.note">
<path value="MedicationRequest.note" />
<short value="Information about the prescription" />
<definition value="Extra information about the prescription that could not be conveyed by the other attributes." />
<comment value="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)." />
<min value="0" />
<max value="*" />
<base>
<path value="MedicationRequest.note" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Annotation" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="N/A" />
</mapping>
<mapping>
<identity value="rim" />
<map value="Act" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.note" />
</mapping>
<mapping>
<identity value="script10.6" />
<map value="Message/Body/NewRx/MedicationPrescribed/Note" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".inboundRelationship[typeCode=SUBJ]/source[classCode=OBS,moodCode=EVN,code="annotation"].value" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction">
<path value="MedicationRequest.dosageInstruction" />
<short value="How the medication should be taken" />
<definition value="Indicates how the medication is to be used by the patient." />
<comment value="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." />
<min value="0" />
<max value="*" />
<base>
<path value="MedicationRequest.dosageInstruction" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Dosage" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT]" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.occurrence[x]" />
</mapping>
<mapping>
<identity value="rim" />
<map value="see dosageInstruction mapping" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.id">
<path value="MedicationRequest.dosageInstruction.id" />
<representation value="xmlAttr" />
<short value="Unique id for inter-element referencing" />
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
<min value="0" />
<max value="1" />
<base>
<path value="Element.id" />
<min value="0" />
<max value="1" />
</base>
<type>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string" />
</extension>
<code value="http://hl7.org/fhirpath/System.String" />
</type>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.extension">
<path value="MedicationRequest.dosageInstruction.extension" />
<slicing>
<discriminator>
<type value="value" />
<path value="url" />
</discriminator>
<description value="Extensions are always sliced by (at least) url" />
<rules value="open" />
</slicing>
<short value="Additional content defined by implementations" />
<definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
<comment value="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." />
<alias value="extensions" />
<alias value="user content" />
<min value="0" />
<max value="*" />
<base>
<path value="Element.extension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.modifierExtension">
<path value="MedicationRequest.dosageInstruction.modifierExtension" />
<short value="Extensions that cannot be ignored even if unrecognized" />
<definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="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." />
<requirements value="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](extensibility.html#modifierExtension)." />
<alias value="extensions" />
<alias value="user content" />
<alias value="modifiers" />
<min value="0" />
<max value="*" />
<base>
<path value="BackboneElement.modifierExtension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<isModifier value="true" />
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.sequence">
<path value="MedicationRequest.dosageInstruction.sequence" />
<short value="The order of the dosage instructions" />
<definition value="Indicates the order in which the dosage instructions should be applied or interpreted." />
<comment value="32 bit number; for values larger than this, use decimal" />
<requirements value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="Dosage.sequence" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="integer" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="TQ1-1" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".text" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.text">
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:able-to-populate" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:no-error" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHOULD:handle" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<path value="MedicationRequest.dosageInstruction.text" />
<short value="Free text dosage instructions e.g. SIG" />
<definition value="Free text dosage instructions e.g. SIG." />
<comment value="Note that FHIR strings SHALL NOT exceed 1MB in size" />
<requirements value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="Dosage.text" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="string" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<mustSupport value="true" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="RXO-6; RXE-21" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".text" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.additionalInstruction">
<path value="MedicationRequest.dosageInstruction.additionalInstruction" />
<short value="Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"" />
<definition value="Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps")." />
<comment value="Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text." />
<requirements value="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." />
<min value="0" />
<max value="*" />
<base>
<path value="Dosage.additionalInstruction" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="AdditionalInstruction" />
</extension>
<strength value="example" />
<description value="A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery"." />
<valueSet value="http://hl7.org/fhir/ValueSet/additional-instruction-codes" />
</binding>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="CE/CNE/CWE" />
</mapping>
<mapping>
<identity value="rim" />
<map value="CD" />
</mapping>
<mapping>
<identity value="orim" />
<map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
</mapping>
<mapping>
<identity value="v2" />
<map value="RXO-7" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".text" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.patientInstruction">
<path value="MedicationRequest.dosageInstruction.patientInstruction" />
<short value="Patient or consumer oriented instructions" />
<definition value="Instructions in terms that are understood by the patient or consumer." />
<comment value="Note that FHIR strings SHALL NOT exceed 1MB in size" />
<min value="0" />
<max value="1" />
<base>
<path value="Dosage.patientInstruction" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="string" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="RXO-7" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".text" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.timing">
<path value="MedicationRequest.dosageInstruction.timing" />
<short value="When medication should be administered" />
<definition value="When medication should be administered." />
<comment value="IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content." />
<requirements value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="Dosage.timing" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Timing" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="N/A" />
</mapping>
<mapping>
<identity value="rim" />
<map value="QSET<TS> (GTS)" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".effectiveTime" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.asNeeded[x]">
<path value="MedicationRequest.dosageInstruction.asNeeded[x]" />
<short value="Take "as needed" (for x)" />
<definition value="Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept)." />
<comment value="Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed"." />
<min value="0" />
<max value="1" />
<base>
<path value="Dosage.asNeeded[x]" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="boolean" />
</type>
<type>
<code value="CodeableConcept" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MedicationAsNeededReason" />
</extension>
<strength value="example" />
<description value="A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc." />
<valueSet value="http://hl7.org/fhir/ValueSet/medication-as-needed-reason" />
</binding>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="TQ1-9" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.site">
<path value="MedicationRequest.dosageInstruction.site" />
<short value="Body site to administer to" />
<definition value="Body site to administer to." />
<comment value="If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [bodySite](extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both." />
<requirements value="A coded specification of the anatomic site where the medication first enters the body." />
<min value="0" />
<max value="1" />
<base>
<path value="Dosage.site" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MedicationAdministrationSite" />
</extension>
<strength value="example" />
<description value="A coded concept describing the site location the medicine enters into or onto the body." />
<valueSet value="http://hl7.org/fhir/ValueSet/approach-site-codes" />
</binding>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="CE/CNE/CWE" />
</mapping>
<mapping>
<identity value="rim" />
<map value="CD" />
</mapping>
<mapping>
<identity value="orim" />
<map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
</mapping>
<mapping>
<identity value="v2" />
<map value="RXR-2" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".approachSiteCode" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.route">
<path value="MedicationRequest.dosageInstruction.route" />
<short value="How drug should enter body" />
<definition value="How drug should enter body." />
<comment value="See additionalBinding extension.\n\n IPS-UV no longer flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received.." />
<requirements value="A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body." />
<min value="0" />
<max value="1" />
<base>
<path value="Dosage.route" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="RouteOfAdministration" />
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://hl7.org/fhir/uv/ips/ValueSet/medicine-route-of-administration" />
</extension>
<extension url="documentation">
<valueMarkdown value="EDQM Standards Terms for route." />
</extension>
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="https://fhir.infoway-inforoute.ca/ValueSet/prescriptionrouteofadministration" />
</extension>
<extension url="documentation">
<valueMarkdown value="Route of administration for the prescription from the PrescribeIT value set. Implementers should anticipate that data collected and or exchanged in the context of ePrescribing may contain concepts from this valueSet. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology." />
</extension>
</extension>
<strength value="preferred" />
<description value="SCTCA Route of Administration" />
<valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/routeofadministration" />
</binding>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="CE/CNE/CWE" />
</mapping>
<mapping>
<identity value="rim" />
<map value="CD" />
</mapping>
<mapping>
<identity value="orim" />
<map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
</mapping>
<mapping>
<identity value="v2" />
<map value="RXR-1" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".routeCode" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.method">
<path value="MedicationRequest.dosageInstruction.method" />
<short value="Technique for administering medication" />
<definition value="Technique for administering medication." />
<comment value="Terminologies used often pre-coordinate this term with the route and or form of administration." />
<requirements value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="Dosage.method" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MedicationAdministrationMethod" />
</extension>
<strength value="example" />
<description value="A coded concept describing the technique by which the medicine is administered." />
<valueSet value="http://hl7.org/fhir/ValueSet/administration-method-codes" />
</binding>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="CE/CNE/CWE" />
</mapping>
<mapping>
<identity value="rim" />
<map value="CD" />
</mapping>
<mapping>
<identity value="orim" />
<map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
</mapping>
<mapping>
<identity value="v2" />
<map value="RXR-4" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".doseQuantity" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.doseAndRate">
<path value="MedicationRequest.dosageInstruction.doseAndRate" />
<short value="Amount of medication administered" />
<definition value="The amount of medication administered." />
<min value="0" />
<max value="*" />
<base>
<path value="Dosage.doseAndRate" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Element" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="TQ1-2" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.doseAndRate.id">
<path value="MedicationRequest.dosageInstruction.doseAndRate.id" />
<representation value="xmlAttr" />
<short value="Unique id for inter-element referencing" />
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
<min value="0" />
<max value="1" />
<base>
<path value="Element.id" />
<min value="0" />
<max value="1" />
</base>
<type>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string" />
</extension>
<code value="http://hl7.org/fhirpath/System.String" />
</type>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.doseAndRate.extension">
<path value="MedicationRequest.dosageInstruction.doseAndRate.extension" />
<slicing>
<discriminator>
<type value="value" />
<path value="url" />
</discriminator>
<description value="Extensions are always sliced by (at least) url" />
<rules value="open" />
</slicing>
<short value="Additional content defined by implementations" />
<definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
<comment value="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." />
<alias value="extensions" />
<alias value="user content" />
<min value="0" />
<max value="*" />
<base>
<path value="Element.extension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.doseAndRate.type">
<path value="MedicationRequest.dosageInstruction.doseAndRate.type" />
<short value="The kind of dose or rate specified" />
<definition value="The kind of dose or rate specified, for example, ordered or calculated." />
<comment value="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." />
<requirements value="If the type is not populated, assume to be "ordered"." />
<min value="0" />
<max value="1" />
<base>
<path value="Dosage.doseAndRate.type" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="DoseAndRateType" />
</extension>
<strength value="example" />
<description value="The kind of dose or rate specified." />
<valueSet value="http://hl7.org/fhir/ValueSet/dose-rate-type" />
</binding>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="CE/CNE/CWE" />
</mapping>
<mapping>
<identity value="rim" />
<map value="CD" />
</mapping>
<mapping>
<identity value="orim" />
<map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
</mapping>
<mapping>
<identity value="v2" />
<map value="RXO-21; RXE-23" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.doseAndRate.dose[x]">
<path value="MedicationRequest.dosageInstruction.doseAndRate.dose[x]" />
<short value="Amount of medication per dose" />
<definition value="Amount of medication per dose." />
<comment value="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." />
<requirements value="The amount of therapeutic or other substance given at one administration event." />
<min value="0" />
<max value="1" />
<base>
<path value="Dosage.doseAndRate.dose[x]" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Range" />
</type>
<type>
<code value="Quantity" />
<profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="RXO-2, RXE-3" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".doseQuantity" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.doseAndRate.rate[x]">
<path value="MedicationRequest.dosageInstruction.doseAndRate.rate[x]" />
<short value="Amount of medication per unit of time" />
<definition value="Amount of medication per unit of time." />
<comment value="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.\n\nIt 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 grammer 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." />
<requirements value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="Dosage.doseAndRate.rate[x]" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Ratio" />
</type>
<type>
<code value="Range" />
</type>
<type>
<code value="Quantity" />
<profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="RXE22, RXE23, RXE-24" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".rateQuantity" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.maxDosePerPeriod">
<path value="MedicationRequest.dosageInstruction.maxDosePerPeriod" />
<short value="Upper limit on medication per unit of time" />
<definition value="Upper limit on medication per unit of time." />
<comment value="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"." />
<requirements value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="Dosage.maxDosePerPeriod" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Ratio" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="rat-1" />
<severity value="error" />
<human value="Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present" />
<expression value="(numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists())" />
<xpath value="(count(f:numerator) = count(f:denominator)) and ((count(f:numerator) > 0) or (count(f:extension) > 0))" />
<source value="http://hl7.org/fhir/StructureDefinition/Ratio" />
</constraint>
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="N/A" />
</mapping>
<mapping>
<identity value="rim" />
<map value="RTO" />
</mapping>
<mapping>
<identity value="v2" />
<map value="RXO-23, RXE-19" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".maxDoseQuantity" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.maxDosePerAdministration">
<path value="MedicationRequest.dosageInstruction.maxDosePerAdministration" />
<short value="Upper limit on medication per administration" />
<definition value="Upper limit on medication per administration." />
<comment value="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." />
<requirements value="The maximum total quantity of a therapeutic substance that may be administered to a subject per administration." />
<min value="0" />
<max value="1" />
<base>
<path value="Dosage.maxDosePerAdministration" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Quantity" />
<profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="qty-3" />
<severity value="error" />
<human value="If a code for the unit is present, the system SHALL also be present" />
<expression value="code.empty() or system.exists()" />
<xpath value="not(exists(f:code)) or exists(f:system)" />
<source value="http://hl7.org/fhir/StructureDefinition/Quantity" />
</constraint>
<constraint>
<key value="sqty-1" />
<severity value="error" />
<human value="The comparator is not used on a SimpleQuantity" />
<expression value="comparator.empty()" />
<xpath value="not(exists(f:comparator))" />
<source value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="SN (see also Range) or CQ" />
</mapping>
<mapping>
<identity value="rim" />
<map value="PQ, IVL<PQ>, MO, CO, depending on the values" />
</mapping>
<mapping>
<identity value="rim" />
<map value="not supported" />
</mapping>
</element>
<element id="MedicationRequest.dosageInstruction.maxDosePerLifetime">
<path value="MedicationRequest.dosageInstruction.maxDosePerLifetime" />
<short value="Upper limit on medication per lifetime of the patient" />
<definition value="Upper limit on medication per lifetime of the patient." />
<comment value="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." />
<requirements value="The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject." />
<min value="0" />
<max value="1" />
<base>
<path value="Dosage.maxDosePerLifetime" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Quantity" />
<profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="qty-3" />
<severity value="error" />
<human value="If a code for the unit is present, the system SHALL also be present" />
<expression value="code.empty() or system.exists()" />
<xpath value="not(exists(f:code)) or exists(f:system)" />
<source value="http://hl7.org/fhir/StructureDefinition/Quantity" />
</constraint>
<constraint>
<key value="sqty-1" />
<severity value="error" />
<human value="The comparator is not used on a SimpleQuantity" />
<expression value="comparator.empty()" />
<xpath value="not(exists(f:comparator))" />
<source value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="SN (see also Range) or CQ" />
</mapping>
<mapping>
<identity value="rim" />
<map value="PQ, IVL<PQ>, MO, CO, depending on the values" />
</mapping>
<mapping>
<identity value="rim" />
<map value="not supported" />
</mapping>
</element>
<element id="MedicationRequest.dispenseRequest">
<path value="MedicationRequest.dispenseRequest" />
<short value="Medication supply authorization" />
<definition value="Indicates 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." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.dispenseRequest" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="BackboneElement" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="script10.6" />
<map value="Message/Body/NewRx/MedicationPrescribed/ExpirationDate" />
</mapping>
<mapping>
<identity value="rim" />
<map value="component.supplyEvent" />
</mapping>
</element>
<element id="MedicationRequest.dispenseRequest.id">
<path value="MedicationRequest.dispenseRequest.id" />
<representation value="xmlAttr" />
<short value="Unique id for inter-element referencing" />
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
<min value="0" />
<max value="1" />
<base>
<path value="Element.id" />
<min value="0" />
<max value="1" />
</base>
<type>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string" />
</extension>
<code value="http://hl7.org/fhirpath/System.String" />
</type>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
</element>
<element id="MedicationRequest.dispenseRequest.extension">
<path value="MedicationRequest.dispenseRequest.extension" />
<slicing>
<discriminator>
<type value="value" />
<path value="url" />
</discriminator>
<description value="Extensions are always sliced by (at least) url" />
<rules value="open" />
</slicing>
<short value="Additional content defined by implementations" />
<definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
<comment value="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." />
<alias value="extensions" />
<alias value="user content" />
<min value="0" />
<max value="*" />
<base>
<path value="Element.extension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="MedicationRequest.dispenseRequest.modifierExtension">
<path value="MedicationRequest.dispenseRequest.modifierExtension" />
<short value="Extensions that cannot be ignored even if unrecognized" />
<definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="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." />
<requirements value="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](extensibility.html#modifierExtension)." />
<alias value="extensions" />
<alias value="user content" />
<alias value="modifiers" />
<min value="0" />
<max value="*" />
<base>
<path value="BackboneElement.modifierExtension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<isModifier value="true" />
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="MedicationRequest.dispenseRequest.initialFill">
<path value="MedicationRequest.dispenseRequest.initialFill" />
<short value="First fill details" />
<definition value="Indicates the quantity or duration for the first dispense of the medication." />
<comment value="If populating this element, either the quantity or the duration must be included." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.dispenseRequest.initialFill" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="BackboneElement" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="SubstanceAdministration -> ActRelationship[sequenceNumber = '1'] -> Supply" />
</mapping>
</element>
<element id="MedicationRequest.dispenseRequest.initialFill.id">
<path value="MedicationRequest.dispenseRequest.initialFill.id" />
<representation value="xmlAttr" />
<short value="Unique id for inter-element referencing" />
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
<min value="0" />
<max value="1" />
<base>
<path value="Element.id" />
<min value="0" />
<max value="1" />
</base>
<type>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string" />
</extension>
<code value="http://hl7.org/fhirpath/System.String" />
</type>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
</element>
<element id="MedicationRequest.dispenseRequest.initialFill.extension">
<path value="MedicationRequest.dispenseRequest.initialFill.extension" />
<slicing>
<discriminator>
<type value="value" />
<path value="url" />
</discriminator>
<description value="Extensions are always sliced by (at least) url" />
<rules value="open" />
</slicing>
<short value="Additional content defined by implementations" />
<definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
<comment value="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." />
<alias value="extensions" />
<alias value="user content" />
<min value="0" />
<max value="*" />
<base>
<path value="Element.extension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="MedicationRequest.dispenseRequest.initialFill.modifierExtension">
<path value="MedicationRequest.dispenseRequest.initialFill.modifierExtension" />
<short value="Extensions that cannot be ignored even if unrecognized" />
<definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="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." />
<requirements value="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](extensibility.html#modifierExtension)." />
<alias value="extensions" />
<alias value="user content" />
<alias value="modifiers" />
<min value="0" />
<max value="*" />
<base>
<path value="BackboneElement.modifierExtension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<isModifier value="true" />
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="MedicationRequest.dispenseRequest.initialFill.quantity">
<path value="MedicationRequest.dispenseRequest.initialFill.quantity" />
<short value="First fill quantity" />
<definition value="The amount or quantity to provide as part of the first dispense." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.dispenseRequest.initialFill.quantity" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Quantity" />
<profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="qty-3" />
<severity value="error" />
<human value="If a code for the unit is present, the system SHALL also be present" />
<expression value="code.empty() or system.exists()" />
<xpath value="not(exists(f:code)) or exists(f:system)" />
<source value="http://hl7.org/fhir/StructureDefinition/Quantity" />
</constraint>
<constraint>
<key value="sqty-1" />
<severity value="error" />
<human value="The comparator is not used on a SimpleQuantity" />
<expression value="comparator.empty()" />
<xpath value="not(exists(f:comparator))" />
<source value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" />
</constraint>
<isModifier value="false" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="SN (see also Range) or CQ" />
</mapping>
<mapping>
<identity value="rim" />
<map value="PQ, IVL<PQ>, MO, CO, depending on the values" />
</mapping>
<mapping>
<identity value="rim" />
<map value="Supply.quantity[moodCode=RQO]" />
</mapping>
</element>
<element id="MedicationRequest.dispenseRequest.initialFill.duration">
<path value="MedicationRequest.dispenseRequest.initialFill.duration" />
<short value="First fill duration" />
<definition value="The length of time that the first dispense is expected to last." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.dispenseRequest.initialFill.duration" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Duration" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="qty-3" />
<severity value="error" />
<human value="If a code for the unit is present, the system SHALL also be present" />
<expression value="code.empty() or system.exists()" />
<xpath value="not(exists(f:code)) or exists(f:system)" />
<source value="http://hl7.org/fhir/StructureDefinition/Quantity" />
</constraint>
<constraint>
<key value="drt-1" />
<severity value="error" />
<human value="There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM." />
<expression value="code.exists() implies ((system = %ucum) and value.exists())" />
<xpath value="(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='http://unitsofmeasure.org')" />
<source value="http://hl7.org/fhir/StructureDefinition/Duration" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="SN (see also Range) or CQ" />
</mapping>
<mapping>
<identity value="rim" />
<map value="PQ, IVL<PQ>, MO, CO, depending on the values" />
</mapping>
<mapping>
<identity value="rim" />
<map value="PQ, IVL<PQ> depending on the values" />
</mapping>
<mapping>
<identity value="rim" />
<map value="Supply.effectivetime[moodCode=RQO]" />
</mapping>
</element>
<element id="MedicationRequest.dispenseRequest.dispenseInterval">
<path value="MedicationRequest.dispenseRequest.dispenseInterval" />
<short value="Minimum period of time between dispenses" />
<definition value="The minimum period of time that must occur between dispenses of the medication." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.dispenseRequest.dispenseInterval" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Duration" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="qty-3" />
<severity value="error" />
<human value="If a code for the unit is present, the system SHALL also be present" />
<expression value="code.empty() or system.exists()" />
<xpath value="not(exists(f:code)) or exists(f:system)" />
<source value="http://hl7.org/fhir/StructureDefinition/Quantity" />
</constraint>
<constraint>
<key value="drt-1" />
<severity value="error" />
<human value="There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM." />
<expression value="code.exists() implies ((system = %ucum) and value.exists())" />
<xpath value="(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='http://unitsofmeasure.org')" />
<source value="http://hl7.org/fhir/StructureDefinition/Duration" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="SN (see also Range) or CQ" />
</mapping>
<mapping>
<identity value="rim" />
<map value="PQ, IVL<PQ>, MO, CO, depending on the values" />
</mapping>
<mapping>
<identity value="rim" />
<map value="PQ, IVL<PQ> depending on the values" />
</mapping>
<mapping>
<identity value="rim" />
<map value="Supply.effectivetime[moodCode=RQO]" />
</mapping>
</element>
<element id="MedicationRequest.dispenseRequest.validityPeriod">
<path value="MedicationRequest.dispenseRequest.validityPeriod" />
<short value="Time period supply is authorized for" />
<definition value="This indicates the validity period of a prescription (stale dating the Prescription)." />
<comment value="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." />
<requirements value="Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.dispenseRequest.validityPeriod" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Period" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="per-1" />
<severity value="error" />
<human value="If present, start SHALL have a lower value than end" />
<expression value="start.hasValue().not() or end.hasValue().not() or (start <= end)" />
<xpath value="not(exists(f:start/@value)) or not(exists(f:end/@value)) or (xs:dateTime(f:start/@value) <= xs:dateTime(f:end/@value))" />
<source value="http://hl7.org/fhir/StructureDefinition/Period" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="DR" />
</mapping>
<mapping>
<identity value="rim" />
<map value="IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]" />
</mapping>
<mapping>
<identity value="script10.6" />
<map value="Message/Body/NewRx/MedicationPrescribed/Refills" />
</mapping>
<mapping>
<identity value="rim" />
<map value="effectiveTime" />
</mapping>
</element>
<element id="MedicationRequest.dispenseRequest.numberOfRepeatsAllowed">
<path value="MedicationRequest.dispenseRequest.numberOfRepeatsAllowed" />
<short value="Number of refills authorized" />
<definition value="An 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." />
<comment value="If displaying "number of authorized fills", add 1 to this number." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.dispenseRequest.numberOfRepeatsAllowed" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="unsignedInt" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="script10.6" />
<map value="Message/Body/NewRx/MedicationPrescribed/Quantity" />
</mapping>
<mapping>
<identity value="v2" />
<map value="RXE-12-Number of Refills" />
</mapping>
<mapping>
<identity value="rim" />
<map value="repeatNumber" />
</mapping>
</element>
<element id="MedicationRequest.dispenseRequest.quantity">
<path value="MedicationRequest.dispenseRequest.quantity" />
<short value="Amount of medication to supply per dispense" />
<definition value="The amount that is to be dispensed for one fill." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.dispenseRequest.quantity" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Quantity" />
<profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="qty-3" />
<severity value="error" />
<human value="If a code for the unit is present, the system SHALL also be present" />
<expression value="code.empty() or system.exists()" />
<xpath value="not(exists(f:code)) or exists(f:system)" />
<source value="http://hl7.org/fhir/StructureDefinition/Quantity" />
</constraint>
<constraint>
<key value="sqty-1" />
<severity value="error" />
<human value="The comparator is not used on a SimpleQuantity" />
<expression value="comparator.empty()" />
<xpath value="not(exists(f:comparator))" />
<source value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" />
</constraint>
<isModifier value="false" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="SN (see also Range) or CQ" />
</mapping>
<mapping>
<identity value="rim" />
<map value="PQ, IVL<PQ>, MO, CO, depending on the values" />
</mapping>
<mapping>
<identity value="script10.6" />
<map value="Message/Body/NewRx/MedicationPrescribed/DaysSupply" />
</mapping>
<mapping>
<identity value="v2" />
<map value="RXD-4-Actual Dispense Amount / RXD-5.1-Actual Dispense Units.code / RXD-5.3-Actual Dispense Units.name of coding system" />
</mapping>
<mapping>
<identity value="rim" />
<map value="quantity" />
</mapping>
</element>
<element id="MedicationRequest.dispenseRequest.expectedSupplyDuration">
<path value="MedicationRequest.dispenseRequest.expectedSupplyDuration" />
<short value="Number of days supply per dispense" />
<definition value="Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.dispenseRequest.expectedSupplyDuration" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Duration" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="qty-3" />
<severity value="error" />
<human value="If a code for the unit is present, the system SHALL also be present" />
<expression value="code.empty() or system.exists()" />
<xpath value="not(exists(f:code)) or exists(f:system)" />
<source value="http://hl7.org/fhir/StructureDefinition/Quantity" />
</constraint>
<constraint>
<key value="drt-1" />
<severity value="error" />
<human value="There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM." />
<expression value="code.exists() implies ((system = %ucum) and value.exists())" />
<xpath value="(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='http://unitsofmeasure.org')" />
<source value="http://hl7.org/fhir/StructureDefinition/Duration" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="SN (see also Range) or CQ" />
</mapping>
<mapping>
<identity value="rim" />
<map value="PQ, IVL<PQ>, MO, CO, depending on the values" />
</mapping>
<mapping>
<identity value="rim" />
<map value="PQ, IVL<PQ> depending on the values" />
</mapping>
<mapping>
<identity value="script10.6" />
<map value="Message/Body/NewRx/MedicationPrescribed/Substitutions" />
</mapping>
<mapping>
<identity value="rim" />
<map value="expectedUseTime" />
</mapping>
</element>
<element id="MedicationRequest.dispenseRequest.performer">
<path value="MedicationRequest.dispenseRequest.performer" />
<short value="Intended dispenser" />
<definition value="Indicates the intended dispensing Organization specified by the prescriber." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.dispenseRequest.performer" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ref-1" />
<severity value="error" />
<human value="SHALL have a contained resource if a local reference is provided" />
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Reference" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.who" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".outboundRelationship[typeCode=COMP].target[classCode=SPLY, moodCode=RQO] .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]" />
</mapping>
</element>
<element id="MedicationRequest.substitution">
<path value="MedicationRequest.substitution" />
<short value="Any restrictions on medication substitution" />
<definition value="Indicates 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." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.substitution" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="BackboneElement" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="script10.6" />
<map value="specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions" />
</mapping>
<mapping>
<identity value="rim" />
<map value="subjectOf.substitutionPersmission" />
</mapping>
</element>
<element id="MedicationRequest.substitution.id">
<path value="MedicationRequest.substitution.id" />
<representation value="xmlAttr" />
<short value="Unique id for inter-element referencing" />
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
<min value="0" />
<max value="1" />
<base>
<path value="Element.id" />
<min value="0" />
<max value="1" />
</base>
<type>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string" />
</extension>
<code value="http://hl7.org/fhirpath/System.String" />
</type>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
</element>
<element id="MedicationRequest.substitution.extension">
<path value="MedicationRequest.substitution.extension" />
<slicing>
<discriminator>
<type value="value" />
<path value="url" />
</discriminator>
<description value="Extensions are always sliced by (at least) url" />
<rules value="open" />
</slicing>
<short value="Additional content defined by implementations" />
<definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
<comment value="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." />
<alias value="extensions" />
<alias value="user content" />
<min value="0" />
<max value="*" />
<base>
<path value="Element.extension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="MedicationRequest.substitution.modifierExtension">
<path value="MedicationRequest.substitution.modifierExtension" />
<short value="Extensions that cannot be ignored even if unrecognized" />
<definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="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." />
<requirements value="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](extensibility.html#modifierExtension)." />
<alias value="extensions" />
<alias value="user content" />
<alias value="modifiers" />
<min value="0" />
<max value="*" />
<base>
<path value="BackboneElement.modifierExtension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<isModifier value="true" />
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="MedicationRequest.substitution.allowed[x]">
<path value="MedicationRequest.substitution.allowed[x]" />
<short value="Whether substitution is allowed or not" />
<definition value="True if the prescriber allows a different drug to be dispensed from what was prescribed." />
<comment value="This element is labeled as a modifier because whether substitution is allow or not, it cannot be ignored." />
<min value="1" />
<max value="1" />
<base>
<path value="MedicationRequest.substitution.allowed[x]" />
<min value="1" />
<max value="1" />
</base>
<type>
<code value="boolean" />
</type>
<type>
<code value="CodeableConcept" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MedicationRequestSubstitution" />
</extension>
<strength value="example" />
<description value="Identifies the type of substitution allowed." />
<valueSet value="http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode" />
</binding>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="script10.6" />
<map value="specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions" />
</mapping>
<mapping>
<identity value="v2" />
<map value="RXO-9-Allow Substitutions / RXE-9-Substitution Status" />
</mapping>
<mapping>
<identity value="rim" />
<map value="code" />
</mapping>
</element>
<element id="MedicationRequest.substitution.reason">
<path value="MedicationRequest.substitution.reason" />
<short value="Why should (not) substitution be made" />
<definition value="Indicates the reason for the substitution, or why substitution must or must not be performed." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.substitution.reason" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MedicationIntendedSubstitutionReason" />
</extension>
<strength value="example" />
<description value="A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed." />
<valueSet value="http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason" />
</binding>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="CE/CNE/CWE" />
</mapping>
<mapping>
<identity value="rim" />
<map value="CD" />
</mapping>
<mapping>
<identity value="orim" />
<map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
</mapping>
<mapping>
<identity value="script10.6" />
<map value="not mapped" />
</mapping>
<mapping>
<identity value="v2" />
<map value="RXE-9 Substition status" />
</mapping>
<mapping>
<identity value="rim" />
<map value="reasonCode" />
</mapping>
</element>
<element id="MedicationRequest.priorPrescription">
<path value="MedicationRequest.priorPrescription" />
<short value="An order/prescription that is being replaced" />
<definition value="A link to a resource representing an earlier order related order or prescription." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="MedicationRequest.priorPrescription" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationRequest" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ref-1" />
<severity value="error" />
<human value="SHALL have a contained resource if a local reference is provided" />
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Reference" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.replaces" />
</mapping>
<mapping>
<identity value="script10.6" />
<map value="not mapped" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".outboundRelationship[typeCode=?RPLC or ?SUCC]/target[classCode=SBADM,moodCode=RQO]" />
</mapping>
</element>
<element id="MedicationRequest.detectedIssue">
<path value="MedicationRequest.detectedIssue" />
<short value="Clinical Issue with action" />
<definition value="Indicates 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." />
<comment value="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." />
<alias value="Contraindication" />
<alias value="Drug Utilization Review (DUR)" />
<alias value="Alert" />
<min value="0" />
<max value="*" />
<base>
<path value="MedicationRequest.detectedIssue" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/DetectedIssue" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ref-1" />
<severity value="error" />
<human value="SHALL have a contained resource if a local reference is provided" />
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Reference" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".inboundRelationship[typeCode=SUBJ]/source[classCode=ALRT,moodCode=EVN].value" />
</mapping>
</element>
<element id="MedicationRequest.eventHistory">
<path value="MedicationRequest.eventHistory" />
<short value="A list of events of interest in the lifecycle" />
<definition value="Links 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." />
<comment value="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.)." />
<min value="0" />
<max value="*" />
<base>
<path value="MedicationRequest.eventHistory" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Provenance" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ref-1" />
<severity value="error" />
<human value="SHALL have a contained resource if a local reference is provided" />
<expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
<source value="http://hl7.org/fhir/StructureDefinition/Reference" />
</constraint>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="rim" />
<map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Request.relevantHistory" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]" />
</mapping>
</element>
</snapshot>
<differential>
<element id="MedicationRequest">
<path value="MedicationRequest" />
<comment value="Jurisdictions mapping prescription data into FHIR profiles for the patient summary should support the MedicationRequest resource. Use of the MedicationStatement profile should be reserved for communicating a statement about the patient's usage of the medication that is ultimately provided by a patient, significant other, or a clinician.\n\nThe MedicationRequest resource is not included in the [current](https://hl7.org/fhir/uv/ips/history.html) (as of November 2021) published release of IPS ([release 1.0.0, STU1](https://hl7.org/fhir/uv/ips/STU1/)), but is in the [development](http://build.fhir.org/ig/HL7/fhir-ips) preview of the next release." />
</element>
<element id="MedicationRequest.extension">
<path value="MedicationRequest.extension" />
<slicing>
<discriminator>
<type value="value" />
<path value="url" />
</discriminator>
<ordered value="false" />
<rules value="open" />
</slicing>
</element>
<element id="MedicationRequest.extension:RenderedDosageInstruction">
<path value="MedicationRequest.extension" />
<sliceName value="RenderedDosageInstruction" />
<short value="Extension for representing rendered dosage instruction." />
<definition value="A free form textual specification generated from the input specifications as created by the provider. This is made up of either an 'Ad-hoc instruction' or 'Textual rendition of the structured dosage lines', plus route, dosage unit, and other pertinent administration information specified by the provider." />
<comment value="Use of structured fields for dosage instructions is heavily encouraged by this specification to promote interoperability of patient summaries. However, this extension is provided to make implementers aware that legacy medication data may come from some systems in this format. This extension is used by PrescribeIT implementations when the system has difficulty sending very complex dosage instructions in the form of structured data. Implementers are encouraged to read the PrescribeIT Specification (https://specs.prescribeit.ca/R5.0/erx/extension-ext-medication-rendered-dosage.html) to understand the context around its use." />
<min value="0" />
<max value="1" />
<type>
<code value="Extension" />
<profile value="http://prescribeit.ca/fhir/StructureDefinition/ext-rendered-dosage-instruction" />
</type>
</element>
<element id="MedicationRequest.status">
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:populate" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:no-error" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:handle" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHOULD:display" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<path value="MedicationRequest.status" />
<comment value="In the scope of the IPS the entered-in-error concept is not allowed." />
<mustSupport value="true" />
</element>
<element id="MedicationRequest.intent">
<path value="MedicationRequest.intent" />
<comment value="This element is considered mandatory in the Base FHIR R4 Specification. \n\nBase R4 Note: 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." />
</element>
<element id="MedicationRequest.doNotPerform">
<path value="MedicationRequest.doNotPerform" />
<comment value="In the scope of the PSCA MedicationRequest, the doNotPerform concept is not allowed to be set to true. Other sections may be used to convey medications that a patient should or will not take." />
<patternBoolean value="false" />
</element>
<element id="MedicationRequest.medication[x]">
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:populate" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:no-error" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:handle" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHOULD:display" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<path value="MedicationRequest.medication[x]" />
<definition value="Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code. To improve global interoperability is strongly encouraged that the reference to a medication resource is used, limiting the usage of the medicationCodeableConcept only to the cases in which no other information than a simple code is available." />
<type>
<code value="CodeableConcept" />
<profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-medication-ca-ps" />
</type>
<type>
<code value="Reference" />
<targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/medication-ca-ps" />
</type>
<mustSupport value="true" />
<binding>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ValueSet/LicensedNaturalHealthProducts" />
</extension>
<extension url="documentation">
<valueMarkdown value="All Natural Product Number (NPN) and Homeopathic Medicine Number (DIN-HM) codes that are licensed by Health Canada and present in the Licensed Natural Health Products Database." />
</extension>
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://hl7.org/fhir/uv/ips/ValueSet/whoatc-uv-ips" />
</extension>
<extension url="documentation">
<valueMarkdown value="WHO ATC classification." />
</extension>
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://hl7.org/fhir/uv/ips/ValueSet/medication-uv-ips" />
</extension>
<extension url="documentation">
<valueMarkdown value="SNOMED CT medications (Medicinal product)" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ValueSet/DIN" />
</extension>
<extension url="documentation">
<valueMarkdown value="Health Canada Drug Identification Number set." />
</extension>
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticalbiologicproductandsubstancecode" />
</extension>
<extension url="documentation">
<valueMarkdown value="per PCHDCF: The alternate value set can be used for the international use case where the medication is not available in Canada and therefore does not appear in the recommended pan-Canadian value sets" />
</extension>
</extension>
<strength value="preferred" />
<valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct" />
</binding>
</element>
<element id="MedicationRequest.subject">
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:populate" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:no-error" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:handle" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHOULD:display" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<path value="MedicationRequest.subject" />
<type>
<code value="Reference" />
<targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps" />
</type>
<mustSupport value="true" />
</element>
<element id="MedicationRequest.subject.reference">
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:populate" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:no-error" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:handle" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHOULD:display" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<path value="MedicationRequest.subject.reference" />
<min value="1" />
<mustSupport value="true" />
</element>
<element id="MedicationRequest.authoredOn">
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:able-to-populate" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:no-error" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHOULD:handle" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<path value="MedicationRequest.authoredOn" />
<mustSupport value="true" />
</element>
<element id="MedicationRequest.reasonCode">
<path value="MedicationRequest.reasonCode" />
<binding>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="https://fhir.infoway-inforoute.ca/ValueSet/prescriptionindicationforuse" />
</extension>
<extension url="documentation">
<valueMarkdown value="Commonly used reason for which a medication is being ordered reference set (foundation metadata concept)" />
</extension>
</extension>
<strength value="preferred" />
<valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/medicationreasoncode" />
</binding>
</element>
<element id="MedicationRequest.dosageInstruction.text">
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:able-to-populate" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHALL:no-error" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/obligation">
<extension url="code">
<valueCode value="SHOULD:handle" />
</extension>
<extension url="actor">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" />
</extension>
</extension>
<path value="MedicationRequest.dosageInstruction.text" />
<mustSupport value="true" />
</element>
<element id="MedicationRequest.dosageInstruction.timing">
<path value="MedicationRequest.dosageInstruction.timing" />
<comment value="IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content." />
</element>
<element id="MedicationRequest.dosageInstruction.route">
<path value="MedicationRequest.dosageInstruction.route" />
<comment value="See additionalBinding extension.\n\n IPS-UV no longer flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received.." />
<binding>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://hl7.org/fhir/uv/ips/ValueSet/medicine-route-of-administration" />
</extension>
<extension url="documentation">
<valueMarkdown value="EDQM Standards Terms for route." />
</extension>
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="https://fhir.infoway-inforoute.ca/ValueSet/prescriptionrouteofadministration" />
</extension>
<extension url="documentation">
<valueMarkdown value="Route of administration for the prescription from the PrescribeIT value set. Implementers should anticipate that data collected and or exchanged in the context of ePrescribing may contain concepts from this valueSet. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology." />
</extension>
</extension>
<strength value="preferred" />
<description value="SCTCA Route of Administration" />
<valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/routeofadministration" />
</binding>
</element>
</differential>
</StructureDefinition>
{
"resourceType": "StructureDefinition",
"id": "medicationrequest-ca-ps",
"url": "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/medicationrequest-ca-ps",
"version": "2.2.0",
"name": "MedicationRequestPSCA",
"title": "Medication Request (PS-CA)",
"status": "draft",
"experimental": false,
"date": "2024-04-09T00:00:00-08:00",
"description": "This profile represents the constraints applied to the MedicationRequest resource by the PS-CA project and allows for cross-border and cross-jurisdiction sharing of information record of a medication request information in the patient summary.",
"copyright": "Copyright © 2024+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy).",
"fhirVersion": "4.0.1",
"kind": "resource",
"abstract": false,
"type": "MedicationRequest",
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/MedicationRequest",
"derivation": "constraint",
"snapshot": {
"element": [
{
"id": "MedicationRequest",
"path": "MedicationRequest",
"short": "Ordering of medication for patient or group",
"definition": "An 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.",
"comment": "Jurisdictions mapping prescription data into FHIR profiles for the patient summary should support the MedicationRequest resource. Use of the MedicationStatement profile should be reserved for communicating a statement about the patient's usage of the medication that is ultimately provided by a patient, significant other, or a clinician.\n\nThe MedicationRequest resource is not included in the [current](https://hl7.org/fhir/uv/ips/history.html) (as of November 2021) published release of IPS ([release 1.0.0, STU1](https://hl7.org/fhir/uv/ips/STU1/)), but is in the [development](http://build.fhir.org/ig/HL7/fhir-ips) preview of the next release.",
"alias": [
"Prescription",
"Order"
],
"min": 0,
"max": "*",
"base": {
"path": "MedicationRequest",
"min": 0,
"max": "*"
},
"constraint": [
{
"key": "dom-2",
"severity": "error",
"human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
"expression": "contained.contained.empty()",
"xpath": "not(parent::f:contained and f:contained)",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key": "dom-4",
"severity": "error",
"human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()",
"xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key": "dom-3",
"severity": "error",
"human": "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",
"expression": "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()",
"xpath": "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice",
"valueBoolean": true
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation",
"valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
}
],
"key": "dom-6",
"severity": "warning",
"human": "A resource should have narrative for robust management",
"expression": "text.`div`.exists()",
"xpath": "exists(f:text/h:div)",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key": "dom-5",
"severity": "error",
"human": "If a resource is contained in another resource, it SHALL NOT have a security label",
"expression": "contained.meta.security.empty()",
"xpath": "not(exists(f:contained/*/f:meta/f:security))",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
}
],
"mapping": [
{
"identity": "rim",
"map": "Entity. Role, or Act"
},
{
"identity": "workflow",
"map": "Request"
},
{
"identity": "script10.6",
"map": "Message/Body/NewRx"
},
{
"identity": "rim",
"map": "CombinedMedicationRequest"
}
]
},
{
"id": "MedicationRequest.id",
"path": "MedicationRequest.id",
"short": "Logical id of this artifact",
"definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.id",
"min": 0,
"max": "1"
},
"type": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
}
],
"code": "http://hl7.org/fhirpath/System.String"
}
],
"isSummary": true
},
{
"id": "MedicationRequest.meta",
"path": "MedicationRequest.meta",
"short": "Metadata about the resource",
"definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.meta",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Meta"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.implicitRules",
"path": "MedicationRequest.implicitRules",
"short": "A set of rules under which this content was created",
"definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.implicitRules",
"min": 0,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": true,
"isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "MedicationRequest.language",
"path": "MedicationRequest.language",
"short": "Language of the resource content",
"definition": "The base language in which the resource is written.",
"comment": "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).",
"min": 0,
"max": "1",
"base": {
"path": "Resource.language",
"min": 0,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
}
],
"strength": "preferred",
"description": "A human language.",
"valueSet": "http://hl7.org/fhir/ValueSet/languages"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "MedicationRequest.text",
"path": "MedicationRequest.text",
"short": "Text summary of the resource, for human interpretation",
"definition": "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
"comment": "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.",
"alias": [
"narrative",
"html",
"xhtml",
"display"
],
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.text",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Narrative"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
},
{
"identity": "rim",
"map": "Act.text?"
}
]
},
{
"id": "MedicationRequest.contained",
"path": "MedicationRequest.contained",
"short": "Contained, inline Resources",
"definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
"comment": "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.",
"alias": [
"inline resources",
"anonymous resources",
"contained resources"
],
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.contained",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Resource"
}
],
"mapping": [
{
"identity": "rim",
"map": "Entity. Role, or Act"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.extension",
"path": "MedicationRequest.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "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.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.extension:RenderedDosageInstruction",
"path": "MedicationRequest.extension",
"sliceName": "RenderedDosageInstruction",
"short": "Extension for representing rendered dosage instruction.",
"definition": "A free form textual specification generated from the input specifications as created by the provider. This is made up of either an 'Ad-hoc instruction' or 'Textual rendition of the structured dosage lines', plus route, dosage unit, and other pertinent administration information specified by the provider.",
"comment": "Use of structured fields for dosage instructions is heavily encouraged by this specification to promote interoperability of patient summaries. However, this extension is provided to make implementers aware that legacy medication data may come from some systems in this format. This extension is used by PrescribeIT implementations when the system has difficulty sending very complex dosage instructions in the form of structured data. Implementers are encouraged to read the PrescribeIT Specification (https://specs.prescribeit.ca/R5.0/erx/extension-ext-medication-rendered-dosage.html) to understand the context around its use.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": [
"http://prescribeit.ca/fhir/StructureDefinition/ext-rendered-dosage-instruction"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.modifierExtension",
"path": "MedicationRequest.modifierExtension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Extensions that cannot be ignored",
"definition": "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "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.",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": true,
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.identifier",
"path": "MedicationRequest.identifier",
"short": "External ids for this request",
"definition": "Identifiers 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.",
"comment": "This is a business identifier, not a resource identifier.",
"min": 0,
"max": "*",
"base": {
"path": "MedicationRequest.identifier",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Identifier"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)"
},
{
"identity": "rim",
"map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]"
},
{
"identity": "servd",
"map": "Identifier"
},
{
"identity": "workflow",
"map": "Request.identifier"
},
{
"identity": "script10.6",
"map": "Message/Header/PrescriberOrderNumber"
},
{
"identity": "w5",
"map": "FiveWs.identifier"
},
{
"identity": "v2",
"map": "ORC-2-Placer Order Number / ORC-3-Filler Order Number"
},
{
"identity": "rim",
"map": ".id"
}
]
},
{
"id": "MedicationRequest.status",
"extension": [
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:populate"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:no-error"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:handle"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHOULD:display"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
}
],
"path": "MedicationRequest.status",
"short": "active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown",
"definition": "A code specifying the current state of the order. Generally, this will be active or completed state.",
"comment": "In the scope of the IPS the entered-in-error concept is not allowed.",
"min": 1,
"max": "1",
"base": {
"path": "MedicationRequest.status",
"min": 1,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport": true,
"isModifier": true,
"isModifierReason": "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid",
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationRequestStatus"
}
],
"strength": "required",
"description": "A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.",
"valueSet": "http://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "workflow",
"map": "Request.status"
},
{
"identity": "script10.6",
"map": "no mapping"
},
{
"identity": "w5",
"map": "FiveWs.status"
},
{
"identity": "rim",
"map": ".statusCode"
}
]
},
{
"id": "MedicationRequest.statusReason",
"path": "MedicationRequest.statusReason",
"short": "Reason for current status",
"definition": "Captures the reason for the current state of the MedicationRequest.",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.statusReason",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationRequestStatusReason"
}
],
"strength": "example",
"description": "Identifies the reasons for a given status.",
"valueSet": "http://hl7.org/fhir/ValueSet/medicationrequest-status-reason"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "CE/CNE/CWE"
},
{
"identity": "rim",
"map": "CD"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
},
{
"identity": "workflow",
"map": "Request.statusReason"
},
{
"identity": "rim",
"map": ".inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde"
}
]
},
{
"id": "MedicationRequest.intent",
"path": "MedicationRequest.intent",
"short": "proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option",
"definition": "Whether the request is a proposal, plan, or an original order.",
"comment": "This element is considered mandatory in the Base FHIR R4 Specification. \n\nBase R4 Note: 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.",
"min": 1,
"max": "1",
"base": {
"path": "MedicationRequest.intent",
"min": 1,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": true,
"isModifierReason": "This element changes the interpretation of all descriptive attributes. For example \"the time the request is recommended to occur\" vs. \"the time the request is authorized to occur\" or \"who is recommended to perform the request\" vs. \"who is authorized to perform the request",
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationRequestIntent"
}
],
"strength": "required",
"description": "The kind of medication order.",
"valueSet": "http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "workflow",
"map": "Request.intent"
},
{
"identity": "w5",
"map": "FiveWs.class"
},
{
"identity": "rim",
"map": ".moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)"
}
]
},
{
"id": "MedicationRequest.category",
"path": "MedicationRequest.category",
"short": "Type of medication usage",
"definition": "Indicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).",
"comment": "The category can be used to include where the medication is expected to be consumed or other types of requests.",
"min": 0,
"max": "*",
"base": {
"path": "MedicationRequest.category",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationRequestCategory"
}
],
"strength": "example",
"description": "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.",
"valueSet": "http://hl7.org/fhir/ValueSet/medicationrequest-category"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "CE/CNE/CWE"
},
{
"identity": "rim",
"map": "CD"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
},
{
"identity": "script10.6",
"map": "Message/Body/NewRx/MedicationPrescribed/Directions\n\nor \n\nMessage/Body/NewRx/MedicationPrescribed/StructuredSIG"
},
{
"identity": "w5",
"map": "FiveWs.class"
},
{
"identity": "rim",
"map": ".inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code=\"type of medication usage\"].value"
}
]
},
{
"id": "MedicationRequest.priority",
"path": "MedicationRequest.priority",
"short": "routine | urgent | asap | stat",
"definition": "Indicates how quickly the Medication Request should be addressed with respect to other requests.",
"comment": "Note that FHIR strings SHALL NOT exceed 1MB in size",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.priority",
"min": 0,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationRequestPriority"
}
],
"strength": "required",
"description": "Identifies the level of importance to be assigned to actioning the request.",
"valueSet": "http://hl7.org/fhir/ValueSet/request-priority|4.0.1"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "workflow",
"map": "Request.priority"
},
{
"identity": "w5",
"map": "FiveWs.grade"
},
{
"identity": "rim",
"map": ".priorityCode"
}
]
},
{
"id": "MedicationRequest.doNotPerform",
"path": "MedicationRequest.doNotPerform",
"short": "True if request is prohibiting action",
"definition": "If true indicates that the provider is asking for the medication request not to occur.",
"comment": "In the scope of the PSCA MedicationRequest, the doNotPerform concept is not allowed to be set to true. Other sections may be used to convey medications that a patient should or will not take.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.doNotPerform",
"min": 0,
"max": "1"
},
"type": [
{
"code": "boolean"
}
],
"patternBoolean": false,
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": true,
"isModifierReason": "This element is labeled as a modifier because this element negates the request to occur (ie, this is a request for the medication not to be ordered or prescribed, etc)",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "SubstanceAdministration.actionNegationInd"
}
]
},
{
"id": "MedicationRequest.reported[x]",
"path": "MedicationRequest.reported[x]",
"short": "Reported rather than primary record",
"definition": "Indicates 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.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.reported[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "boolean"
},
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Patient",
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole",
"http://hl7.org/fhir/StructureDefinition/RelatedPerson",
"http://hl7.org/fhir/StructureDefinition/Organization"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": ".participation[typeCode=INF].role"
}
]
},
{
"id": "MedicationRequest.medication[x]",
"extension": [
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:populate"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:no-error"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:handle"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHOULD:display"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
}
],
"path": "MedicationRequest.medication[x]",
"short": "Medication to be taken",
"definition": "Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code. To improve global interoperability is strongly encouraged that the reference to a medication resource is used, limiting the usage of the medicationCodeableConcept only to the cases in which no other information than a simple code is available.",
"comment": "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.",
"min": 1,
"max": "1",
"base": {
"path": "MedicationRequest.medication[x]",
"min": 1,
"max": "1"
},
"type": [
{
"code": "CodeableConcept",
"profile": [
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-medication-ca-ps"
]
},
{
"code": "Reference",
"targetProfile": [
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/medication-ca-ps"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport": true,
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationCode"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/LicensedNaturalHealthProducts"
},
{
"url": "documentation",
"valueMarkdown": "All Natural Product Number (NPN) and Homeopathic Medicine Number (DIN-HM) codes that are licensed by Health Canada and present in the Licensed Natural Health Products Database."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/whoatc-uv-ips"
},
{
"url": "documentation",
"valueMarkdown": "WHO ATC classification."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/medication-uv-ips"
},
{
"url": "documentation",
"valueMarkdown": "SNOMED CT medications (Medicinal product)"
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/DIN"
},
{
"url": "documentation",
"valueMarkdown": "Health Canada Drug Identification Number set."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticalbiologicproductandsubstancecode"
},
{
"url": "documentation",
"valueMarkdown": "per PCHDCF: The alternate value set can be used for the international use case where the medication is not available in Canada and therefore does not appear in the recommended pan-Canadian value sets"
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
}
],
"strength": "preferred",
"description": "A coded concept identifying substance or product that can be ordered.",
"valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "workflow",
"map": "Request.code"
},
{
"identity": "script10.6",
"map": "Message/Body/NewRx/MedicationPrescribed\n\nMedication.code.coding.code = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCode\n\nMedication.code.coding.system = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCodeQualifier\n\nMedication.code.coding.display = Message/Body/NewRx/MedicationPrescribed/DrugDescription"
},
{
"identity": "w5",
"map": "FiveWs.what[x]"
},
{
"identity": "v2",
"map": "RXE-2-Give Code / RXO-1-Requested Give Code / RXC-2-Component Code"
},
{
"identity": "rim",
"map": "consumable.administrableMedication"
}
]
},
{
"id": "MedicationRequest.subject",
"extension": [
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:populate"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:no-error"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:handle"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHOULD:display"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
}
],
"path": "MedicationRequest.subject",
"short": "Who or group medication request is for",
"definition": "A link to a resource representing the person or set of individuals to whom the medication will be given.",
"comment": "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.",
"min": 1,
"max": "1",
"base": {
"path": "MedicationRequest.subject",
"min": 1,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ref-1",
"severity": "error",
"human": "SHALL have a contained resource if a local reference is provided",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference"
}
],
"mustSupport": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
},
{
"identity": "workflow",
"map": "Request.subject"
},
{
"identity": "script10.6",
"map": "Message/Body/NewRx/Patient\n\n(need detail to link to specific patient … Patient.Identification in SCRIPT)"
},
{
"identity": "w5",
"map": "FiveWs.subject[x]"
},
{
"identity": "v2",
"map": "PID-3-Patient ID List"
},
{
"identity": "rim",
"map": ".participation[typeCode=AUT].role"
},
{
"identity": "w5",
"map": "FiveWs.subject"
}
]
},
{
"id": "MedicationRequest.subject.id",
"path": "MedicationRequest.subject.id",
"representation": [
"xmlAttr"
],
"short": "Unique id for inter-element referencing",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
}
],
"code": "http://hl7.org/fhirpath/System.String"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "MedicationRequest.subject.extension",
"path": "MedicationRequest.subject.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "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.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.subject.reference",
"extension": [
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:populate"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:no-error"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:handle"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHOULD:display"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
}
],
"path": "MedicationRequest.subject.reference",
"short": "Literal reference, Relative, internal or absolute URL",
"definition": "A 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.",
"comment": "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.",
"min": 1,
"max": "1",
"base": {
"path": "Reference.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ele-1",
"ref-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.subject.type",
"path": "MedicationRequest.subject.type",
"short": "Type the reference refers to (e.g. \"Patient\")",
"definition": "The 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.\n\nThe 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).",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.type",
"min": 0,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "FHIRResourceTypeExt"
}
],
"strength": "extensible",
"description": "Aa resource (or, for logical models, the URI of the logical model).",
"valueSet": "http://hl7.org/fhir/ValueSet/resource-types"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.subject.identifier",
"path": "MedicationRequest.subject.identifier",
"short": "Logical reference, when literal reference is not known",
"definition": "An 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.",
"comment": "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. \n\nWhen 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\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.\n\nReference 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).",
"min": 0,
"max": "1",
"base": {
"path": "Reference.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)"
},
{
"identity": "rim",
"map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]"
},
{
"identity": "servd",
"map": "Identifier"
},
{
"identity": "rim",
"map": ".identifier"
}
]
},
{
"id": "MedicationRequest.subject.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "MedicationRequest.subject.display",
"short": "Text alternative for the resource",
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.display",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.encounter",
"path": "MedicationRequest.encounter",
"short": "Encounter created as part of encounter/admission/stay",
"definition": "The Encounter during which this [x] was created or to which the creation of this record is tightly associated.",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.encounter",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Encounter"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ref-1",
"severity": "error",
"human": "SHALL have a contained resource if a local reference is provided",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
},
{
"identity": "workflow",
"map": "Request.context"
},
{
"identity": "script10.6",
"map": "no mapping"
},
{
"identity": "w5",
"map": "FiveWs.context"
},
{
"identity": "v2",
"map": "PV1-19-Visit Number"
},
{
"identity": "rim",
"map": ".inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code=\"type of encounter or episode\"]"
}
]
},
{
"id": "MedicationRequest.supportingInformation",
"path": "MedicationRequest.supportingInformation",
"short": "Information to support ordering of the medication",
"definition": "Include additional information (for example, patient height and weight) that supports the ordering of the medication.",
"comment": "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.",
"min": 0,
"max": "*",
"base": {
"path": "MedicationRequest.supportingInformation",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Resource"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ref-1",
"severity": "error",
"human": "SHALL have a contained resource if a local reference is provided",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
},
{
"identity": "workflow",
"map": "Request.supportingInfo"
},
{
"identity": "w5",
"map": "FiveWs.context"
},
{
"identity": "rim",
"map": ".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)]"
}
]
},
{
"id": "MedicationRequest.authoredOn",
"extension": [
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:able-to-populate"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:no-error"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHOULD:handle"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
}
],
"path": "MedicationRequest.authoredOn",
"short": "When request was initially authored",
"definition": "The date (and perhaps time) when the prescription was initially written or authored on.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.authoredOn",
"min": 0,
"max": "1"
},
"type": [
{
"code": "dateTime"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "workflow",
"map": "Request.authoredOn"
},
{
"identity": "script10.6",
"map": "Message/Body/NewRx/MedicationPrescribed/WrittenDate"
},
{
"identity": "w5",
"map": "FiveWs.recorded"
},
{
"identity": "v2",
"map": "RXE-32-Original Order Date/Time / ORC-9-Date/Time of Transaction"
},
{
"identity": "rim",
"map": "author.time"
}
]
},
{
"id": "MedicationRequest.requester",
"path": "MedicationRequest.requester",
"short": "Who/What requested the Request",
"definition": "The individual, organization, or device that initiated the request and has responsibility for its activation.",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.requester",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole",
"http://hl7.org/fhir/StructureDefinition/Organization",
"http://hl7.org/fhir/StructureDefinition/Patient",
"http://hl7.org/fhir/StructureDefinition/RelatedPerson",
"http://hl7.org/fhir/StructureDefinition/Device"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ref-1",
"severity": "error",
"human": "SHALL have a contained resource if a local reference is provided",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
},
{
"identity": "workflow",
"map": "Request.requester"
},
{
"identity": "w5",
"map": "FiveWs.author"
},
{
"identity": "rim",
"map": ".participation[typeCode=AUT].role"
}
]
},
{
"id": "MedicationRequest.performer",
"path": "MedicationRequest.performer",
"short": "Intended performer of administration",
"definition": "The specified desired performer of the medication treatment (e.g. the performer of the medication administration).",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.performer",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole",
"http://hl7.org/fhir/StructureDefinition/Organization",
"http://hl7.org/fhir/StructureDefinition/Patient",
"http://hl7.org/fhir/StructureDefinition/Device",
"http://hl7.org/fhir/StructureDefinition/RelatedPerson",
"http://hl7.org/fhir/StructureDefinition/CareTeam"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ref-1",
"severity": "error",
"human": "SHALL have a contained resource if a local reference is provided",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
},
{
"identity": "workflow",
"map": "Request.performer"
},
{
"identity": "w5",
"map": "FiveWs.actor"
},
{
"identity": "rim",
"map": ".participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]"
}
]
},
{
"id": "MedicationRequest.performerType",
"path": "MedicationRequest.performerType",
"short": "Desired kind of performer of the medication administration",
"definition": "Indicates the type of performer of the administration of the medication.",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.performerType",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationRequestPerformerType"
}
],
"strength": "example",
"description": "Identifies the type of individual that is desired to administer the medication.",
"valueSet": "http://hl7.org/fhir/ValueSet/performer-role"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "CE/CNE/CWE"
},
{
"identity": "rim",
"map": "CD"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
},
{
"identity": "workflow",
"map": "Request.performerType"
},
{
"identity": "rim",
"map": ".participation[typeCode=PRF].role[scoper.determinerCode=KIND].code"
}
]
},
{
"id": "MedicationRequest.recorder",
"path": "MedicationRequest.recorder",
"short": "Person who entered the request",
"definition": "The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order.",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.recorder",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ref-1",
"severity": "error",
"human": "SHALL have a contained resource if a local reference is provided",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
},
{
"identity": "w5",
"map": "FiveWs.who"
},
{
"identity": "rim",
"map": ".participation[typeCode=TRANS].role[classCode=ASSIGNED].code (HealthcareProviderType)"
}
]
},
{
"id": "MedicationRequest.reasonCode",
"path": "MedicationRequest.reasonCode",
"short": "Reason or indication for ordering or not ordering the medication",
"definition": "The reason or the indication for ordering or not ordering the medication.",
"comment": "This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference.",
"min": 0,
"max": "*",
"base": {
"path": "MedicationRequest.reasonCode",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationRequestReason"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionindicationforuse"
},
{
"url": "documentation",
"valueMarkdown": "Commonly used reason for which a medication is being ordered reference set (foundation metadata concept)"
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
}
],
"strength": "preferred",
"description": "A coded concept indicating why the medication was ordered.",
"valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/medicationreasoncode"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "CE/CNE/CWE"
},
{
"identity": "rim",
"map": "CD"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
},
{
"identity": "workflow",
"map": "Request.reasonCode"
},
{
"identity": "script10.6",
"map": "Message/Body/NewRx/MedicationPrescribed/Diagnosis/Primary/Value"
},
{
"identity": "w5",
"map": "FiveWs.why[x]"
},
{
"identity": "v2",
"map": "ORC-16-Order Control Code Reason /RXE-27-Give Indication/RXO-20-Indication / RXD-21-Indication / RXG-22-Indication / RXA-19-Indication"
},
{
"identity": "rim",
"map": "reason.observation.reasonCode"
}
]
},
{
"id": "MedicationRequest.reasonReference",
"path": "MedicationRequest.reasonReference",
"short": "Condition or observation that supports why the prescription is being written",
"definition": "Condition or observation that supports why the medication was ordered.",
"comment": "This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode.",
"min": 0,
"max": "*",
"base": {
"path": "MedicationRequest.reasonReference",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Condition",
"http://hl7.org/fhir/StructureDefinition/Observation"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ref-1",
"severity": "error",
"human": "SHALL have a contained resource if a local reference is provided",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
},
{
"identity": "workflow",
"map": "Request.reasonReference"
},
{
"identity": "script10.6",
"map": "no mapping"
},
{
"identity": "w5",
"map": "FiveWs.why[x]"
},
{
"identity": "rim",
"map": "reason.observation[code=ASSERTION].value"
}
]
},
{
"id": "MedicationRequest.instantiatesCanonical",
"path": "MedicationRequest.instantiatesCanonical",
"short": "Instantiates FHIR protocol or definition",
"definition": "The URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest.",
"comment": "see [Canonical References](references.html#canonical)",
"min": 0,
"max": "*",
"base": {
"path": "MedicationRequest.instantiatesCanonical",
"min": 0,
"max": "*"
},
"type": [
{
"code": "canonical"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "workflow",
"map": "Request.instantiates"
},
{
"identity": "rim",
"map": ".outboundRelationship[typeCode=DEFN].target"
}
]
},
{
"id": "MedicationRequest.instantiatesUri",
"path": "MedicationRequest.instantiatesUri",
"short": "Instantiates external protocol or definition",
"definition": "The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this MedicationRequest.",
"comment": "see http://en.wikipedia.org/wiki/Uniform_resource_identifier",
"min": 0,
"max": "*",
"base": {
"path": "MedicationRequest.instantiatesUri",
"min": 0,
"max": "*"
},
"type": [
{
"code": "uri"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": ".outboundRelationship[typeCode=DEFN].target"
}
]
},
{
"id": "MedicationRequest.basedOn",
"path": "MedicationRequest.basedOn",
"short": "What request fulfills",
"definition": "A plan or request that is fulfilled in whole or in part by this medication request.",
"comment": "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.",
"min": 0,
"max": "*",
"base": {
"path": "MedicationRequest.basedOn",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/CarePlan",
"http://hl7.org/fhir/StructureDefinition/MedicationRequest",
"http://hl7.org/fhir/StructureDefinition/ServiceRequest",
"http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ref-1",
"severity": "error",
"human": "SHALL have a contained resource if a local reference is provided",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
},
{
"identity": "workflow",
"map": "Request.basedOn"
},
{
"identity": "rim",
"map": ".outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]"
}
]
},
{
"id": "MedicationRequest.groupIdentifier",
"path": "MedicationRequest.groupIdentifier",
"short": "Composite request this is part of",
"definition": "A 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.",
"requirements": "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.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.groupIdentifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)"
},
{
"identity": "rim",
"map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]"
},
{
"identity": "servd",
"map": "Identifier"
},
{
"identity": "workflow",
"map": "Request.groupIdentifier"
},
{
"identity": "rim",
"map": ".outboundRelationship(typeCode=COMP].target[classCode=SBADM, moodCode=INT].id"
}
]
},
{
"id": "MedicationRequest.courseOfTherapyType",
"path": "MedicationRequest.courseOfTherapyType",
"short": "Overall pattern of medication administration",
"definition": "The description of the overall patte3rn of the administration of the medication to the patient.",
"comment": "This attribute should not be confused with the protocol of the medication.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.courseOfTherapyType",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationRequestCourseOfTherapy"
}
],
"strength": "example",
"description": "Identifies the overall pattern of medication administratio.",
"valueSet": "http://hl7.org/fhir/ValueSet/medicationrequest-course-of-therapy"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "CE/CNE/CWE"
},
{
"identity": "rim",
"map": "CD"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
},
{
"identity": "rim",
"map": "Act.code where classCode = LIST and moodCode = EVN"
}
]
},
{
"id": "MedicationRequest.insurance",
"path": "MedicationRequest.insurance",
"short": "Associated insurance coverage",
"definition": "Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service.",
"comment": "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.",
"min": 0,
"max": "*",
"base": {
"path": "MedicationRequest.insurance",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Coverage",
"http://hl7.org/fhir/StructureDefinition/ClaimResponse"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ref-1",
"severity": "error",
"human": "SHALL have a contained resource if a local reference is provided",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
},
{
"identity": "workflow",
"map": "Request.insurance"
},
{
"identity": "rim",
"map": ".outboundRelationship[typeCode=COVBY].target"
}
]
},
{
"id": "MedicationRequest.note",
"path": "MedicationRequest.note",
"short": "Information about the prescription",
"definition": "Extra information about the prescription that could not be conveyed by the other attributes.",
"comment": "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).",
"min": 0,
"max": "*",
"base": {
"path": "MedicationRequest.note",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Annotation"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "N/A"
},
{
"identity": "rim",
"map": "Act"
},
{
"identity": "workflow",
"map": "Request.note"
},
{
"identity": "script10.6",
"map": "Message/Body/NewRx/MedicationPrescribed/Note"
},
{
"identity": "rim",
"map": ".inboundRelationship[typeCode=SUBJ]/source[classCode=OBS,moodCode=EVN,code=\"annotation\"].value"
}
]
},
{
"id": "MedicationRequest.dosageInstruction",
"path": "MedicationRequest.dosageInstruction",
"short": "How the medication should be taken",
"definition": "Indicates how the medication is to be used by the patient.",
"comment": "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.",
"min": 0,
"max": "*",
"base": {
"path": "MedicationRequest.dosageInstruction",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Dosage"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": ".outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT]"
},
{
"identity": "workflow",
"map": "Request.occurrence[x]"
},
{
"identity": "rim",
"map": "see dosageInstruction mapping"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.id",
"path": "MedicationRequest.dosageInstruction.id",
"representation": [
"xmlAttr"
],
"short": "Unique id for inter-element referencing",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
}
],
"code": "http://hl7.org/fhirpath/System.String"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.extension",
"path": "MedicationRequest.dosageInstruction.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "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.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.modifierExtension",
"path": "MedicationRequest.dosageInstruction.modifierExtension",
"short": "Extensions that cannot be ignored even if unrecognized",
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "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.",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": true,
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.sequence",
"path": "MedicationRequest.dosageInstruction.sequence",
"short": "The order of the dosage instructions",
"definition": "Indicates the order in which the dosage instructions should be applied or interpreted.",
"comment": "32 bit number; for values larger than this, use decimal",
"requirements": "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.",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.sequence",
"min": 0,
"max": "1"
},
"type": [
{
"code": "integer"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "TQ1-1"
},
{
"identity": "rim",
"map": ".text"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.text",
"extension": [
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:able-to-populate"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:no-error"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHOULD:handle"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
}
],
"path": "MedicationRequest.dosageInstruction.text",
"short": "Free text dosage instructions e.g. SIG",
"definition": "Free text dosage instructions e.g. SIG.",
"comment": "Note that FHIR strings SHALL NOT exceed 1MB in size",
"requirements": "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.",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.text",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "RXO-6; RXE-21"
},
{
"identity": "rim",
"map": ".text"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.additionalInstruction",
"path": "MedicationRequest.dosageInstruction.additionalInstruction",
"short": "Supplemental instruction or warnings to the patient - e.g. \"with meals\", \"may cause drowsiness\"",
"definition": "Supplemental instructions to the patient on how to take the medication (e.g. \"with meals\" or\"take half to one hour before food\") or warnings for the patient about the medication (e.g. \"may cause drowsiness\" or \"avoid exposure of skin to direct sunlight or sunlamps\").",
"comment": "Information about administration or preparation of the medication (e.g. \"infuse as rapidly as possibly via intraperitoneal port\" or \"immediately following drug x\") should be populated in dosage.text.",
"requirements": "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.",
"min": 0,
"max": "*",
"base": {
"path": "Dosage.additionalInstruction",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AdditionalInstruction"
}
],
"strength": "example",
"description": "A coded concept identifying additional instructions such as \"take with water\" or \"avoid operating heavy machinery\".",
"valueSet": "http://hl7.org/fhir/ValueSet/additional-instruction-codes"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "CE/CNE/CWE"
},
{
"identity": "rim",
"map": "CD"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
},
{
"identity": "v2",
"map": "RXO-7"
},
{
"identity": "rim",
"map": ".text"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.patientInstruction",
"path": "MedicationRequest.dosageInstruction.patientInstruction",
"short": "Patient or consumer oriented instructions",
"definition": "Instructions in terms that are understood by the patient or consumer.",
"comment": "Note that FHIR strings SHALL NOT exceed 1MB in size",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.patientInstruction",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "RXO-7"
},
{
"identity": "rim",
"map": ".text"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.timing",
"path": "MedicationRequest.dosageInstruction.timing",
"short": "When medication should be administered",
"definition": "When medication should be administered.",
"comment": "IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content.",
"requirements": "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.",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.timing",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Timing"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "N/A"
},
{
"identity": "rim",
"map": "QSET<TS> (GTS)"
},
{
"identity": "rim",
"map": ".effectiveTime"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.asNeeded[x]",
"path": "MedicationRequest.dosageInstruction.asNeeded[x]",
"short": "Take \"as needed\" (for x)",
"definition": "Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).",
"comment": "Can express \"as needed\" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express \"as needed\" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not \"prn\" or \"as needed\".",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.asNeeded[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "boolean"
},
{
"code": "CodeableConcept"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationAsNeededReason"
}
],
"strength": "example",
"description": "A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example \"pain\", \"30 minutes prior to sexual intercourse\", \"on flare-up\" etc.",
"valueSet": "http://hl7.org/fhir/ValueSet/medication-as-needed-reason"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "TQ1-9"
},
{
"identity": "rim",
"map": ".outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code=\"as needed\"].value=boolean or codable concept"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.site",
"path": "MedicationRequest.dosageInstruction.site",
"short": "Body site to administer to",
"definition": "Body site to administer to.",
"comment": "If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [bodySite](extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both.",
"requirements": "A coded specification of the anatomic site where the medication first enters the body.",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.site",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationAdministrationSite"
}
],
"strength": "example",
"description": "A coded concept describing the site location the medicine enters into or onto the body.",
"valueSet": "http://hl7.org/fhir/ValueSet/approach-site-codes"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "CE/CNE/CWE"
},
{
"identity": "rim",
"map": "CD"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
},
{
"identity": "v2",
"map": "RXR-2"
},
{
"identity": "rim",
"map": ".approachSiteCode"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.route",
"path": "MedicationRequest.dosageInstruction.route",
"short": "How drug should enter body",
"definition": "How drug should enter body.",
"comment": "See additionalBinding extension.\n\n IPS-UV no longer flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received..",
"requirements": "A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.route",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RouteOfAdministration"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/medicine-route-of-administration"
},
{
"url": "documentation",
"valueMarkdown": "EDQM Standards Terms for route."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionrouteofadministration"
},
{
"url": "documentation",
"valueMarkdown": "Route of administration for the prescription from the PrescribeIT value set. Implementers should anticipate that data collected and or exchanged in the context of ePrescribing may contain concepts from this valueSet. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
}
],
"strength": "preferred",
"description": "SCTCA Route of Administration",
"valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/routeofadministration"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "CE/CNE/CWE"
},
{
"identity": "rim",
"map": "CD"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
},
{
"identity": "v2",
"map": "RXR-1"
},
{
"identity": "rim",
"map": ".routeCode"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.method",
"path": "MedicationRequest.dosageInstruction.method",
"short": "Technique for administering medication",
"definition": "Technique for administering medication.",
"comment": "Terminologies used often pre-coordinate this term with the route and or form of administration.",
"requirements": "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.",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.method",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationAdministrationMethod"
}
],
"strength": "example",
"description": "A coded concept describing the technique by which the medicine is administered.",
"valueSet": "http://hl7.org/fhir/ValueSet/administration-method-codes"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "CE/CNE/CWE"
},
{
"identity": "rim",
"map": "CD"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
},
{
"identity": "v2",
"map": "RXR-4"
},
{
"identity": "rim",
"map": ".doseQuantity"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.doseAndRate",
"path": "MedicationRequest.dosageInstruction.doseAndRate",
"short": "Amount of medication administered",
"definition": "The amount of medication administered.",
"min": 0,
"max": "*",
"base": {
"path": "Dosage.doseAndRate",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Element"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "TQ1-2"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.doseAndRate.id",
"path": "MedicationRequest.dosageInstruction.doseAndRate.id",
"representation": [
"xmlAttr"
],
"short": "Unique id for inter-element referencing",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
}
],
"code": "http://hl7.org/fhirpath/System.String"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.doseAndRate.extension",
"path": "MedicationRequest.dosageInstruction.doseAndRate.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "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.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.doseAndRate.type",
"path": "MedicationRequest.dosageInstruction.doseAndRate.type",
"short": "The kind of dose or rate specified",
"definition": "The kind of dose or rate specified, for example, ordered or calculated.",
"comment": "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.",
"requirements": "If the type is not populated, assume to be \"ordered\".",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.doseAndRate.type",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "DoseAndRateType"
}
],
"strength": "example",
"description": "The kind of dose or rate specified.",
"valueSet": "http://hl7.org/fhir/ValueSet/dose-rate-type"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "CE/CNE/CWE"
},
{
"identity": "rim",
"map": "CD"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
},
{
"identity": "v2",
"map": "RXO-21; RXE-23"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.doseAndRate.dose[x]",
"path": "MedicationRequest.dosageInstruction.doseAndRate.dose[x]",
"short": "Amount of medication per dose",
"definition": "Amount of medication per dose.",
"comment": "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.",
"requirements": "The amount of therapeutic or other substance given at one administration event.",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.doseAndRate.dose[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Range"
},
{
"code": "Quantity",
"profile": [
"http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "RXO-2, RXE-3"
},
{
"identity": "rim",
"map": ".doseQuantity"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.doseAndRate.rate[x]",
"path": "MedicationRequest.dosageInstruction.doseAndRate.rate[x]",
"short": "Amount of medication per unit of time",
"definition": "Amount of medication per unit of time.",
"comment": "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.\n\nIt 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 grammer 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.",
"requirements": "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.",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.doseAndRate.rate[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Ratio"
},
{
"code": "Range"
},
{
"code": "Quantity",
"profile": [
"http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "RXE22, RXE23, RXE-24"
},
{
"identity": "rim",
"map": ".rateQuantity"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.maxDosePerPeriod",
"path": "MedicationRequest.dosageInstruction.maxDosePerPeriod",
"short": "Upper limit on medication per unit of time",
"definition": "Upper limit on medication per unit of time.",
"comment": "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\".",
"requirements": "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.",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.maxDosePerPeriod",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Ratio"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "rat-1",
"severity": "error",
"human": "Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present",
"expression": "(numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists())",
"xpath": "(count(f:numerator) = count(f:denominator)) and ((count(f:numerator) > 0) or (count(f:extension) > 0))",
"source": "http://hl7.org/fhir/StructureDefinition/Ratio"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "N/A"
},
{
"identity": "rim",
"map": "RTO"
},
{
"identity": "v2",
"map": "RXO-23, RXE-19"
},
{
"identity": "rim",
"map": ".maxDoseQuantity"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.maxDosePerAdministration",
"path": "MedicationRequest.dosageInstruction.maxDosePerAdministration",
"short": "Upper limit on medication per administration",
"definition": "Upper limit on medication per administration.",
"comment": "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.",
"requirements": "The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.maxDosePerAdministration",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Quantity",
"profile": [
"http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "qty-3",
"severity": "error",
"human": "If a code for the unit is present, the system SHALL also be present",
"expression": "code.empty() or system.exists()",
"xpath": "not(exists(f:code)) or exists(f:system)",
"source": "http://hl7.org/fhir/StructureDefinition/Quantity"
},
{
"key": "sqty-1",
"severity": "error",
"human": "The comparator is not used on a SimpleQuantity",
"expression": "comparator.empty()",
"xpath": "not(exists(f:comparator))",
"source": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "SN (see also Range) or CQ"
},
{
"identity": "rim",
"map": "PQ, IVL<PQ>, MO, CO, depending on the values"
},
{
"identity": "rim",
"map": "not supported"
}
]
},
{
"id": "MedicationRequest.dosageInstruction.maxDosePerLifetime",
"path": "MedicationRequest.dosageInstruction.maxDosePerLifetime",
"short": "Upper limit on medication per lifetime of the patient",
"definition": "Upper limit on medication per lifetime of the patient.",
"comment": "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.",
"requirements": "The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.maxDosePerLifetime",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Quantity",
"profile": [
"http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "qty-3",
"severity": "error",
"human": "If a code for the unit is present, the system SHALL also be present",
"expression": "code.empty() or system.exists()",
"xpath": "not(exists(f:code)) or exists(f:system)",
"source": "http://hl7.org/fhir/StructureDefinition/Quantity"
},
{
"key": "sqty-1",
"severity": "error",
"human": "The comparator is not used on a SimpleQuantity",
"expression": "comparator.empty()",
"xpath": "not(exists(f:comparator))",
"source": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "SN (see also Range) or CQ"
},
{
"identity": "rim",
"map": "PQ, IVL<PQ>, MO, CO, depending on the values"
},
{
"identity": "rim",
"map": "not supported"
}
]
},
{
"id": "MedicationRequest.dispenseRequest",
"path": "MedicationRequest.dispenseRequest",
"short": "Medication supply authorization",
"definition": "Indicates 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.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.dispenseRequest",
"min": 0,
"max": "1"
},
"type": [
{
"code": "BackboneElement"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "script10.6",
"map": "Message/Body/NewRx/MedicationPrescribed/ExpirationDate"
},
{
"identity": "rim",
"map": "component.supplyEvent"
}
]
},
{
"id": "MedicationRequest.dispenseRequest.id",
"path": "MedicationRequest.dispenseRequest.id",
"representation": [
"xmlAttr"
],
"short": "Unique id for inter-element referencing",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
}
],
"code": "http://hl7.org/fhirpath/System.String"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "MedicationRequest.dispenseRequest.extension",
"path": "MedicationRequest.dispenseRequest.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "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.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.dispenseRequest.modifierExtension",
"path": "MedicationRequest.dispenseRequest.modifierExtension",
"short": "Extensions that cannot be ignored even if unrecognized",
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "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.",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": true,
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.dispenseRequest.initialFill",
"path": "MedicationRequest.dispenseRequest.initialFill",
"short": "First fill details",
"definition": "Indicates the quantity or duration for the first dispense of the medication.",
"comment": "If populating this element, either the quantity or the duration must be included.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.dispenseRequest.initialFill",
"min": 0,
"max": "1"
},
"type": [
{
"code": "BackboneElement"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "SubstanceAdministration -> ActRelationship[sequenceNumber = '1'] -> Supply"
}
]
},
{
"id": "MedicationRequest.dispenseRequest.initialFill.id",
"path": "MedicationRequest.dispenseRequest.initialFill.id",
"representation": [
"xmlAttr"
],
"short": "Unique id for inter-element referencing",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
}
],
"code": "http://hl7.org/fhirpath/System.String"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "MedicationRequest.dispenseRequest.initialFill.extension",
"path": "MedicationRequest.dispenseRequest.initialFill.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "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.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.dispenseRequest.initialFill.modifierExtension",
"path": "MedicationRequest.dispenseRequest.initialFill.modifierExtension",
"short": "Extensions that cannot be ignored even if unrecognized",
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "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.",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": true,
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.dispenseRequest.initialFill.quantity",
"path": "MedicationRequest.dispenseRequest.initialFill.quantity",
"short": "First fill quantity",
"definition": "The amount or quantity to provide as part of the first dispense.",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.dispenseRequest.initialFill.quantity",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Quantity",
"profile": [
"http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "qty-3",
"severity": "error",
"human": "If a code for the unit is present, the system SHALL also be present",
"expression": "code.empty() or system.exists()",
"xpath": "not(exists(f:code)) or exists(f:system)",
"source": "http://hl7.org/fhir/StructureDefinition/Quantity"
},
{
"key": "sqty-1",
"severity": "error",
"human": "The comparator is not used on a SimpleQuantity",
"expression": "comparator.empty()",
"xpath": "not(exists(f:comparator))",
"source": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
}
],
"isModifier": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "SN (see also Range) or CQ"
},
{
"identity": "rim",
"map": "PQ, IVL<PQ>, MO, CO, depending on the values"
},
{
"identity": "rim",
"map": "Supply.quantity[moodCode=RQO]"
}
]
},
{
"id": "MedicationRequest.dispenseRequest.initialFill.duration",
"path": "MedicationRequest.dispenseRequest.initialFill.duration",
"short": "First fill duration",
"definition": "The length of time that the first dispense is expected to last.",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.dispenseRequest.initialFill.duration",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Duration"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "qty-3",
"severity": "error",
"human": "If a code for the unit is present, the system SHALL also be present",
"expression": "code.empty() or system.exists()",
"xpath": "not(exists(f:code)) or exists(f:system)",
"source": "http://hl7.org/fhir/StructureDefinition/Quantity"
},
{
"key": "drt-1",
"severity": "error",
"human": "There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM.",
"expression": "code.exists() implies ((system = %ucum) and value.exists())",
"xpath": "(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='http://unitsofmeasure.org')",
"source": "http://hl7.org/fhir/StructureDefinition/Duration"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "SN (see also Range) or CQ"
},
{
"identity": "rim",
"map": "PQ, IVL<PQ>, MO, CO, depending on the values"
},
{
"identity": "rim",
"map": "PQ, IVL<PQ> depending on the values"
},
{
"identity": "rim",
"map": "Supply.effectivetime[moodCode=RQO]"
}
]
},
{
"id": "MedicationRequest.dispenseRequest.dispenseInterval",
"path": "MedicationRequest.dispenseRequest.dispenseInterval",
"short": "Minimum period of time between dispenses",
"definition": "The minimum period of time that must occur between dispenses of the medication.",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.dispenseRequest.dispenseInterval",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Duration"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "qty-3",
"severity": "error",
"human": "If a code for the unit is present, the system SHALL also be present",
"expression": "code.empty() or system.exists()",
"xpath": "not(exists(f:code)) or exists(f:system)",
"source": "http://hl7.org/fhir/StructureDefinition/Quantity"
},
{
"key": "drt-1",
"severity": "error",
"human": "There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM.",
"expression": "code.exists() implies ((system = %ucum) and value.exists())",
"xpath": "(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='http://unitsofmeasure.org')",
"source": "http://hl7.org/fhir/StructureDefinition/Duration"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "SN (see also Range) or CQ"
},
{
"identity": "rim",
"map": "PQ, IVL<PQ>, MO, CO, depending on the values"
},
{
"identity": "rim",
"map": "PQ, IVL<PQ> depending on the values"
},
{
"identity": "rim",
"map": "Supply.effectivetime[moodCode=RQO]"
}
]
},
{
"id": "MedicationRequest.dispenseRequest.validityPeriod",
"path": "MedicationRequest.dispenseRequest.validityPeriod",
"short": "Time period supply is authorized for",
"definition": "This indicates the validity period of a prescription (stale dating the Prescription).",
"comment": "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.",
"requirements": "Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.dispenseRequest.validityPeriod",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Period"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "per-1",
"severity": "error",
"human": "If present, start SHALL have a lower value than end",
"expression": "start.hasValue().not() or end.hasValue().not() or (start <= end)",
"xpath": "not(exists(f:start/@value)) or not(exists(f:end/@value)) or (xs:dateTime(f:start/@value) <= xs:dateTime(f:end/@value))",
"source": "http://hl7.org/fhir/StructureDefinition/Period"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "DR"
},
{
"identity": "rim",
"map": "IVL<TS>[lowClosed=\"true\" and highClosed=\"true\"] or URG<TS>[lowClosed=\"true\" and highClosed=\"true\"]"
},
{
"identity": "script10.6",
"map": "Message/Body/NewRx/MedicationPrescribed/Refills"
},
{
"identity": "rim",
"map": "effectiveTime"
}
]
},
{
"id": "MedicationRequest.dispenseRequest.numberOfRepeatsAllowed",
"path": "MedicationRequest.dispenseRequest.numberOfRepeatsAllowed",
"short": "Number of refills authorized",
"definition": "An 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.",
"comment": "If displaying \"number of authorized fills\", add 1 to this number.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.dispenseRequest.numberOfRepeatsAllowed",
"min": 0,
"max": "1"
},
"type": [
{
"code": "unsignedInt"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "script10.6",
"map": "Message/Body/NewRx/MedicationPrescribed/Quantity"
},
{
"identity": "v2",
"map": "RXE-12-Number of Refills"
},
{
"identity": "rim",
"map": "repeatNumber"
}
]
},
{
"id": "MedicationRequest.dispenseRequest.quantity",
"path": "MedicationRequest.dispenseRequest.quantity",
"short": "Amount of medication to supply per dispense",
"definition": "The amount that is to be dispensed for one fill.",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.dispenseRequest.quantity",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Quantity",
"profile": [
"http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "qty-3",
"severity": "error",
"human": "If a code for the unit is present, the system SHALL also be present",
"expression": "code.empty() or system.exists()",
"xpath": "not(exists(f:code)) or exists(f:system)",
"source": "http://hl7.org/fhir/StructureDefinition/Quantity"
},
{
"key": "sqty-1",
"severity": "error",
"human": "The comparator is not used on a SimpleQuantity",
"expression": "comparator.empty()",
"xpath": "not(exists(f:comparator))",
"source": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
}
],
"isModifier": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "SN (see also Range) or CQ"
},
{
"identity": "rim",
"map": "PQ, IVL<PQ>, MO, CO, depending on the values"
},
{
"identity": "script10.6",
"map": "Message/Body/NewRx/MedicationPrescribed/DaysSupply"
},
{
"identity": "v2",
"map": "RXD-4-Actual Dispense Amount / RXD-5.1-Actual Dispense Units.code / RXD-5.3-Actual Dispense Units.name of coding system"
},
{
"identity": "rim",
"map": "quantity"
}
]
},
{
"id": "MedicationRequest.dispenseRequest.expectedSupplyDuration",
"path": "MedicationRequest.dispenseRequest.expectedSupplyDuration",
"short": "Number of days supply per dispense",
"definition": "Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last.",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.dispenseRequest.expectedSupplyDuration",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Duration"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "qty-3",
"severity": "error",
"human": "If a code for the unit is present, the system SHALL also be present",
"expression": "code.empty() or system.exists()",
"xpath": "not(exists(f:code)) or exists(f:system)",
"source": "http://hl7.org/fhir/StructureDefinition/Quantity"
},
{
"key": "drt-1",
"severity": "error",
"human": "There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM.",
"expression": "code.exists() implies ((system = %ucum) and value.exists())",
"xpath": "(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='http://unitsofmeasure.org')",
"source": "http://hl7.org/fhir/StructureDefinition/Duration"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "SN (see also Range) or CQ"
},
{
"identity": "rim",
"map": "PQ, IVL<PQ>, MO, CO, depending on the values"
},
{
"identity": "rim",
"map": "PQ, IVL<PQ> depending on the values"
},
{
"identity": "script10.6",
"map": "Message/Body/NewRx/MedicationPrescribed/Substitutions"
},
{
"identity": "rim",
"map": "expectedUseTime"
}
]
},
{
"id": "MedicationRequest.dispenseRequest.performer",
"path": "MedicationRequest.dispenseRequest.performer",
"short": "Intended dispenser",
"definition": "Indicates the intended dispensing Organization specified by the prescriber.",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.dispenseRequest.performer",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Organization"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ref-1",
"severity": "error",
"human": "SHALL have a contained resource if a local reference is provided",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
},
{
"identity": "w5",
"map": "FiveWs.who"
},
{
"identity": "rim",
"map": ".outboundRelationship[typeCode=COMP].target[classCode=SPLY, moodCode=RQO] .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]"
}
]
},
{
"id": "MedicationRequest.substitution",
"path": "MedicationRequest.substitution",
"short": "Any restrictions on medication substitution",
"definition": "Indicates 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.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.substitution",
"min": 0,
"max": "1"
},
"type": [
{
"code": "BackboneElement"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "script10.6",
"map": "specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions"
},
{
"identity": "rim",
"map": "subjectOf.substitutionPersmission"
}
]
},
{
"id": "MedicationRequest.substitution.id",
"path": "MedicationRequest.substitution.id",
"representation": [
"xmlAttr"
],
"short": "Unique id for inter-element referencing",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
}
],
"code": "http://hl7.org/fhirpath/System.String"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "MedicationRequest.substitution.extension",
"path": "MedicationRequest.substitution.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "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.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.substitution.modifierExtension",
"path": "MedicationRequest.substitution.modifierExtension",
"short": "Extensions that cannot be ignored even if unrecognized",
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "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.",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": true,
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.substitution.allowed[x]",
"path": "MedicationRequest.substitution.allowed[x]",
"short": "Whether substitution is allowed or not",
"definition": "True if the prescriber allows a different drug to be dispensed from what was prescribed.",
"comment": "This element is labeled as a modifier because whether substitution is allow or not, it cannot be ignored.",
"min": 1,
"max": "1",
"base": {
"path": "MedicationRequest.substitution.allowed[x]",
"min": 1,
"max": "1"
},
"type": [
{
"code": "boolean"
},
{
"code": "CodeableConcept"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationRequestSubstitution"
}
],
"strength": "example",
"description": "Identifies the type of substitution allowed.",
"valueSet": "http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "script10.6",
"map": "specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions"
},
{
"identity": "v2",
"map": "RXO-9-Allow Substitutions / RXE-9-Substitution Status"
},
{
"identity": "rim",
"map": "code"
}
]
},
{
"id": "MedicationRequest.substitution.reason",
"path": "MedicationRequest.substitution.reason",
"short": "Why should (not) substitution be made",
"definition": "Indicates the reason for the substitution, or why substitution must or must not be performed.",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.substitution.reason",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationIntendedSubstitutionReason"
}
],
"strength": "example",
"description": "A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.",
"valueSet": "http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "CE/CNE/CWE"
},
{
"identity": "rim",
"map": "CD"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
},
{
"identity": "script10.6",
"map": "not mapped"
},
{
"identity": "v2",
"map": "RXE-9 Substition status"
},
{
"identity": "rim",
"map": "reasonCode"
}
]
},
{
"id": "MedicationRequest.priorPrescription",
"path": "MedicationRequest.priorPrescription",
"short": "An order/prescription that is being replaced",
"definition": "A link to a resource representing an earlier order related order or prescription.",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.priorPrescription",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/MedicationRequest"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ref-1",
"severity": "error",
"human": "SHALL have a contained resource if a local reference is provided",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
},
{
"identity": "workflow",
"map": "Request.replaces"
},
{
"identity": "script10.6",
"map": "not mapped"
},
{
"identity": "rim",
"map": ".outboundRelationship[typeCode=?RPLC or ?SUCC]/target[classCode=SBADM,moodCode=RQO]"
}
]
},
{
"id": "MedicationRequest.detectedIssue",
"path": "MedicationRequest.detectedIssue",
"short": "Clinical Issue with action",
"definition": "Indicates 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.",
"comment": "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.",
"alias": [
"Contraindication",
"Drug Utilization Review (DUR)",
"Alert"
],
"min": 0,
"max": "*",
"base": {
"path": "MedicationRequest.detectedIssue",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/DetectedIssue"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ref-1",
"severity": "error",
"human": "SHALL have a contained resource if a local reference is provided",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
},
{
"identity": "rim",
"map": ".inboundRelationship[typeCode=SUBJ]/source[classCode=ALRT,moodCode=EVN].value"
}
]
},
{
"id": "MedicationRequest.eventHistory",
"path": "MedicationRequest.eventHistory",
"short": "A list of events of interest in the lifecycle",
"definition": "Links 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.",
"comment": "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.).",
"min": 0,
"max": "*",
"base": {
"path": "MedicationRequest.eventHistory",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Provenance"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ref-1",
"severity": "error",
"human": "SHALL have a contained resource if a local reference is provided",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
},
{
"identity": "workflow",
"map": "Request.relevantHistory"
},
{
"identity": "rim",
"map": ".inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]"
}
]
}
]
},
"differential": {
"element": [
{
"id": "MedicationRequest",
"path": "MedicationRequest",
"comment": "Jurisdictions mapping prescription data into FHIR profiles for the patient summary should support the MedicationRequest resource. Use of the MedicationStatement profile should be reserved for communicating a statement about the patient's usage of the medication that is ultimately provided by a patient, significant other, or a clinician.\n\nThe MedicationRequest resource is not included in the [current](https://hl7.org/fhir/uv/ips/history.html) (as of November 2021) published release of IPS ([release 1.0.0, STU1](https://hl7.org/fhir/uv/ips/STU1/)), but is in the [development](http://build.fhir.org/ig/HL7/fhir-ips) preview of the next release."
},
{
"id": "MedicationRequest.extension",
"path": "MedicationRequest.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
}
},
{
"id": "MedicationRequest.extension:RenderedDosageInstruction",
"path": "MedicationRequest.extension",
"sliceName": "RenderedDosageInstruction",
"short": "Extension for representing rendered dosage instruction.",
"definition": "A free form textual specification generated from the input specifications as created by the provider. This is made up of either an 'Ad-hoc instruction' or 'Textual rendition of the structured dosage lines', plus route, dosage unit, and other pertinent administration information specified by the provider.",
"comment": "Use of structured fields for dosage instructions is heavily encouraged by this specification to promote interoperability of patient summaries. However, this extension is provided to make implementers aware that legacy medication data may come from some systems in this format. This extension is used by PrescribeIT implementations when the system has difficulty sending very complex dosage instructions in the form of structured data. Implementers are encouraged to read the PrescribeIT Specification (https://specs.prescribeit.ca/R5.0/erx/extension-ext-medication-rendered-dosage.html) to understand the context around its use.",
"min": 0,
"max": "1",
"type": [
{
"code": "Extension",
"profile": [
"http://prescribeit.ca/fhir/StructureDefinition/ext-rendered-dosage-instruction"
]
}
]
},
{
"id": "MedicationRequest.status",
"extension": [
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:populate"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:no-error"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:handle"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHOULD:display"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
}
],
"path": "MedicationRequest.status",
"comment": "In the scope of the IPS the entered-in-error concept is not allowed.",
"mustSupport": true
},
{
"id": "MedicationRequest.intent",
"path": "MedicationRequest.intent",
"comment": "This element is considered mandatory in the Base FHIR R4 Specification. \n\nBase R4 Note: 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."
},
{
"id": "MedicationRequest.doNotPerform",
"path": "MedicationRequest.doNotPerform",
"comment": "In the scope of the PSCA MedicationRequest, the doNotPerform concept is not allowed to be set to true. Other sections may be used to convey medications that a patient should or will not take.",
"patternBoolean": false
},
{
"id": "MedicationRequest.medication[x]",
"extension": [
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:populate"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:no-error"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:handle"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHOULD:display"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
}
],
"path": "MedicationRequest.medication[x]",
"definition": "Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code. To improve global interoperability is strongly encouraged that the reference to a medication resource is used, limiting the usage of the medicationCodeableConcept only to the cases in which no other information than a simple code is available.",
"type": [
{
"code": "CodeableConcept",
"profile": [
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-medication-ca-ps"
]
},
{
"code": "Reference",
"targetProfile": [
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/medication-ca-ps"
]
}
],
"mustSupport": true,
"binding": {
"extension": [
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/LicensedNaturalHealthProducts"
},
{
"url": "documentation",
"valueMarkdown": "All Natural Product Number (NPN) and Homeopathic Medicine Number (DIN-HM) codes that are licensed by Health Canada and present in the Licensed Natural Health Products Database."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/whoatc-uv-ips"
},
{
"url": "documentation",
"valueMarkdown": "WHO ATC classification."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/medication-uv-ips"
},
{
"url": "documentation",
"valueMarkdown": "SNOMED CT medications (Medicinal product)"
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/DIN"
},
{
"url": "documentation",
"valueMarkdown": "Health Canada Drug Identification Number set."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticalbiologicproductandsubstancecode"
},
{
"url": "documentation",
"valueMarkdown": "per PCHDCF: The alternate value set can be used for the international use case where the medication is not available in Canada and therefore does not appear in the recommended pan-Canadian value sets"
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
}
],
"strength": "preferred",
"valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct"
}
},
{
"id": "MedicationRequest.subject",
"extension": [
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:populate"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:no-error"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:handle"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHOULD:display"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
}
],
"path": "MedicationRequest.subject",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps"
]
}
],
"mustSupport": true
},
{
"id": "MedicationRequest.subject.reference",
"extension": [
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:populate"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:no-error"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:handle"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHOULD:display"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
}
],
"path": "MedicationRequest.subject.reference",
"min": 1,
"mustSupport": true
},
{
"id": "MedicationRequest.authoredOn",
"extension": [
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:able-to-populate"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:no-error"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHOULD:handle"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
}
],
"path": "MedicationRequest.authoredOn",
"mustSupport": true
},
{
"id": "MedicationRequest.reasonCode",
"path": "MedicationRequest.reasonCode",
"binding": {
"extension": [
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionindicationforuse"
},
{
"url": "documentation",
"valueMarkdown": "Commonly used reason for which a medication is being ordered reference set (foundation metadata concept)"
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
}
],
"strength": "preferred",
"valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/medicationreasoncode"
}
},
{
"id": "MedicationRequest.dosageInstruction.text",
"extension": [
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:able-to-populate"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHALL:no-error"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
},
{
"extension": [
{
"url": "code",
"valueCode": "SHOULD:handle"
},
{
"url": "actor",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/obligation"
}
],
"path": "MedicationRequest.dosageInstruction.text",
"mustSupport": true
},
{
"id": "MedicationRequest.dosageInstruction.timing",
"path": "MedicationRequest.dosageInstruction.timing",
"comment": "IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content."
},
{
"id": "MedicationRequest.dosageInstruction.route",
"path": "MedicationRequest.dosageInstruction.route",
"comment": "See additionalBinding extension.\n\n IPS-UV no longer flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received..",
"binding": {
"extension": [
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/medicine-route-of-administration"
},
{
"url": "documentation",
"valueMarkdown": "EDQM Standards Terms for route."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionrouteofadministration"
},
{
"url": "documentation",
"valueMarkdown": "Route of administration for the prescription from the PrescribeIT value set. Implementers should anticipate that data collected and or exchanged in the context of ePrescribing may contain concepts from this valueSet. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
}
],
"strength": "preferred",
"description": "SCTCA Route of Administration",
"valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/routeofadministration"
}
}
]
}
}

Terminology bindings (Differential)

PathConformanceValueSet
MedicationRequest.medication[x]preferredhttps://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct
MedicationRequest.reasonCodepreferredhttps://fhir.infoway-inforoute.ca/ValueSet/medicationreasoncode
MedicationRequest.dosageInstruction.routepreferredhttps://fhir.infoway-inforoute.ca/ValueSet/routeofadministration

Terminology bindings (Snapshot)

PathConformanceValueSet
MedicationRequest.languagepreferredhttp://hl7.org/fhir/ValueSet/languages
MedicationRequest.statusrequiredhttp://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1
MedicationRequest.statusReasonexamplehttp://hl7.org/fhir/ValueSet/medicationrequest-status-reason
MedicationRequest.intentrequiredhttp://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1
MedicationRequest.categoryexamplehttp://hl7.org/fhir/ValueSet/medicationrequest-category
MedicationRequest.priorityrequiredhttp://hl7.org/fhir/ValueSet/request-priority|4.0.1
MedicationRequest.medication[x]preferredhttps://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct
MedicationRequest.subject.typeextensiblehttp://hl7.org/fhir/ValueSet/resource-types
MedicationRequest.performerTypeexamplehttp://hl7.org/fhir/ValueSet/performer-role
MedicationRequest.reasonCodepreferredhttps://fhir.infoway-inforoute.ca/ValueSet/medicationreasoncode
MedicationRequest.courseOfTherapyTypeexamplehttp://hl7.org/fhir/ValueSet/medicationrequest-course-of-therapy
MedicationRequest.dosageInstruction.additionalInstructionexamplehttp://hl7.org/fhir/ValueSet/additional-instruction-codes
MedicationRequest.dosageInstruction.asNeeded[x]examplehttp://hl7.org/fhir/ValueSet/medication-as-needed-reason
MedicationRequest.dosageInstruction.siteexamplehttp://hl7.org/fhir/ValueSet/approach-site-codes
MedicationRequest.dosageInstruction.routepreferredhttps://fhir.infoway-inforoute.ca/ValueSet/routeofadministration
MedicationRequest.dosageInstruction.methodexamplehttp://hl7.org/fhir/ValueSet/administration-method-codes
MedicationRequest.dosageInstruction.doseAndRate.typeexamplehttp://hl7.org/fhir/ValueSet/dose-rate-type
MedicationRequest.substitution.allowed[x]examplehttp://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode
MedicationRequest.substitution.reasonexamplehttp://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason

Constraints

Key Differences between the IPS-UV and PS-CA

Must Support Differences:

  • MedicationRequest.dosageInstruction.timing is Must Support in IPS-UV and not in PS-CA.

  • MedicationRequest.status is not Must Support in IPS-UV but is Must Support in PS-CA.

    Note: Systems that support these elements are encouraged to send them in patient summaries

Cardinality Differences:

  • There are no cardinality differences between this profile and IPS-UV

Vocabulary Differences:

  • MedicationRequest.medicationCodeableConcept

    • added preferred binding of CCDD PrescriptionMedicinalProduct
    • additional bindings now match Medication.code additional bindings Medication (PS-CA)

  • MedicatonRequest.dosageInstruction.route

    • added preferred binding of RouteOfAdministration Route Of Administration
    • additionalBindings added for:
      • PrescribeIT codes (derived from HL7 v3) PrescribeIT Prescription Route Of Administration,
      • EDQM Medicine Dose Form (slice in the IPS) RouteOfAdministration

Terminology Guidance: In Canada, CCDD is the preferred binding type for medication codes. However, for broader international comprehension, it's recommended that, where mappings exist, implementers also include IPS concepts alongside CCDD. This approach aims to balance national preferences with the need for international interoperability. Additionally, systems have the flexibility to send other Canadian codes, such as SNOMED CT CA, DIN, and NPN.

Other differences between the IPS and PS-CA Include:

  • Data type profiles (e.g., CodeableConcept) and reference targets (e.g., Patient) replaced with PS-CA equivalents when appropriate

IG © based on FHIR R4 | Package package:ca.infoway.io.psca@2.2.0-ti-ballot
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