StructureDefinition UKCore-MedicationStatement

Canonical_URLStatusCurrent_VersionLast_UpdatedDescription
https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationStatementactive2.5.02024-07-11

This profile defines the UK constraints and extensions on the International FHIR resource MedicationStatement.


Profile_Purpose

This profile allows exchange of a record of a medication that is being consumed by a patient.

A MedicationStatement may indicate that the individual 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 individual, significant other (such as a family member or spouse), or a clinician.

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
pharmacistVerifiedIndicatorI0..1Extension(boolean)
medicationPrescribingOrganizationTypeI0..1Extension(CodeableConcept)
medicationStatementLastIssueDateI0..1Extension(dateTime)
modifierExtension?! I0..*Extension
id0..1string
extensionI0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ1..1uri
valueΣ1..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(Organization)
basedOnS Σ I0..*Reference(MedicationRequest | CarePlan | ServiceRequest)
partOfΣ I0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Observation)
statusS Σ ?!1..1codeBinding
statusReason0..*CodeableConcept
categoryS Σ0..1CodeableConceptBinding
medicationCodeableConceptCodeableConcept
medicationReferenceReference(Medication)
subjectS Σ I1..1Reference(Patient | Group)
contextΣ I0..1Reference(Encounter | EpisodeOfCare)
effectiveDateTimedateTime
effectivePeriodPeriod
dateAssertedS Σ0..1dateTime
informationSourceS I0..1Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization)
derivedFromS I0..*Reference(Resource)
reasonCode0..*CodeableConcept
reasonReferenceI0..*Reference(Condition | Observation | DiagnosticReport)
note0..*Annotation
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
sequenceΣ0..1integer
textΣ0..1string
additionalInstructionΣ0..*CodeableConcept
patientInstructionΣ0..1string
timingΣ0..1Timing
asNeededBooleanboolean
asNeededCodeableConceptCodeableConcept
siteΣ0..1CodeableConceptBinding
routeΣ0..1CodeableConceptBinding
methodΣ0..1CodeableConceptBinding
id0..1string
extensionI0..*Extension
typeΣ0..1CodeableConcept
doseRangeRange
doseQuantitySimpleQuantity
rateRatioRatio
rateRangeRange
rateQuantitySimpleQuantity
maxDosePerPeriodΣ I0..1Ratio
maxDosePerAdministrationΣ I0..1SimpleQuantity
maxDosePerLifetimeΣ I0..1SimpleQuantity

Detailed Descriptions

MedicationStatement
DefinitionA 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.
Cardinality0...*
Comments

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.

Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.empty()
  • dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
  • dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim: Entity. Role, or Act
  • workflow: Event
  • rim: SubstanceAdministration
MedicationStatement.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

MedicationStatement.meta
DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
MedicationStatement.implicitRules
DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
MedicationStatement.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
MedicationStatement.text
DefinitionA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
MedicationStatement.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

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

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
MedicationStatement.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

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

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
MedicationStatement.extension:pharmacistVerifiedIndicator
DefinitionThis extension is used to indicate whether a pharmacist verified a medication.
Cardinality0...1
TypeExtension(boolean)
Aliasextensions, user content
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
MedicationStatement.extension:medicationPrescribingOrganizationType
DefinitionThis extension carries the type of organisation or setting responsible for authorising and issuing a medication.
Cardinality0...1
TypeExtension(CodeableConcept)
Aliasextensions, user content
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
MedicationStatement.extension:medicationStatementLastIssueDate
DefinitionThis extension supports the exchange of the date information when a prescription was last issued.
Cardinality0...1
TypeExtension(dateTime)
Aliasextensions, user content
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
MedicationStatement.modifierExtension
DefinitionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

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

Comments

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

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
MedicationStatement.identifier
DefinitionIdentifiers 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.
Cardinality0...*
TypeIdentifier
Must SupportTrue
SummaryTrue
Comments

This is a business identifier, not a resource identifier.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Event.identifier
  • w5: FiveWs.identifier
  • rim: .id
MedicationStatement.identifier.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
MedicationStatement.identifier.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

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

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
MedicationStatement.identifier.use
DefinitionThe purpose of this identifier.
Cardinality0...1
Typecode
Binding

Identifies the purpose for this identifier, if known .

IdentifierUse (required)
ModifierTrue
SummaryTrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: Role.code or implied by context
MedicationStatement.identifier.type
DefinitionA coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Cardinality0...1
TypeCodeableConcept
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)
SummaryTrue
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: CX.5
  • rim: Role.code or implied by context
MedicationStatement.identifier.system
DefinitionEstablishes the namespace for the value - that is, a URL that describes a set values that are unique.
Cardinality1...1
Typeuri
SummaryTrue
Requirements

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.

Comments

Identifier.system is always case sensitive.

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

http://www.acme.com/identifiers/patient


Mappings
  • rim: n/a
  • v2: CX.4 / EI-2-4
  • rim: II.root or Role.id.root
  • servd: ./IdentifierType
MedicationStatement.identifier.value
DefinitionThe portion of the identifier typically relevant to the user and which is unique within the context of the system.
Cardinality1...1
Typestring
SummaryTrue
Comments

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.

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

123456


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
MedicationStatement.identifier.period
DefinitionTime period during which identifier is/was valid for use.
Cardinality0...1
TypePeriod
SummaryTrue
Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • v2: CX.7 + CX.8
  • rim: Role.effectiveTime or implied by context
  • servd: ./StartDate and ./EndDate
MedicationStatement.identifier.assigner
DefinitionOrganization that issued/manages the identifier.
Cardinality0...1
TypeReference(Organization)
SummaryTrue
Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • 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
MedicationStatement.basedOn
DefinitionA plan, proposal or order that is fulfilled in whole or in part by this event.
Cardinality0...*
TypeReference(MedicationRequest | CarePlan | ServiceRequest)
Must SupportTrue
SummaryTrue
Requirements

Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.

Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.basedOn
  • rim: .outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]
MedicationStatement.partOf
DefinitionA larger event of which this particular event is a component or step.
Cardinality0...*
TypeReference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Observation)
SummaryTrue
Requirements

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.

Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.partOf
  • rim: .outboundRelationship[typeCode=COMP]/target[classCode=SPLY or SBADM or PROC or OBS,moodCode=EVN]
MedicationStatement.status
DefinitionA 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.
Cardinality1...1
Typecode
Binding

A coded concept indicating the current status of a MedicationStatement.

Medication Status Codes (required)
Must SupportTrue
ModifierTrue
SummaryTrue
Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.status
  • w5: FiveWs.status
  • rim: .statusCode
MedicationStatement.statusReason
DefinitionCaptures the reason for the current state of the MedicationStatement.
Cardinality0...*
TypeCodeableConcept
Binding

A coded concept indicating the reason for the status of the statement.

SNOMEDCTDrugTherapyStatusCodes (example)
Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.statusReason
  • rim: .inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde
MedicationStatement.category
DefinitionIndicates where the medication is expected to be consumed or administered.
Cardinality0...1
TypeCodeableConcept
Binding

A coded concept identifying where the medication included in the MedicationStatement is expected to be consumed or administered.

UKCoreMedicationStatementCategory (extensible)
Must SupportTrue
SummaryTrue
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.class
  • rim: .inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication usage"].value
MedicationStatement.medication[x]
DefinitionIdentifies 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.
Cardinality1...1
TypeCodeableConcept
Binding

A coded concept identifying the substance or product being taken.

UKCoreMedicationCode (preferred)
Must SupportTrue
SummaryTrue
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.code
  • w5: FiveWs.what[x]
  • rim: .participation[typeCode=CSM].role[classCode=ADMM or MANU]
MedicationStatement.subject
DefinitionThe person, animal or group who is/was taking the medication.
Cardinality1...1
TypeReference(Patient | Group)
Must SupportTrue
SummaryTrue
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.subject
  • w5: FiveWs.subject[x]
  • v2: PID-3-Patient ID List
  • rim: .participation[typeCode=SBJ].role[classCode=PAT]
  • w5: FiveWs.subject
MedicationStatement.context
DefinitionThe encounter or episode of care that establishes the context for this MedicationStatement.
Cardinality0...1
TypeReference(Encounter | EpisodeOfCare)
SummaryTrue
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.context
  • rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]
MedicationStatement.effective[x]
DefinitionThe 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).
Cardinality0...1
TypedateTime
Must SupportTrue
SummaryTrue
Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.occurrence[x]
  • w5: FiveWs.done[x]
  • rim: .effectiveTime
MedicationStatement.dateAsserted
DefinitionThe date when the medication statement was asserted by the information source.
Cardinality0...1
TypedateTime
Must SupportTrue
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.recorded
  • rim: .participation[typeCode=AUT].time
MedicationStatement.informationSource
DefinitionThe 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.
Cardinality0...1
TypeReference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization)
Must SupportTrue
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.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)
MedicationStatement.derivedFrom
DefinitionAllows linking the MedicationStatement to the underlying MedicationRequest, or to other information that supports or is used to derive the MedicationStatement.
Cardinality0...*
TypeReference(Resource)
Must SupportTrue
Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .outboundRelationship[typeCode=SPRT]/target[classCode=ACT,moodCode=EVN]
MedicationStatement.reasonCode
DefinitionA reason for why the medication is being/was taken.
Cardinality0...*
TypeCodeableConcept
Binding

A coded concept identifying why the medication is being taken.

Condition/Problem/DiagnosisCodes (example)
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.reasonCode
  • w5: FiveWs.why[x]
  • rim: .reasonCode
MedicationStatement.reasonReference
DefinitionCondition or observation that supports why the medication is being/was taken.
Cardinality0...*
TypeReference(Condition | Observation | DiagnosticReport)
Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.reasonReference
  • w5: FiveWs.why[x]
  • rim: .outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="reason for use"].value
MedicationStatement.note
DefinitionProvides extra information about the medication statement that is not conveyed by the other attributes.
Cardinality0...*
TypeAnnotation
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: Act
  • workflow: Event.note
  • rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=OBS,moodCode=EVN,code="annotation"].value
MedicationStatement.dosage
DefinitionIndicates how the medication is/was or should be taken by the patient.
Cardinality0...*
TypeDosage
Must SupportTrue
Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT]
  • rim: refer dosageInstruction mapping
MedicationStatement.dosage.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
MedicationStatement.dosage.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

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

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
MedicationStatement.dosage.modifierExtension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

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

Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
MedicationStatement.dosage.sequence
DefinitionIndicates the order in which the dosage instructions should be applied or interpreted.
Cardinality0...1
Typeinteger
SummaryTrue
Requirements

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

Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: TQ1-1
  • rim: .text
MedicationStatement.dosage.text
DefinitionFree text dosage instructions e.g. SIG.
Cardinality0...1
Typestring
SummaryTrue
Requirements

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

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: RXO-6; RXE-21
  • rim: .text
MedicationStatement.dosage.additionalInstruction
DefinitionSupplemental 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").
Cardinality0...*
TypeCodeableConcept
Binding

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

SNOMEDCTAdditionalDosageInstructions (example)
SummaryTrue
Requirements

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

Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: RXO-7
  • rim: .text
MedicationStatement.dosage.patientInstruction
DefinitionInstructions in terms that are understood by the patient or consumer.
Cardinality0...1
Typestring
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: RXO-7
  • rim: .text
MedicationStatement.dosage.timing
DefinitionWhen medication should be administered.
Cardinality0...1
TypeTiming
SummaryTrue
Requirements

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

Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: QSET<TS> (GTS)
  • rim: .effectiveTime
MedicationStatement.dosage.asNeeded[x]
DefinitionIndicates 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).
Cardinality0...1
Typeboolean
Binding

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

SNOMEDCTMedicationAsNeededReasonCodes (preferred)
SummaryTrue
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: TQ1-9
  • rim: .outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept
MedicationStatement.dosage.site
DefinitionBody site to administer to.
Cardinality0...1
TypeCodeableConcept
Binding

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

UKCoreBodySite (preferred)
SummaryTrue
Requirements

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

Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: RXR-2
  • rim: .approachSiteCode
MedicationStatement.dosage.route
DefinitionHow drug should enter body.
Cardinality0...1
TypeCodeableConcept
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)
SummaryTrue
Requirements

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

Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: RXR-1
  • rim: .routeCode
MedicationStatement.dosage.method
DefinitionTechnique for administering medication.
Cardinality0...1
TypeCodeableConcept
Binding

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

UKCoreMedicationDosageMethod (preferred)
SummaryTrue
Requirements

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

Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: RXR-4
  • rim: .doseQuantity
MedicationStatement.dosage.doseAndRate
DefinitionThe amount of medication administered.
Cardinality0...*
TypeElement
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: TQ1-2
MedicationStatement.dosage.doseAndRate.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
MedicationStatement.dosage.doseAndRate.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

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

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
MedicationStatement.dosage.doseAndRate.type
DefinitionThe kind of dose or rate specified, for example, ordered or calculated.
Cardinality0...1
TypeCodeableConcept
Binding

The kind of dose or rate specified.

DoseAndRateType (example)
SummaryTrue
Requirements

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

Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: RXO-21; RXE-23
MedicationStatement.dosage.doseAndRate.dose[x]
DefinitionAmount of medication per dose.
Cardinality0...1
TypeRange
SummaryTrue
Requirements

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

Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: RXO-2, RXE-3
  • rim: .doseQuantity
MedicationStatement.dosage.doseAndRate.rate[x]
DefinitionAmount of medication per unit of time.
Cardinality0...1
TypeRatio
SummaryTrue
Requirements

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

Comments

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

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: RXE22, RXE23, RXE-24
  • rim: .rateQuantity
MedicationStatement.dosage.maxDosePerPeriod
DefinitionUpper limit on medication per unit of time.
Cardinality0...1
TypeRatio
SummaryTrue
Requirements

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

Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • rat-1: Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present
    (numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: RTO
  • v2: RXO-23, RXE-19
  • rim: .maxDoseQuantity
MedicationStatement.dosage.maxDosePerAdministration
DefinitionUpper limit on medication per administration.
Cardinality0...1
TypeSimpleQuantity
SummaryTrue
Requirements

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

Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • sqty-1: The comparator is not used on a SimpleQuantity
    comparator.empty()
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • rim: not supported
MedicationStatement.dosage.maxDosePerLifetime
DefinitionUpper limit on medication per lifetime of the patient.
Cardinality0...1
TypeSimpleQuantity
SummaryTrue
Requirements

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

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • sqty-1: The comparator is not used on a SimpleQuantity
    comparator.empty()
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • rim: not supported

Table View

MedicationStatement..
MedicationStatement.extensionExtension..
MedicationStatement.extensionExtension..
MedicationStatement.extensionExtension..
MedicationStatement.identifier..
MedicationStatement.identifier.system1..
MedicationStatement.identifier.value1..
MedicationStatement.basedOn..
MedicationStatement.status..
MedicationStatement.category..
MedicationStatement.medication[x]..
MedicationStatement.subject..
MedicationStatement.effective[x]..
MedicationStatement.dateAsserted..
MedicationStatement.informationSource..
MedicationStatement.derivedFrom..
MedicationStatement.dosage..
MedicationStatement.dosage.asNeeded[x]..
MedicationStatement.dosage.site..
MedicationStatement.dosage.route..
MedicationStatement.dosage.method..

XML View

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="UKCore-MedicationStatement" />
    <url value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationStatement" />
    <version value="2.5.0" />
    <name value="UKCoreMedicationStatement" />
    <title value="UK Core Medication Statement" />
    <status value="active" />
    <date value="2024-07-11" />
    <publisher value="HL7 UK" />
    <contact>
        <name value="HL7 UK" />
        <telecom>
            <system value="email" />
            <value value="ukcore@hl7.org.uk" />
            <use value="work" />
            <rank value="1" />
        </telecom>
    </contact>
    <description value="This profile defines the UK constraints and extensions on the International FHIR resource [MedicationStatement](https://hl7.org/fhir/R4/MedicationStatement.html)." />
    <purpose value="This profile allows exchange of a record of a medication that is being consumed by a patient. \n\nA MedicationStatement may indicate that the individual 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 individual, significant other (such as a family member or spouse), or a clinician." />
    <copyright value="Copyright &#169; 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the &quot;License&quot;); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an &quot;AS IS&quot; BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7&#174; FHIR&#174; standard Copyright &#169; 2011+ HL7 The HL7&#174; FHIR&#174; standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html." />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="MedicationStatement" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/MedicationStatement" />
    <derivation value="constraint" />
    <differential>
        <element id="MedicationStatement.extension:pharmacistVerifiedIndicator">
            <path value="MedicationStatement.extension" />
            <sliceName value="pharmacistVerifiedIndicator" />
            <short value="Indicates whether a pharmacist verified a medication." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-PharmacistVerifiedIndicator" />
            </type>
        </element>
        <element id="MedicationStatement.extension:medicationPrescribingOrganizationType">
            <path value="MedicationStatement.extension" />
            <sliceName value="medicationPrescribingOrganizationType" />
            <short value="Identifies if the medication was `prescribed-at-gp-practice` or `prescribed-by-another-organisation`.\n\nThis extension is likely only to be populated by GP systems." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationPrescribingOrganizationType" />
            </type>
        </element>
        <element id="MedicationStatement.extension:medicationStatementLastIssueDate">
            <path value="MedicationStatement.extension" />
            <sliceName value="medicationStatementLastIssueDate" />
            <short value="The date or date/time that the medication described in the `MedicationStatement` was last requested/prescribed.\n\nThe presence of this data does not imply medication has been dispensed or supplied to the patient." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationStatementLastIssueDate" />
            </type>
        </element>
        <element id="MedicationStatement.identifier">
            <path value="MedicationStatement.identifier" />
            <short value="Allows the resource to be referenced within / by other resources." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationStatement.identifier.system">
            <path value="MedicationStatement.identifier.system" />
            <min value="1" />
        </element>
        <element id="MedicationStatement.identifier.value">
            <path value="MedicationStatement.identifier.value" />
            <min value="1" />
        </element>
        <element id="MedicationStatement.basedOn">
            <path value="MedicationStatement.basedOn" />
            <short value="To reference to a `MedicationRequest` resource, where applicable." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationStatement.status">
            <path value="MedicationStatement.status" />
            <short value="A code representing the patient or other source&#39;s judgement about the state of the medication used that this statement is about." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationStatement.category">
            <path value="MedicationStatement.category" />
            <short value="Indicates where the medication is expected to be consumed or administered." />
            <mustSupport value="true" />
            <binding>
                <strength value="extensible" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationStatementCategory" />
            </binding>
        </element>
        <element id="MedicationStatement.medication[x]">
            <path value="MedicationStatement.medication[x]" />
            <short value="Identifies the medication being administered." />
            <mustSupport value="true" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationCode" />
            </binding>
        </element>
        <element id="MedicationStatement.subject">
            <path value="MedicationStatement.subject" />
            <short value="Who is / was taking the medication." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationStatement.effective[x]">
            <path value="MedicationStatement.effective[x]" />
            <short value="The date / time, or interval, when the medication is / was / will be taken." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationStatement.dateAsserted">
            <path value="MedicationStatement.dateAsserted" />
            <short value="To timestamp the statement assertion." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationStatement.informationSource">
            <path value="MedicationStatement.informationSource" />
            <short value="To reference other resources, where applicable." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationStatement.derivedFrom">
            <path value="MedicationStatement.derivedFrom" />
            <short value="To reference other resources, where applicable." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationStatement.dosage">
            <path value="MedicationStatement.dosage" />
            <short value="The medication dosage for the statement." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationStatement.dosage.asNeeded[x]">
            <path value="MedicationStatement.dosage.asNeeded[x]" />
            <binding>
                <strength value="preferred" />
            </binding>
        </element>
        <element id="MedicationStatement.dosage.site">
            <path value="MedicationStatement.dosage.site" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-BodySite" />
            </binding>
        </element>
        <element id="MedicationStatement.dosage.route">
            <path value="MedicationStatement.dosage.route" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute" />
            </binding>
        </element>
        <element id="MedicationStatement.dosage.method">
            <path value="MedicationStatement.dosage.method" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationDosageMethod" />
            </binding>
        </element>
    </differential>
</StructureDefinition>

JSON View

{
    "resourceType": "StructureDefinition",
    "id": "UKCore-MedicationStatement",
    "url": "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationStatement",
    "version": "2.5.0",
    "name": "UKCoreMedicationStatement",
    "title": "UK Core Medication Statement",
    "status": "active",
    "date": "2024-07-11",
    "publisher": "HL7 UK",
    "contact":  [
        {
            "name": "HL7 UK",
            "telecom":  [
                {
                    "system": "email",
                    "value": "ukcore@hl7.org.uk",
                    "use": "work",
                    "rank": 1
                }
            ]
        }
    ],
    "description": "This profile defines the UK constraints and extensions on the International FHIR resource [MedicationStatement](https://hl7.org/fhir/R4/MedicationStatement.html).",
    "purpose": "This profile allows exchange of a record of a medication that is being consumed by a patient. \n\nA MedicationStatement may indicate that the individual 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 individual, significant other (such as a family member or spouse), or a clinician.",
    "copyright": "Copyright © 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the \"License\"); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an \"AS IS\" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7® FHIR® standard Copyright © 2011+ HL7 The HL7® FHIR® standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html.",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "MedicationStatement",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/MedicationStatement",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "MedicationStatement.extension:pharmacistVerifiedIndicator",
                "path": "MedicationStatement.extension",
                "sliceName": "pharmacistVerifiedIndicator",
                "short": "Indicates whether a pharmacist verified a medication.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-PharmacistVerifiedIndicator"
                        ]
                    }
                ]
            },
            {
                "id": "MedicationStatement.extension:medicationPrescribingOrganizationType",
                "path": "MedicationStatement.extension",
                "sliceName": "medicationPrescribingOrganizationType",
                "short": "Identifies if the medication was `prescribed-at-gp-practice` or `prescribed-by-another-organisation`.\\n\\nThis extension is likely only to be populated by GP systems.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationPrescribingOrganizationType"
                        ]
                    }
                ]
            },
            {
                "id": "MedicationStatement.extension:medicationStatementLastIssueDate",
                "path": "MedicationStatement.extension",
                "sliceName": "medicationStatementLastIssueDate",
                "short": "The date or date/time that the medication described in the `MedicationStatement` was last requested/prescribed.\\n\\nThe presence of this data does not imply medication has been dispensed or supplied to the patient.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationStatementLastIssueDate"
                        ]
                    }
                ]
            },
            {
                "id": "MedicationStatement.identifier",
                "path": "MedicationStatement.identifier",
                "short": "Allows the resource to be referenced within / by other resources.",
                "mustSupport": true
            },
            {
                "id": "MedicationStatement.identifier.system",
                "path": "MedicationStatement.identifier.system",
                "min": 1
            },
            {
                "id": "MedicationStatement.identifier.value",
                "path": "MedicationStatement.identifier.value",
                "min": 1
            },
            {
                "id": "MedicationStatement.basedOn",
                "path": "MedicationStatement.basedOn",
                "short": "To reference to a `MedicationRequest` resource, where applicable.",
                "mustSupport": true
            },
            {
                "id": "MedicationStatement.status",
                "path": "MedicationStatement.status",
                "short": "A code representing the patient or other source's judgement about the state of the medication used that this statement is about.",
                "mustSupport": true
            },
            {
                "id": "MedicationStatement.category",
                "path": "MedicationStatement.category",
                "short": "Indicates where the medication is expected to be consumed or administered.",
                "mustSupport": true,
                "binding": {
                    "strength": "extensible",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationStatementCategory"
                }
            },
            {
                "id": "MedicationStatement.medication[x]",
                "path": "MedicationStatement.medication[x]",
                "short": "Identifies the medication being administered.",
                "mustSupport": true,
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationCode"
                }
            },
            {
                "id": "MedicationStatement.subject",
                "path": "MedicationStatement.subject",
                "short": "Who is / was taking the medication.",
                "mustSupport": true
            },
            {
                "id": "MedicationStatement.effective[x]",
                "path": "MedicationStatement.effective[x]",
                "short": "The date / time, or interval, when the medication is / was / will be taken.",
                "mustSupport": true
            },
            {
                "id": "MedicationStatement.dateAsserted",
                "path": "MedicationStatement.dateAsserted",
                "short": "To timestamp the statement assertion.",
                "mustSupport": true
            },
            {
                "id": "MedicationStatement.informationSource",
                "path": "MedicationStatement.informationSource",
                "short": "To reference other resources, where applicable.",
                "mustSupport": true
            },
            {
                "id": "MedicationStatement.derivedFrom",
                "path": "MedicationStatement.derivedFrom",
                "short": "To reference other resources, where applicable.",
                "mustSupport": true
            },
            {
                "id": "MedicationStatement.dosage",
                "path": "MedicationStatement.dosage",
                "short": "The medication dosage for the statement.",
                "mustSupport": true
            },
            {
                "id": "MedicationStatement.dosage.asNeeded[x]",
                "path": "MedicationStatement.dosage.asNeeded[x]",
                "binding": {
                    "strength": "preferred"
                }
            },
            {
                "id": "MedicationStatement.dosage.site",
                "path": "MedicationStatement.dosage.site",
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-BodySite"
                }
            },
            {
                "id": "MedicationStatement.dosage.route",
                "path": "MedicationStatement.dosage.route",
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute"
                }
            },
            {
                "id": "MedicationStatement.dosage.method",
                "path": "MedicationStatement.dosage.method",
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationDosageMethod"
                }
            }
        ]
    }
}

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Examples

Amoxicillin - An example to illustrate a medication statement of Amoxicillin.
Example UKCore-MedicationStatement-Amoxicillin

Last Issue Date - An example to illustrate the LastIssueDate extension.
Example UKCore-Extension-LastIssueDate

Medication Prescribing Organization Type - An example to illustrate the MedicationPrescribingOrganizationType extension.
Example UKCore-Extension-MedicationPrescribingOrganizationType

Pharmacist Verified Indicator - An example to illustrate the PharmacistVerifiedIndicator extension.
Example UKCore-Extension-PharmacistVerifiedIndicator

Example Usage Scenarios

The following are example usage scenarios for the UK Core MedicationStatement profile:

  • Query and retrieve a patient's current medication
  • Record or update a patient's current medication.

Profile Specific Implementation Guidance:

Mandatory and Must Support Data Elements

The following elements are identified as MustSupport, and it is expected that consumers and suppliers SHALL support these as per the MustSupport Guidance.

ElementReason
MedicationStatement.identifierAllows the resource to be referenced within / by other resources.
MedicationStatement.basedOnTo reference to a `MedicationRequest` resource, where applicable.
MedicationStatement.statusA code representing the patient or other source's judgement about the state of the medication used that this statement is about.
MedicationStatement.categoryIndicates where the medication is expected to be consumed or administered.
MedicationStatement.medication[x]Identifies the medication being administered.
MedicationStatement.subjectWho is / was taking the medication.
MedicationStatement.effective[x]The date / time, or interval, when the medication is / was / will be taken.
MedicationStatement.dateAssertedTo timestamp the statement assertion.
MedicationStatement.informationSourceTo reference other resources, where applicable.
MedicationStatement.derivedFromTo reference other resources, where applicable.
MedicationStatement.dosageThe medication dosage for the statement.


Extensions

More information about the extensions on the UKCore-MedicationStatement profile can be found using the links below.

ExtensionContextLinkComment
pharmacistVerifiedIndicatorMedicationStatement.extensionhttps://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-PharmacistVerifiedIndicatorIndicates whether a pharmacist verified a medication.
medicationPrescribingOrganizationTypeMedicationStatement.extensionhttps://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationPrescribingOrganizationTypeIdentifies if the medication was `prescribed-at-gp-practice` or `prescribed-by-another-organisation`.\n\nThis extension is likely only to be populated by GP systems.
medicationStatementLastIssueDateMedicationStatement.extensionhttps://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationStatementLastIssueDateThe date or date/time that the medication described in the `MedicationStatement` was last requested/prescribed.\n\nThe presence of this data does not imply medication has been dispensed or supplied to the patient.


Bindings (differential)

More information about the bindings to UK Core ValueSets can be found below.

ContextStrengthLink
MedicationStatement.categoryextensiblehttps://fhir.hl7.org.uk/ValueSet/UKCore-MedicationStatementCategory
MedicationStatement.medication[x]preferredhttps://fhir.hl7.org.uk/ValueSet/UKCore-MedicationCode
MedicationStatement.dosage.sitepreferredhttps://fhir.hl7.org.uk/ValueSet/UKCore-BodySite
MedicationStatement.dosage.routepreferredhttps://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute
MedicationStatement.dosage.methodpreferredhttps://fhir.hl7.org.uk/ValueSet/UKCore-MedicationDosageMethod

MedicationStatement.extension:medicationPrescribingOrganizationType extensible ValueSet UKCore-MedicationPrescribingOrganizationType

basedOn

Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles:

If the clinical system has implemented the CarePlan resource, a logical link to the care plan for which the medication request is based has business benefit.


partOf

This SHOULD NOT be used as the use-case and purpose is ambiguous.


status

Status FHIR Definition Recommendation
active The medication is still being taken. It is believed the medication is active in the patient's system.
completed The medication is no longer being taken. A course of medication has been completed and the medication is not active in the patient's system.
entered-in-error Some of the actions that are implied by the medication statement may have occurred. For example, the patient may have taken some of the medication. Clinical decision support systems SHOULD take this status into account. Indicates the MedicationStatement is INVALID. It is not expected that a MedicationStatement with this status would be included in exchanges.
intended The medication may be taken at some time in the future. It is intended that the medication will be given to the patient. When this is used effective[x] SHALL indicate when it is intended that the medication is to be taken.
stopped Actions implied by the statement have been permanently halted, before all of them occurred. This SHOULD NOT be used if the statement was entered in error. Medication has been stopped before the completion of the prescribed course and there is no plan to restart it. When used the reason SHALL be indicated in MedicationStatement.statusReason.
on-hold Actions implied by the statement have been temporarily halted, but are expected to continue later. May also be called "suspended". Medication has been temporarily stopped.
When used the reason SHALL be indicated in MedicationStatement.statusReason.
Where it is known when it is intended to restart it this MAY be indicated in MedicationStatement.statusReason.
unknown The state of the medication use is not currently known. The patient may have had some encounter with this medication, but the current status is unknown. Avoid the use of this status value where possible.
not-taken The medication was not consumed by the patient Use this when there is certainty that the patient has not consumed any of the intended medication.

A MedicationStatement represents a snapshot in time of a patient medication - and if the status is not available in the source system, then the following business rule MAY apply to compute the state.

Status How it can be determined
active A completed MedicationRequest (if known) where the current date is between the MedicationRequest.dispenseRequest.validityPeriod element. The MedicationStatement.effectivePeriod element SHOULD reflect this information.
or
Where the current date is between the MedicationStatement.effectivePeriod
completed Where the current date is after the MedicationStatement.effectivePeriod
or
A completed MedicationRequest (if known) where the MedicationRequest.dispenseRequest element is either not defined, or the current date is greater than the dispenseRequest.validityPeriod.

statusReason

Used to expand on the intent for the status of the MedicationStatement.

An example use-case for this could be if an organisation sets a medication status to on-hold with the intent to restart the medication at some point (move back to active).


category

The ValueSet UKCore-MedicationStatementCategory has been extended with leave and discharge to align with the equivalent value set used by MedicationRequest.


medication[x]

Medication WITH dm+d code

Where a dm+d code exists it SHALL be used either as MedicationStatement.medicationCodeableConcept.coding or as MedicationStatement.medicationReference:Medication.code.

Where CodeableConcept is used, MedicationStatement.medicationCodeableConcept.coding is the dm+d code and MedicationStatement.medicationCodeableConcept.text is dm+d concept name/description.

Can be either a dm+d code as a CodeableConcept or reference to Profile UKCore-Medication resource. Using a CodeableConcept is preferred unless additional data if required that would be contained within a Profile UKCore-Medication resource.

The elements MedicationStatement.medicationCodeableConcept.coding and MedicationStatement.medicationReference:Medication.code are both bound to ValueSet UKCore-MedicationCode

Examples where a reference to a Profile UKCore-Medication would be applicable include:

  • Record a VTM with a specific form
  • Record manufacturer with a concept as described in ValueSet UKCore-MedicationCode
  • Record batch number
  • Record ingredients (for example with a magisterial prescription or an excipient).

Medication WITHOUT dm+d code

Medication not published within the dm+d may be requested in the Acute care setting.

In this scenario it is recommended to use the CodeableConcept variant for this element.

If the prescribing system has both a locally assigned code and description for the medication then;

  • The MedicationStatement.medicationCodeableConcept.text SHOULD be the description for the medication.
  • The MedicationStatement.medicationCodeableConcept.coding.code SHOULD be the code for the medication.
  • The MedicationStatement.medicationCodeableConcept.coding.display SHOULD be the description for the medication, i.e. the same value as MedicationStatement.medicationCodeableConcept.text.

If the prescribing system only has a description for the medication then;

  • The MedicationStatement.medicationCodeableConcept.text SHOULD be the locally assigned description for the medication.

subject

A reference to the patient.

Within a FHIR Messaging or FHIR Document implementation, include a Profile UKCore-Patient resource within the Bundle with at least the minimum dataset populated as defined within the UK Core standard. The MedicationStatement.subject.reference points to the resource in the Bundle.

Within a RESTful implementation a MedicationStatement.subject.reference and/or MedicationStatement.subject.identifier SHALL be provided that allows the consumer system to query another API if they need to access the complete Profile UKCore-Patient resource.

For implementations within England and Wales, the MedicationStatement.subject.identifier could be the patient's NHS Number, allowing a consumer system to use the NHS England Personal Demographics Service FHIR API to return a Patient resource.

For implementations within Scotland, the MedicationStatement.subject.identifier could be the patient's CHI Number.


context

Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles:


informationSource

Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles:

Referencing an organisation is likely to be more useful than a person. Individual work patterns and/or employer may change while the care setting organisation is likely to be more static and relevant within historic instances of this resource.

When referencing an organisation - the following SHALL be provided:

  • Organization.contact.name
  • Organization.contact.telecom
  • Organization.identifier.odsOrganisationCode or Organization.identifier.odsSiteCode

Where the organisation is an Acute Trust, an ODS Site Code MAY be more useful than the parent Trust-wide ODS organisation code.


derivedFrom

Where a UK Core profile exists, the resource being referenced SHOULD conform to the profile.

This SHOULD be used only to reference information that can not be referenced by MedicationStatement.basedOn.


reasonReference

Further details of why the medication is being taken by reference. Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles:


note

If present, notes must be displayed by consuming systems.

Where author is known and to be shared, the use of MedicationStatement.note.authorReference is preferred over using a free-text version MedicationStatement.note.authorString.


dosage

Consider aligning to the Implementation Guide for Digital Medicines, but as a minimum, MedicationStatement.dosage.text.