| MedicationStatement | I | | MedicationStatement | There are no (further) constraints on this element Element IdShort description Record of medication being taken by a patient Definition A record of a medication that is being consumed by a patient. A MedicationStatement may indicate that the patient may be taking the medication now or has taken the medication in the past or will be taking the medication in the future. The source of this information can be the patient, significant other (such as a family member or spouse), or a clinician. A common scenario where this information is captured is during the history taking process during a patient visit or stay. The medication information may come from sources such as the patient's memory, from a prescription bottle, or from a list of medications the patient, clinician or other party maintains.
The primary difference between a medication statement and a medication administration is that the medication administration has complete administration information and is based on actual administration information from the person who administered the medication. A medication statement is often, if not always, less specific. There is no required date/time when the medication was administered, in fact we only know that a source has reported the patient is taking this medication, where details such as time, quantity, or rate or even medication product may be incomplete or missing or less precise. As stated earlier, the medication statement information may come from the patient's memory, from a prescription bottle or from a list of medications the patient, clinician or other party maintains. Medication administration is more formal and is not missing detailed information.
When interpreting a medicationStatement, the value of the status and NotTaken needed to be considered:
MedicationStatement.status + MedicationStatement.wasNotTaken
Status=Active + NotTaken=T = Not currently taking
Status=Completed + NotTaken=T = Not taken in the past
Status=Intended + NotTaken=T = No intention of taking
Status=Active + NotTaken=F = Taking, but not as prescribed
Status=Active + NotTaken=F = Taking
Status=Intended +NotTaken= F = Will be taking (not started)
Status=Completed + NotTaken=F = Taken in past
Status=In Error + NotTaken=N/A = In Error.
MedicationStatement 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()
- rim:Entity. Role, or Act
- workflow:Event
- rim:SubstanceAdministration
|
| extension | I | 0..* | Extension | Element IdMedicationStatement.extension 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.
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.
Extension Sliced: Unordered, Open, by url(Value) 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()
|
| pharmacistVerifiedIndicator | I | 0..1 | Extension(boolean) | Element IdMedicationStatement.extension:pharmacistVerifiedIndicator Indicates whether a pharmacist verified a medication Alternate names extensions, user content Definition This extension is used to indicate whether a pharmacist verified a medication.
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.
Extension(boolean) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-PharmacistVerifiedIndicator 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()
|
| medicationPrescribingOrganizationType | I | 0..1 | Extension(CodeableConcept) | Element IdMedicationStatement.extension:medicationPrescribingOrganizationType The type of organisation or setting responsible for authorising and issuing a medication Alternate names extensions, user content Definition This extension carries the type of organisation or setting responsible for authorising and issuing a medication.
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.
Extension(CodeableConcept) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationPrescribingOrganizationType 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()
|
| medicationStatementLastIssueDate | I | 0..1 | Extension(dateTime) | Element IdMedicationStatement.extension:medicationStatementLastIssueDate The date when a prescription was last issued Alternate names extensions, user content Definition This extension supports the exchange of the date information when a prescription was last issued.
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.
Extension(dateTime) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationStatementLastIssueDate 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()
|
| identifier | Σ | 0..* | Identifier | There are no (further) constraints on this element Element IdMedicationStatement.identifier External identifier Definition Identifiers associated with this Medication Statement that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.
This is a business identifier, not a resource identifier.
Identifier Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- 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:Event.identifier
- w5:FiveWs.identifier
- rim:.id
|
| use | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element IdMedicationStatement.identifier.use usual | official | temp | secondary | old (If known) Definition The purpose of this identifier.
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:N/A
- rim:Role.code or implied by context
|
| type | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element IdMedicationStatement.identifier.type Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Allows users to make use of identifiers when the identifier system is not known.
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:CE/CNE/CWE
- rim:CD
- orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2:CX.5
- rim:Role.code or implied by context
|
| system | Σ | 1..1 | uri | There are no (further) constraints on this element Element IdMedicationStatement.identifier.system The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Identifier.system is always case sensitive.
uri Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Generalhttp://www.acme.com/identifiers/patient
Mappings- rim:n/a
- v2:CX.4 / EI-2-4
- rim:II.root or Role.id.root
- servd:./IdentifierType
|
| value | Σ | 1..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.identifier.value The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system.
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim:n/a
- v2:CX.1 / EI.1
- rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
- servd:./Value
|
| period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element IdMedicationStatement.identifier.period Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use.
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
Period is not used for a duration (a measure of elapsed time). See Duration.
Period 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)
- rim:n/a
- v2:DR
- rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
- v2:CX.7 + CX.8
- rim:Role.effectiveTime or implied by context
- servd:./StartDate and ./EndDate
|
| assigner | Σ I | 0..1 | Reference(UK Core Organization) | Element IdMedicationStatement.identifier.assigner Organization that issued id (may be just text) Definition Organization that issued/manages the identifier.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Reference(UK Core Organization) 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'))
- rim:n/a
- rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- v2:CX.4 / (CX.4,CX.9,CX.10)
- rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
- servd:./IdentifierIssuingAuthority
|
| basedOn | Σ I | 0..* | Reference(UK Core CarePlan | UK Core MedicationRequest | UK Core ServiceRequest) | Element IdMedicationStatement.basedOn Fulfils plan, proposal or order Definition A plan, proposal or order that is fulfilled in whole or in part by this event.
Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Reference(UK Core CarePlan | UK Core MedicationRequest | UK Core ServiceRequest) 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'))
- rim:n/a
- rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- workflow:Event.basedOn
- rim:.outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]
|
| reference | Σ I | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.basedOn.reference 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.
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.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| type | Σ | 0..1 | uriBinding | There are no (further) constraints on this element Element IdMedicationStatement.basedOn.type 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).
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.
uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element IdMedicationStatement.basedOn.identifier 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.
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).
Identifier Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- 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
|
| use | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element IdMedicationStatement.basedOn.identifier.use usual | official | temp | secondary | old (If known) Definition The purpose of this identifier.
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:N/A
- rim:Role.code or implied by context
|
| type | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element IdMedicationStatement.basedOn.identifier.type Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Allows users to make use of identifiers when the identifier system is not known.
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:CE/CNE/CWE
- rim:CD
- orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2:CX.5
- rim:Role.code or implied by context
|
| system | Σ | 0..1 | uri | There are no (further) constraints on this element Element IdMedicationStatement.basedOn.identifier.system The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Identifier.system is always case sensitive.
uri Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Generalhttp://www.acme.com/identifiers/patient
Mappings- rim:n/a
- v2:CX.4 / EI-2-4
- rim:II.root or Role.id.root
- servd:./IdentifierType
|
| value | Σ | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.basedOn.identifier.value The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system.
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim:n/a
- v2:CX.1 / EI.1
- rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
- servd:./Value
|
| period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element IdMedicationStatement.basedOn.identifier.period Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use.
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
Period is not used for a duration (a measure of elapsed time). See Duration.
Period 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)
- rim:n/a
- v2:DR
- rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
- v2:CX.7 + CX.8
- rim:Role.effectiveTime or implied by context
- servd:./StartDate and ./EndDate
|
| assigner | Σ I | 0..1 | Reference(UK Core Organization) | Element IdMedicationStatement.basedOn.identifier.assigner Organization that issued id (may be just text) Definition Organization that issued/manages the identifier.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Reference(UK Core Organization) 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'))
- rim:n/a
- rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- v2:CX.4 / (CX.4,CX.9,CX.10)
- rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
- servd:./IdentifierIssuingAuthority
|
| display | Σ | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.basedOn.display Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference.
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| partOf | Σ I | 0..* | Reference(UK Core MedicationDispense | UK Core MedicationStatement | UK Core Observation | UK Core Procedure | UK Core MedicationAdministration) | Element IdMedicationStatement.partOf Part of referenced event Definition A larger event of which this particular event is a component or step.
This should not be used when indicating which resource a MedicationStatement has been derived from. If that is the use case, then MedicationStatement.derivedFrom should be used.
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Reference(UK Core MedicationDispense | UK Core MedicationStatement | UK Core Observation | UK Core Procedure | UK Core MedicationAdministration) 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'))
- rim:n/a
- rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- workflow:Event.partOf
- rim:.outboundRelationship[typeCode=COMP]/target[classCode=SPLY or SBADM or PROC or OBS,moodCode=EVN]
|
| reference | Σ I | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.partOf.reference 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.
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.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| type | Σ | 0..1 | uriBinding | There are no (further) constraints on this element Element IdMedicationStatement.partOf.type 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).
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.
uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element IdMedicationStatement.partOf.identifier 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.
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).
Identifier Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- 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
|
| use | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element IdMedicationStatement.partOf.identifier.use usual | official | temp | secondary | old (If known) Definition The purpose of this identifier.
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:N/A
- rim:Role.code or implied by context
|
| type | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element IdMedicationStatement.partOf.identifier.type Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Allows users to make use of identifiers when the identifier system is not known.
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:CE/CNE/CWE
- rim:CD
- orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2:CX.5
- rim:Role.code or implied by context
|
| system | Σ | 0..1 | uri | There are no (further) constraints on this element Element IdMedicationStatement.partOf.identifier.system The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Identifier.system is always case sensitive.
uri Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Generalhttp://www.acme.com/identifiers/patient
Mappings- rim:n/a
- v2:CX.4 / EI-2-4
- rim:II.root or Role.id.root
- servd:./IdentifierType
|
| value | Σ | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.partOf.identifier.value The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system.
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim:n/a
- v2:CX.1 / EI.1
- rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
- servd:./Value
|
| period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element IdMedicationStatement.partOf.identifier.period Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use.
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
Period is not used for a duration (a measure of elapsed time). See Duration.
Period 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)
- rim:n/a
- v2:DR
- rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
- v2:CX.7 + CX.8
- rim:Role.effectiveTime or implied by context
- servd:./StartDate and ./EndDate
|
| assigner | Σ I | 0..1 | Reference(UK Core Organization) | Element IdMedicationStatement.partOf.identifier.assigner Organization that issued id (may be just text) Definition Organization that issued/manages the identifier.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Reference(UK Core Organization) 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'))
- rim:n/a
- rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- v2:CX.4 / (CX.4,CX.9,CX.10)
- rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
- servd:./IdentifierIssuingAuthority
|
| display | Σ | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.partOf.display Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference.
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| status | Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element IdMedicationStatement.status active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken Definition A code representing the patient or other source's judgment about the state of the medication used that this statement is about. Generally, this will be active or completed.
MedicationStatement is a statement at a point in time. The status is only representative at the point when it was asserted. The value set for MedicationStatement.status contains codes that assert the status of the use of the medication by the patient (for example, stopped or on hold) as well as codes that assert the status of the medication statement itself (for example, entered in error).
This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
code Binding A coded concept indicating the current status of a MedicationStatement. Medication Status Codes (required)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- workflow:Event.status
- w5:FiveWs.status
- rim:.statusCode
|
| statusReason | | 0..* | CodeableConcept | There are no (further) constraints on this element Element IdMedicationStatement.statusReason Reason for current status Definition Captures the reason for the current state of the MedicationStatement.
This is generally only used for "exception" statuses such as "not-taken", "on-hold", "cancelled" or "entered-in-error". The reason for performing the event at all is captured in reasonCode, not here.
CodeableConcept Binding A coded concept indicating the reason for the status of the statement. SNOMEDCTDrugTherapyStatusCodes (example)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:CE/CNE/CWE
- rim:CD
- orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
- workflow:Event.statusReason
- rim:.inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde
|
| category | Σ | 0..1 | CodeableConceptBinding | Element IdMedicationStatement.category Type of medication usage Definition Indicates where the medication is expected to be consumed or administered.
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
CodeableConcept Binding A coded concept identifying where the medication included in the MedicationStatement is expected to be consumed or administered. UKCoreMedicationStatementCategory (extensible)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:CE/CNE/CWE
- rim:CD
- orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
- w5:FiveWs.class
- rim:.inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication usage"].value
|
| medication[x] | Σ | 1..1 | Binding | Element IdMedicationStatement.medication[x] What medication was 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 that identifies the medication from a known list of medications.
If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example, if you require form or lot number, then you must reference the Medication resource.
A coded concept identifying the substance or product being taken. UKCoreMedicationCode (preferred)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- workflow:Event.code
- w5:FiveWs.what[x]
- rim:.participation[typeCode=CSM].role[classCode=ADMM or MANU]
|
| medicationCodeableConcept | | | CodeableConcept | Data Type CodeableConcept |
| medicationReference | | | Reference(UK Core Medication) | Data Type Reference(UK Core Medication) |
| subject | Σ I | 1..1 | Reference(Group | UK Core Patient) | Element IdMedicationStatement.subject Who is/was taking the medication Definition The person, animal or group who is/was taking the medication.
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Reference(Group | UK Core Patient) 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'))
- rim:n/a
- rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- workflow:Event.subject
- w5:FiveWs.subject[x]
- v2:PID-3-Patient ID List
- rim:.participation[typeCode=SBJ].role[classCode=PAT]
- w5:FiveWs.subject
|
| reference | Σ I | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.subject.reference 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.
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.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| type | Σ | 0..1 | uriBinding | There are no (further) constraints on this element Element IdMedicationStatement.subject.type 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).
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.
uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element IdMedicationStatement.subject.identifier 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.
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).
Identifier Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- 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
|
| use | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element IdMedicationStatement.subject.identifier.use usual | official | temp | secondary | old (If known) Definition The purpose of this identifier.
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:N/A
- rim:Role.code or implied by context
|
| type | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element IdMedicationStatement.subject.identifier.type Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Allows users to make use of identifiers when the identifier system is not known.
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:CE/CNE/CWE
- rim:CD
- orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2:CX.5
- rim:Role.code or implied by context
|
| system | Σ | 0..1 | uri | There are no (further) constraints on this element Element IdMedicationStatement.subject.identifier.system The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Identifier.system is always case sensitive.
uri Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Generalhttp://www.acme.com/identifiers/patient
Mappings- rim:n/a
- v2:CX.4 / EI-2-4
- rim:II.root or Role.id.root
- servd:./IdentifierType
|
| value | Σ | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.subject.identifier.value The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system.
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim:n/a
- v2:CX.1 / EI.1
- rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
- servd:./Value
|
| period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element IdMedicationStatement.subject.identifier.period Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use.
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
Period is not used for a duration (a measure of elapsed time). See Duration.
Period 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)
- rim:n/a
- v2:DR
- rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
- v2:CX.7 + CX.8
- rim:Role.effectiveTime or implied by context
- servd:./StartDate and ./EndDate
|
| assigner | Σ I | 0..1 | Reference(UK Core Organization) | Element IdMedicationStatement.subject.identifier.assigner Organization that issued id (may be just text) Definition Organization that issued/manages the identifier.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Reference(UK Core Organization) 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'))
- rim:n/a
- rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- v2:CX.4 / (CX.4,CX.9,CX.10)
- rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
- servd:./IdentifierIssuingAuthority
|
| display | Σ | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.subject.display Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference.
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| context | Σ I | 0..1 | Reference(UK Core EpisodeOfCare | UK Core Encounter) | Element IdMedicationStatement.context Encounter / Episode associated with MedicationStatement Definition The encounter or episode of care that establishes the context for this MedicationStatement.
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Reference(UK Core EpisodeOfCare | UK Core Encounter) 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'))
- rim:n/a
- rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- workflow:Event.context
- rim:.inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]
|
| reference | Σ I | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.context.reference 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.
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.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| type | Σ | 0..1 | uriBinding | There are no (further) constraints on this element Element IdMedicationStatement.context.type 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).
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.
uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element IdMedicationStatement.context.identifier 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.
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).
Identifier Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- 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
|
| use | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element IdMedicationStatement.context.identifier.use usual | official | temp | secondary | old (If known) Definition The purpose of this identifier.
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:N/A
- rim:Role.code or implied by context
|
| type | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element IdMedicationStatement.context.identifier.type Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Allows users to make use of identifiers when the identifier system is not known.
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:CE/CNE/CWE
- rim:CD
- orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2:CX.5
- rim:Role.code or implied by context
|
| system | Σ | 0..1 | uri | There are no (further) constraints on this element Element IdMedicationStatement.context.identifier.system The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Identifier.system is always case sensitive.
uri Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Generalhttp://www.acme.com/identifiers/patient
Mappings- rim:n/a
- v2:CX.4 / EI-2-4
- rim:II.root or Role.id.root
- servd:./IdentifierType
|
| value | Σ | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.context.identifier.value The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system.
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim:n/a
- v2:CX.1 / EI.1
- rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
- servd:./Value
|
| period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element IdMedicationStatement.context.identifier.period Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use.
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
Period is not used for a duration (a measure of elapsed time). See Duration.
Period 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)
- rim:n/a
- v2:DR
- rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
- v2:CX.7 + CX.8
- rim:Role.effectiveTime or implied by context
- servd:./StartDate and ./EndDate
|
| assigner | Σ I | 0..1 | Reference(UK Core Organization) | Element IdMedicationStatement.context.identifier.assigner Organization that issued id (may be just text) Definition Organization that issued/manages the identifier.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Reference(UK Core Organization) 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'))
- rim:n/a
- rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- v2:CX.4 / (CX.4,CX.9,CX.10)
- rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
- servd:./IdentifierIssuingAuthority
|
| display | Σ | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.context.display Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference.
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| effective[x] | Σ | 0..1 | | There are no (further) constraints on this element Element IdMedicationStatement.effective[x] The date/time or interval when the medication is/was/will be taken Definition The interval of time during which it is being asserted that the patient is/was/will be taking the medication (or was not taking, when the MedicationStatement.taken element is No).
This attribute reflects the period over which the patient consumed the medication and is expected to be populated on the majority of Medication Statements. If the medication is still being taken at the time the statement is recorded, the "end" date will be omitted. The date/time attribute supports a variety of dates - year, year/month and exact date. If something more than this is required, this should be conveyed as text.
- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- workflow:Event.occurrence[x]
- w5:FiveWs.done[x]
- rim:.effectiveTime
|
| effectiveDateTime | | | dateTime | There are no (further) constraints on this element Data Type dateTime |
| effectivePeriod | | | Period | There are no (further) constraints on this element Data Type Period |
| dateAsserted | Σ | 0..1 | dateTime | There are no (further) constraints on this element Element IdMedicationStatement.dateAsserted When the statement was asserted? Definition The date when the medication statement was asserted by the information source.
dateTime Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- w5:FiveWs.recorded
- rim:.participation[typeCode=AUT].time
|
| informationSource | I | 0..1 | Reference(UK Core Organization | UK Core Patient | UK Core Practitioner | UK Core RelatedPerson | UK Core PractitionerRole) | Element IdMedicationStatement.informationSource Person or organization that provided the information about the taking of this medication Definition The person or organization that provided the information about the taking of this medication. Note: Use derivedFrom when a MedicationStatement is derived from other resources, e.g. Claim or MedicationRequest.
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Reference(UK Core Organization | UK Core Patient | UK Core Practitioner | UK Core RelatedPerson | UK Core PractitionerRole) 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'))
- rim:n/a
- rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- w5:FiveWs.source
- rim:.participation[typeCode=INF].role[classCode=PAT, or codes for Practioner or Related Person (if PAT is the informer, then syntax for self-reported =true)
|
| reference | Σ I | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.informationSource.reference 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.
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.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| type | Σ | 0..1 | uriBinding | There are no (further) constraints on this element Element IdMedicationStatement.informationSource.type 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).
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.
uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element IdMedicationStatement.informationSource.identifier 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.
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).
Identifier Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- 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
|
| use | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element IdMedicationStatement.informationSource.identifier.use usual | official | temp | secondary | old (If known) Definition The purpose of this identifier.
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:N/A
- rim:Role.code or implied by context
|
| type | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element IdMedicationStatement.informationSource.identifier.type Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Allows users to make use of identifiers when the identifier system is not known.
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:CE/CNE/CWE
- rim:CD
- orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2:CX.5
- rim:Role.code or implied by context
|
| system | Σ | 0..1 | uri | There are no (further) constraints on this element Element IdMedicationStatement.informationSource.identifier.system The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Identifier.system is always case sensitive.
uri Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Generalhttp://www.acme.com/identifiers/patient
Mappings- rim:n/a
- v2:CX.4 / EI-2-4
- rim:II.root or Role.id.root
- servd:./IdentifierType
|
| value | Σ | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.informationSource.identifier.value The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system.
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim:n/a
- v2:CX.1 / EI.1
- rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
- servd:./Value
|
| period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element IdMedicationStatement.informationSource.identifier.period Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use.
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
Period is not used for a duration (a measure of elapsed time). See Duration.
Period 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)
- rim:n/a
- v2:DR
- rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
- v2:CX.7 + CX.8
- rim:Role.effectiveTime or implied by context
- servd:./StartDate and ./EndDate
|
| assigner | Σ I | 0..1 | Reference(UK Core Organization) | Element IdMedicationStatement.informationSource.identifier.assigner Organization that issued id (may be just text) Definition Organization that issued/manages the identifier.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Reference(UK Core Organization) 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'))
- rim:n/a
- rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- v2:CX.4 / (CX.4,CX.9,CX.10)
- rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
- servd:./IdentifierIssuingAuthority
|
| display | Σ | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.informationSource.display Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference.
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| derivedFrom | I | 0..* | Reference(Resource) | There are no (further) constraints on this element Element IdMedicationStatement.derivedFrom Additional supporting information Definition Allows linking the MedicationStatement to the underlying MedicationRequest, or to other information that supports or is used to derive the MedicationStatement.
Likely references would be to MedicationRequest, MedicationDispense, Claim, Observation or QuestionnaireAnswers. The most common use cases for deriving a MedicationStatement comes from creating a MedicationStatement from a MedicationRequest or from a lab observation or a claim. it should be noted that the amount of information that is available varies from the type resource that you derive the MedicationStatement from.
Reference(Resource) 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'))
- rim:n/a
- rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- rim:.outboundRelationship[typeCode=SPRT]/target[classCode=ACT,moodCode=EVN]
|
| reference | Σ I | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.derivedFrom.reference 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.
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.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| type | Σ | 0..1 | uriBinding | There are no (further) constraints on this element Element IdMedicationStatement.derivedFrom.type 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).
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.
uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element IdMedicationStatement.derivedFrom.identifier 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.
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).
Identifier Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- 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
|
| use | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element IdMedicationStatement.derivedFrom.identifier.use usual | official | temp | secondary | old (If known) Definition The purpose of this identifier.
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:N/A
- rim:Role.code or implied by context
|
| type | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element IdMedicationStatement.derivedFrom.identifier.type Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Allows users to make use of identifiers when the identifier system is not known.
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:CE/CNE/CWE
- rim:CD
- orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2:CX.5
- rim:Role.code or implied by context
|
| system | Σ | 0..1 | uri | There are no (further) constraints on this element Element IdMedicationStatement.derivedFrom.identifier.system The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Identifier.system is always case sensitive.
uri Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Generalhttp://www.acme.com/identifiers/patient
Mappings- rim:n/a
- v2:CX.4 / EI-2-4
- rim:II.root or Role.id.root
- servd:./IdentifierType
|
| value | Σ | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.derivedFrom.identifier.value The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system.
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim:n/a
- v2:CX.1 / EI.1
- rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
- servd:./Value
|
| period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element IdMedicationStatement.derivedFrom.identifier.period Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use.
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
Period is not used for a duration (a measure of elapsed time). See Duration.
Period 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)
- rim:n/a
- v2:DR
- rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
- v2:CX.7 + CX.8
- rim:Role.effectiveTime or implied by context
- servd:./StartDate and ./EndDate
|
| assigner | Σ I | 0..1 | Reference(UK Core Organization) | Element IdMedicationStatement.derivedFrom.identifier.assigner Organization that issued id (may be just text) Definition Organization that issued/manages the identifier.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Reference(UK Core Organization) 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'))
- rim:n/a
- rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- v2:CX.4 / (CX.4,CX.9,CX.10)
- rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
- servd:./IdentifierIssuingAuthority
|
| display | Σ | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.derivedFrom.display Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference.
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| reasonCode | | 0..* | CodeableConcept | There are no (further) constraints on this element Element IdMedicationStatement.reasonCode Reason for why the medication is being/was taken Definition A reason for why the medication is being/was taken.
This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonForUseReference.
CodeableConcept Binding A coded concept identifying why the medication is being taken. Condition/Problem/DiagnosisCodes (example)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:CE/CNE/CWE
- rim:CD
- orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
- workflow:Event.reasonCode
- w5:FiveWs.why[x]
- rim:.reasonCode
|
| reasonReference | I | 0..* | Reference(UK Core Condition | UK Core Observation | UK Core DiagnosticReport) | Element IdMedicationStatement.reasonReference Condition or observation that supports why the medication is being/was taken Definition Condition or observation that supports why the medication is being/was taken.
This is a reference to a condition that is the reason why the medication is being/was taken. If only a code exists, use reasonForUseCode.
Reference(UK Core Condition | UK Core Observation | UK Core DiagnosticReport) 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'))
- rim:n/a
- rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- workflow:Event.reasonReference
- w5:FiveWs.why[x]
- rim:.outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="reason for use"].value
|
| reference | Σ I | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.reasonReference.reference 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.
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.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| type | Σ | 0..1 | uriBinding | There are no (further) constraints on this element Element IdMedicationStatement.reasonReference.type 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).
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.
uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element IdMedicationStatement.reasonReference.identifier 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.
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).
Identifier Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- 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
|
| use | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element IdMedicationStatement.reasonReference.identifier.use usual | official | temp | secondary | old (If known) Definition The purpose of this identifier.
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:N/A
- rim:Role.code or implied by context
|
| type | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element IdMedicationStatement.reasonReference.identifier.type Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Allows users to make use of identifiers when the identifier system is not known.
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:CE/CNE/CWE
- rim:CD
- orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2:CX.5
- rim:Role.code or implied by context
|
| system | Σ | 0..1 | uri | There are no (further) constraints on this element Element IdMedicationStatement.reasonReference.identifier.system The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Identifier.system is always case sensitive.
uri Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Generalhttp://www.acme.com/identifiers/patient
Mappings- rim:n/a
- v2:CX.4 / EI-2-4
- rim:II.root or Role.id.root
- servd:./IdentifierType
|
| value | Σ | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.reasonReference.identifier.value The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system.
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim:n/a
- v2:CX.1 / EI.1
- rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
- servd:./Value
|
| period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element IdMedicationStatement.reasonReference.identifier.period Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use.
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
Period is not used for a duration (a measure of elapsed time). See Duration.
Period 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)
- rim:n/a
- v2:DR
- rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
- v2:CX.7 + CX.8
- rim:Role.effectiveTime or implied by context
- servd:./StartDate and ./EndDate
|
| assigner | Σ I | 0..1 | Reference(UK Core Organization) | Element IdMedicationStatement.reasonReference.identifier.assigner Organization that issued id (may be just text) Definition Organization that issued/manages the identifier.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Reference(UK Core Organization) 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'))
- rim:n/a
- rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- v2:CX.4 / (CX.4,CX.9,CX.10)
- rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
- servd:./IdentifierIssuingAuthority
|
| display | Σ | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.reasonReference.display Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference.
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| note | | 0..* | Annotation | There are no (further) constraints on this element Element IdShort description Further information about the statement Definition Provides extra information about the medication statement that is not conveyed by the other attributes.
For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).
Annotation Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:N/A
- rim:Act
- workflow:Event.note
- rim:.inboundRelationship[typeCode=SUBJ]/source[classCode=OBS,moodCode=EVN,code="annotation"].value
|
| author[x] | Σ | 0..1 | | There are no (further) constraints on this element Element IdMedicationStatement.note.author[x] Individual responsible for the annotation Definition The individual responsible for making the annotation.
Organization is used when there's no need for specific attribution as to who made the comment.
- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:N/A
- rim:Act.participant[typeCode=AUT].role
|
| authorString | | | string | Data Type string |
| authorReference | | | Reference(UK Core Patient | UK Core Practitioner | UK Core RelatedPerson) | Data Type Reference(UK Core Patient | UK Core Practitioner | UK Core RelatedPerson) |
| time | Σ | 0..1 | dateTime | There are no (further) constraints on this element Element IdMedicationStatement.note.time When the annotation was made Definition Indicates when this particular annotation was made.
dateTime Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:N/A
- rim:Act.effectiveTime
|
| text | Σ | 1..1 | markdown | There are no (further) constraints on this element Element IdMedicationStatement.note.text The annotation - text content (as markdown) Definition The text of the annotation in markdown format.
Systems are not required to have markdown support, so the text should be readable without markdown processing. The markdown syntax is GFM - see https://github.github.com/gfm/
markdown Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:N/A
- rim:Act.text
|
| dosage | | 0..* | Dosage | There are no (further) constraints on this element Element IdMedicationStatement.dosage Details of how medication is/was taken or should be taken Definition Indicates how the medication is/was or should be taken by the patient.
The dates included in the dosage on a Medication Statement reflect the dates for a given dose. For example, "from November 1, 2016 to November 3, 2016, take one tablet daily and from November 4, 2016 to November 7, 2016, take two tablets daily." It is expected that this specificity may only be populated where the patient brings in their labeled container or where the Medication Statement is derived from a MedicationRequest.
Dosage Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- rim:.outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT]
- rim:refer dosageInstruction mapping
|
| sequence | Σ | 0..1 | integer | There are no (further) constraints on this element Element IdMedicationStatement.dosage.sequence The order of the dosage instructions Definition Indicates the order in which the dosage instructions should be applied or interpreted.
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.
32 bit number; for values larger than this, use decimal
integer Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| text | Σ | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.dosage.text Free text dosage instructions e.g. SIG Definition Free text dosage instructions e.g. SIG.
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.
Note that FHIR strings SHALL NOT exceed 1MB in size
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:RXO-6; RXE-21
- rim:.text
|
| additionalInstruction | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element IdMedicationStatement.dosage.additionalInstruction 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").
Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.
Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.
CodeableConcept Binding A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery". SNOMEDCTAdditionalDosageInstructions (example)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:CE/CNE/CWE
- rim:CD
- orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2:RXO-7
- rim:.text
|
| patientInstruction | Σ | 0..1 | string | There are no (further) constraints on this element Element IdMedicationStatement.dosage.patientInstruction Patient or consumer oriented instructions Definition Instructions in terms that are understood by the patient or consumer.
Note that FHIR strings SHALL NOT exceed 1MB in size
string Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| timing | Σ | 0..1 | Timing | There are no (further) constraints on this element Element IdMedicationStatement.dosage.timing When medication should be administered Definition When medication should be administered.
The timing schedule for giving the medication to the patient. This data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.
This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.
Timing Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:N/A
- rim:QSET<TS> (GTS)
- rim:.effectiveTime
|
| asNeeded[x] | Σ | 0..1 | Binding | Element IdMedicationStatement.dosage.asNeeded[x] 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).
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".
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 (preferred)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:TQ1-9
- rim:.outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept
|
| asNeededBoolean | | | boolean | There are no (further) constraints on this element Data Type boolean |
| asNeededCodeableConcept | | | CodeableConcept | There are no (further) constraints on this element Data Type CodeableConcept |
| site | Σ | 0..1 | CodeableConceptBinding | Element IdMedicationStatement.dosage.site Body site to administer to Definition Body site to administer to.
A coded specification of the anatomic site where the medication first enters the body.
If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.
CodeableConcept Binding A coded concept describing the site location the medicine enters into or onto the body. UKCoreBodySite (preferred)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:CE/CNE/CWE
- rim:CD
- orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2:RXR-2
- rim:.approachSiteCode
|
| route | Σ | 0..1 | CodeableConceptBinding | Element IdMedicationStatement.dosage.route How drug should enter body Definition How drug should enter body.
A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.
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.
CodeableConcept Binding A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject. UKCoreSubstanceOrProductAdministrationRoute (preferred)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:CE/CNE/CWE
- rim:CD
- orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2:RXR-1
- rim:.routeCode
|
| method | Σ | 0..1 | CodeableConceptBinding | Element IdMedicationStatement.dosage.method Technique for administering medication Definition Technique for administering medication.
A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.
Terminologies used often pre-coordinate this term with the route and or form of administration.
CodeableConcept Binding A coded concept describing the technique by which the medicine is administered. UKCoreMedicationDosageMethod (preferred)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:CE/CNE/CWE
- rim:CD
- orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2:RXR-4
- rim:.doseQuantity
|
| doseAndRate | Σ | 0..* | Element | There are no (further) constraints on this element Element IdMedicationStatement.dosage.doseAndRate Amount of medication administered Definition The amount of medication administered.
Element Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| type | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element IdMedicationStatement.dosage.doseAndRate.type The kind of dose or rate specified Definition The kind of dose or rate specified, for example, ordered or calculated.
If the type is not populated, assume to be "ordered".
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.
CodeableConcept Binding The kind of dose or rate specified. DoseAndRateType (example)Constraints- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:CE/CNE/CWE
- rim:CD
- orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2:RXO-21; RXE-23
|
| dose[x] | Σ | 0..1 | | There are no (further) constraints on this element Element IdMedicationStatement.dosage.doseAndRate.dose[x] Amount of medication per dose Definition Amount of medication per dose.
The amount of therapeutic or other substance given at one administration event.
Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.
- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:RXO-2, RXE-3
- rim:.doseQuantity
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| doseRange | | | Range | There are no (further) constraints on this element Data Type Range |
| doseQuantity | | | SimpleQuantity | There are no (further) constraints on this element Data Type SimpleQuantity |
| rate[x] | Σ | 0..1 | | There are no (further) constraints on this element Element IdMedicationStatement.dosage.doseAndRate.rate[x] Amount of medication per unit of time Definition Amount of medication per unit of time.
Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.
It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.
It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM 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.
- ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim:n/a
- v2:RXE22, RXE23, RXE-24
- rim:.rateQuantity
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| rateRatio | | | Ratio | There are no (further) constraints on this element Data Type Ratio |
| rateRange | | | Range | There are no (further) constraints on this element Data Type Range |
| rateQuantity | | | SimpleQuantity | There are no (further) constraints on this element Data Type SimpleQuantity |
| maxDosePerPeriod | Σ I | 0..1 | Ratio | There are no (further) constraints on this element Element IdMedicationStatement.dosage.maxDosePerPeriod Upper limit on medication per unit of time Definition Upper limit on medication per unit of time.
The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.
This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".
Ratio 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())
- rim:n/a
- v2:N/A
- rim:RTO
- v2:RXO-23, RXE-19
- rim:.maxDoseQuantity
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| maxDosePerAdministration | Σ I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element IdMedicationStatement.dosage.maxDosePerAdministration Upper limit on medication per administration Definition Upper limit on medication per administration.
The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.
This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.
SimpleQuantity 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()
- rim:n/a
- v2:SN (see also Range) or CQ
- rim:PQ, IVL<PQ>, MO, CO, depending on the values
- rim:not supported
|
| maxDosePerLifetime | Σ I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element IdMedicationStatement.dosage.maxDosePerLifetime Upper limit on medication per lifetime of the patient Definition Upper limit on medication per lifetime of the patient.
The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.
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.
SimpleQuantity 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()
- rim:n/a
- v2:SN (see also Range) or CQ
- rim:PQ, IVL<PQ>, MO, CO, depending on the values
- rim:not supported
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