Profile: MedicationRequest
Additional guidance based on the UKCore MedicationRequest resource, for which the tree view of the profiled resource is shown below.
| UKCoreMedicationRequest (MedicationRequest) | C | MedicationRequest | There are no (further) constraints on this element Element idMedicationRequestShort description Ordering of medication for patient or group Alternate namesPrescription, Order DefinitionAn order or request for both supply of the medication and the instructions for administration of the medication to a patient. The resource is called "MedicationRequest" rather than "MedicationPrescription" or "MedicationOrder" to generalize the use across inpatient and outpatient settings, including care plans, etc., and to harmonize with workflow patterns.
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| id | Σ | 0..1 | id | There are no (further) constraints on this element Element idMedicationRequest.idShort description Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idMedicationRequest.metaShort description Metadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idMedicationRequest.implicitRulesShort description A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| language | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.languageShort description Language of the resource content DefinitionThe base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). A human language. Binding extensions
The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| text | 0..1 | Narrative | There are no (further) constraints on this element Element idMedicationRequest.textShort description Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| contained | 0..* | Resource | There are no (further) constraints on this element Element idMedicationRequest.containedShort description Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| medicationRepeatInformation | C | 0..1 | Extension(Complex) | Element idMedicationRequest.extension:medicationRepeatInformationShort description Allows the resource to be referenced within / by other resources. Alternate namesextensions, user content DefinitionMedication repeat information. 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(Complex) Extension URLExtensionUKCoreMedicationRepeatInformation ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | ?! C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.modifierExtensionShort description Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| identifier | S | 0..* | Identifier | Element idMedicationRequest.identifierShort description Allows the resource to be referenced within / by other resources. DefinitionIdentifiers associated with this medication request that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server. This is a business identifier, not a resource identifier. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| status | S Σ ?! | 1..1 | codeBinding | Element idMedicationRequest.statusShort description A code specifying the current state of the order. DefinitionA code specifying the current state of the order. Generally, this will be active or completed state. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription. medicationrequest Status (required) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| statusReason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idMedicationRequest.statusReasonShort description Reason for current status DefinitionCaptures the reason for the current state of the MedicationRequest. This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the MedicationRequest was created at all is captured in reasonCode, not here. Identifies the reasons for a given status. medicationRequest Status Reason Codes (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| intent | S Σ ?! | 1..1 | codeBinding | Element idMedicationRequest.intentShort description Whether the request is a proposal, plan, or an original order. DefinitionWhether the request is a proposal, plan, or an original order. It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only. An instance-order is an instantiation of a request or order and may be used to populate Medication Administration Record. This element is labeled as a modifier because the intent alters when and how the resource is actually applicable. The kind of medication order. medicationRequest Intent (required) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| category | S | 0..* | CodeableConceptBinding | Element idMedicationRequest.categoryShort description Provides the business context for the relevant dispensing processes. DefinitionIndicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)). The category can be used to include where the medication is expected to be consumed or other types of requests. A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment. UKCoreMedicationRequestCategory (extensible) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| priority | Σ | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationRequest.priorityShort description routine | urgent | asap | stat DefinitionIndicates how quickly the Medication Request should be addressed with respect to other requests. Note that FHIR strings SHALL NOT exceed 1MB in size Identifies the level of importance to be assigned to actioning the request. ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| doNotPerform | Σ ?! | 0..1 | boolean | There are no (further) constraints on this element Element idMedicationRequest.doNotPerformShort description True if request is prohibiting action DefinitionIf true indicates that the provider is asking for the medication request not to occur. If do not perform is not specified, the request is a positive request e.g. "do perform". The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| reported[x] | Σ | 0..1 | There are no (further) constraints on this element Element idMedicationRequest.reported[x]Short description Reported rather than primary record DefinitionIndicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the report. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| reportedBoolean | boolean | There are no (further) constraints on this element Data type | ||||
| reportedReference | Reference(Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) | There are no (further) constraints on this element Data typeReference(Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) | ||||
| medication[x] | S Σ | 1..1 | Binding | Element idMedicationRequest.medication[x]Short description Identifies the medication being requested. DefinitionIdentifies the medication being requested. This is a link to a resource that represents the medication which may be the details of the medication or simply an 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 or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource. A coded concept identifying substance or product that can be ordered. UKCoreMedicationCode (preferred) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| medicationCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||||
| medicationReference | Reference(Medication) | There are no (further) constraints on this element Data type | ||||
| subject | S Σ C | 1..1 | Reference(Group | Patient) | Element idMedicationRequest.subjectShort description Who the medication request is for. DefinitionA link to a resource representing the person or set of individuals to whom the medication will be given. The subject on a medication request is mandatory. For the secondary use case where the actual subject is not provided, there still must be an anonymized subject specified. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| encounter | C | 0..1 | Reference(Encounter) | There are no (further) constraints on this element Element idMedicationRequest.encounterShort description Encounter created as part of encounter/admission/stay DefinitionThe Encounter during which this [x] was created or to which the creation of this record is tightly associated. This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter." If there is a need to link to episodes of care they will be handled with an extension. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| supportingInformation | C | 0..* | Reference(Resource) | There are no (further) constraints on this element Element idMedicationRequest.supportingInformationShort description Information to support ordering of the medication DefinitionInclude additional information (for example, patient height and weight) that supports the ordering of the medication. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| authoredOn | S Σ | 0..1 | dateTime | Element idMedicationRequest.authoredOnShort description The date / time that the medication request was initially authored. DefinitionThe date (and perhaps time) when the prescription was initially written or authored on. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| requester | S Σ C | 0..1 | Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) | Element idMedicationRequest.requesterShort description Who is requesting the medication. DefinitionThe individual, organization, or device that initiated the request and has responsibility for its activation. 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(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| performer | C | 0..1 | Reference(CareTeam | Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) | There are no (further) constraints on this element Element idMedicationRequest.performerShort description Intended performer of administration DefinitionThe specified desired performer of the medication treatment (e.g. the performer of the medication administration). 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(CareTeam | Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| performerType | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idMedicationRequest.performerTypeShort description Desired kind of performer of the medication administration DefinitionIndicates the type of performer of the administration of the medication. If specified without indicating a performer, this indicates that the performer must be of the specified type. If specified with a performer then it indicates the requirements of the performer if the designated performer is not available. Identifies the type of individual that is desired to administer the medication. ProcedurePerformerRoleCodes (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| recorder | C | 0..1 | Reference(Practitioner | PractitionerRole) | There are no (further) constraints on this element Element idMedicationRequest.recorderShort description Person who entered the request DefinitionThe person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order. 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(Practitioner | PractitionerRole) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| reasonCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element idMedicationRequest.reasonCodeShort description Reason or indication for ordering or not ordering the medication DefinitionThe reason or the indication for ordering or not ordering the medication. This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference. A coded concept indicating why the medication was ordered. Condition/Problem/DiagnosisCodes (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| reasonReference | C | 0..* | Reference(Condition | Observation) | There are no (further) constraints on this element Element idMedicationRequest.reasonReferenceShort description Condition or observation that supports why the prescription is being written DefinitionCondition or observation that supports why the medication was ordered. This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode. Reference(Condition | Observation) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| instantiatesCanonical | Σ | 0..* | canonical | There are no (further) constraints on this element Element idMedicationRequest.instantiatesCanonicalShort description Instantiates FHIR protocol or definition DefinitionThe URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| instantiatesUri | Σ | 0..* | uri | There are no (further) constraints on this element Element idMedicationRequest.instantiatesUriShort description Instantiates external protocol or definition DefinitionThe URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this MedicationRequest. see http://en.wikipedia.org/wiki/Uniform_resource_identifier The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| basedOn | Σ C | 0..* | Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | ServiceRequest) | There are no (further) constraints on this element Element idMedicationRequest.basedOnShort description What request fulfills DefinitionA plan or request that is fulfilled in whole or in part by this medication request. 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(CarePlan | ImmunizationRecommendation | MedicationRequest | ServiceRequest) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| groupIdentifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idMedicationRequest.groupIdentifierShort description Composite request this is part of DefinitionA shared identifier common to all requests that were authorized more or less simultaneously by a single author, representing the identifier of the requisition or prescription. Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| courseOfTherapyType | 0..1 | CodeableConceptBinding | Element idMedicationRequest.courseOfTherapyTypeShort description A course of therapy for a medication request DefinitionThe description of the course of therapy for a medication request. This attribute should not be confused with the protocol of the medication. Identifies the overall pattern of medication administratio. UKCoreMedicationRequestCourseOfTherapy (extensible) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| insurance | C | 0..* | Reference(ClaimResponse | Coverage) | There are no (further) constraints on this element Element idMedicationRequest.insuranceShort description Associated insurance coverage DefinitionInsurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service. 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(ClaimResponse | Coverage) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| note | 0..* | Annotation | There are no (further) constraints on this element Element idMedicationRequest.noteShort description Information about the prescription DefinitionExtra information about the prescription that could not be 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). The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| dosageInstruction | S | 0..* | Dosage | Element idMedicationRequest.dosageInstructionShort description Dosage instructions for the medication. DefinitionIndicates how the medication is to be used by the patient. There are examples where a medication request may include the option of an oral dose or an Intravenous or Intramuscular dose. For example, "Ondansetron 8mg orally or IV twice a day as needed for nausea" or "Compazine® (prochlorperazine) 5-10mg PO or 25mg PR bid prn nausea or vomiting". In these cases, two medication requests would be created that could be grouped together. The decision on which dose and route of administration to use is based on the patient's condition at the time the dose is needed. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.modifierExtensionShort description Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers 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). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| sequence | Σ | 0..1 | integer | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.sequenceShort description The order of the dosage instructions DefinitionIndicates 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 The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| text | S Σ | 0..1 | string | Element idMedicationRequest.dosageInstruction.textShort description Free text dosage instructions. DefinitionFree 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 The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| additionalInstruction | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.additionalInstructionShort description Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" 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"). 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. A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery". SNOMEDCTAdditionalDosageInstructions (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| patientInstruction | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.patientInstructionShort description Patient or consumer oriented instructions DefinitionInstructions in terms that are understood by the patient or consumer. Note that FHIR strings SHALL NOT exceed 1MB in size The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| timing | S Σ | 0..1 | Timing | Element idMedicationRequest.dosageInstruction.timingShort description When the medication should be administered. DefinitionWhen 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| asNeeded[x] | Σ | 0..1 | Binding | Element idMedicationRequest.dosageInstruction.asNeeded[x]Short description Take "as needed" (for 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). 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) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| asNeededBoolean | boolean | There are no (further) constraints on this element Data type | ||||
| asNeededCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||||
| site | Σ | 0..1 | CodeableConceptBinding | Element idMedicationRequest.dosageInstruction.siteShort description Body site to administer to DefinitionBody 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. A coded concept describing the site location the medicine enters into or onto the body. ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| route | Σ | 0..1 | CodeableConceptBinding | Element idMedicationRequest.dosageInstruction.routeShort description How drug should enter body DefinitionHow 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. 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) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| method | Σ | 0..1 | CodeableConceptBinding | Element idMedicationRequest.dosageInstruction.methodShort description Technique for administering medication DefinitionTechnique 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. A coded concept describing the technique by which the medicine is administered. UKCoreMedicationDosageMethod (preferred) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| doseAndRate | S Σ | 0..* | Element | Element idMedicationRequest.dosageInstruction.doseAndRateShort description Dosage instructions for the requested medication. DefinitionThe amount of medication administered. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.doseAndRate.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.doseAndRate.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| type | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.doseAndRate.typeShort description The kind of dose or rate specified DefinitionThe 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. The kind of dose or rate specified. ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| dose[x] | S Σ | 0..1 | Element idMedicationRequest.dosageInstruction.doseAndRate.dose[x]Short description Quantity of requested medication to be administered. DefinitionAmount 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| doseQuantity | SimpleQuantity | There are no (further) constraints on this element Data type | ||||
| doseRange | Range | There are no (further) constraints on this element Data type | ||||
| rate[x] | S Σ | 0..1 | Element idMedicationRequest.dosageInstruction.doseAndRate.rate[x]Short description Rate at which the requested medication is to be administered. DefinitionAmount 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| rateQuantity | SimpleQuantity | There are no (further) constraints on this element Data type | ||||
| rateRange | Range | There are no (further) constraints on this element Data type | ||||
| rateRatio | Ratio | There are no (further) constraints on this element Data type | ||||
| maxDosePerPeriod | Σ C | 0..1 | Ratio | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerPeriodShort description Upper limit on medication per unit of time DefinitionUpper 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". The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| maxDosePerAdministration | Σ C | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerAdministrationShort description Upper limit on medication per administration DefinitionUpper 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| maxDosePerLifetime | Σ C | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idMedicationRequest.dosageInstruction.maxDosePerLifetimeShort description Upper limit on medication per lifetime of the patient DefinitionUpper 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| dispenseRequest | S | 0..1 | BackboneElement | Element idMedicationRequest.dispenseRequestShort description Specific dispensing quantity instructions. DefinitionIndicates the specific details for the dispense or medication supply part of a medication request (also known as a Medication Prescription or Medication Order). Note that this information is not always sent with the order. There may be in some settings (e.g. hospitals) institutional or system support for completing the dispense details in the pharmacy department. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.modifierExtensionShort description Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers 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). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| initialFill | 0..1 | BackboneElement | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFillShort description First fill details DefinitionIndicates the quantity or duration for the first dispense of the medication. If populating this element, either the quantity or the duration must be included. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.modifierExtensionShort description Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers 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). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| quantity | C | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.quantityShort description First fill quantity DefinitionThe amount or quantity to provide as part of the first dispense. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| duration | C | 0..1 | Duration | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.initialFill.durationShort description First fill duration DefinitionThe length of time that the first dispense is expected to last. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| dispenseInterval | C | 0..1 | Duration | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.dispenseIntervalShort description Minimum period of time between dispenses DefinitionThe minimum period of time that must occur between dispenses of the medication. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| validityPeriod | C | 0..1 | Period | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.validityPeriodShort description Time period supply is authorized for DefinitionThis indicates the validity period of a prescription (stale dating the Prescription). Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription. It reflects the prescribers' perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| numberOfRepeatsAllowed | 0..1 | unsignedInt | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.numberOfRepeatsAllowedShort description Number of refills authorized DefinitionAn integer indicating the number of times, in addition to the original dispense, (aka refills or repeats) that the patient can receive the prescribed medication. Usage Notes: This integer does not include the original order dispense. This means that if an order indicates dispense 30 tablets plus "3 repeats", then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets. A prescriber may explicitly say that zero refills are permitted after the initial dispense. If displaying "number of authorized fills", add 1 to this number. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| quantity | S C | 0..1 | SimpleQuantity | Element idMedicationRequest.dispenseRequest.quantityShort description >Amount of medication to supply per dispense. DefinitionThe amount that is to be dispensed for one fill. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| expectedSupplyDuration | C | 0..1 | Duration | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.expectedSupplyDurationShort description Number of days supply per dispense DefinitionIdentifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last. In some situations, this attribute may be used instead of quantity to identify the amount supplied by how long it is expected to last, rather than the physical quantity issued, e.g. 90 days supply of medication (based on an ordered dosage). When possible, it is always better to specify quantity, as this tends to be more precise. expectedSupplyDuration will always be an estimate that can be influenced by external factors. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| performer | C | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element idMedicationRequest.dispenseRequest.performerShort description Intended dispenser DefinitionIndicates the intended dispensing Organization specified by the prescriber. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| substitution | S | 1..1 | BackboneElement | Element idMedicationRequest.substitutionShort description Any restrictions on medication substitution. DefinitionIndicates whether or not substitution can or should be part of the dispense. In some cases, substitution must happen, in other cases substitution must not happen. This block explains the prescriber's intent. If nothing is specified substitution may be done. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationRequest.substitution.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.substitution.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationRequest.substitution.modifierExtensionShort description Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers 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). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| allowed[x] | 1..1 | Element idMedicationRequest.substitution.allowed[x]Short description Whether substitution is allowed or not DefinitionThe purpose of this element is to allow the prescriber to dispense a different drug from what was prescribed. This element is labeled as a modifier because whether substitution is allow or not, it cannot be ignored. Identifies the type of substitution allowed. ActSubstanceAdminSubstitutionCode (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| allowedBoolean | boolean | There are no (further) constraints on this element Data type | ||||
| allowedCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||||
| reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idMedicationRequest.substitution.reasonShort description Why should (not) substitution be made DefinitionIndicates the reason for the substitution, or why substitution must or must not be performed. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed. SubstanceAdminSubstitutionReason (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| priorPrescription | C | 0..1 | Reference(MedicationRequest) | There are no (further) constraints on this element Element idMedicationRequest.priorPrescriptionShort description An order/prescription that is being replaced DefinitionA link to a resource representing an earlier order related order or prescription. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| detectedIssue | C | 0..* | Reference(DetectedIssue) | There are no (further) constraints on this element Element idMedicationRequest.detectedIssueShort description Clinical Issue with action Alternate namesContraindication, Drug Utilization Review (DUR), Alert DefinitionIndicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etc. This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| eventHistory | C | 0..* | Reference(Provenance) | There are no (further) constraints on this element Element idMedicationRequest.eventHistoryShort description A list of events of interest in the lifecycle DefinitionLinks to Provenance records for past versions of this resource or fulfilling request or event resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resource. This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.). The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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Additional Guidance
Guidance in consultation with the Digital Medicines Community of Interest
Note1: Where the cardinality in the table below states "required" this relates to the element being part of the UKCore Minimum Viable Content.
Note2: Where "dispensing system" is referenced below this would be a pharmacy dispensing system for the use case of sending an order to pharmacy. This would be an Automated Dispensing Cabinet (ADC) when sending a plan or order to an ADC.
Note3: ADCs typically do not like to work with dm+d VTMs due to variable drug formulations but it is not impossible. Where a VTM is used a typical ADC may display ALL the available products applicable for the VTM. It is therefore recommended to include a route within the dosageInstruction to help the ward clinician select an appropriate product. Product selection will be a manual process using the ADC console screen.
| Element | Cardinality | Guidance |
|---|---|---|
| extension: medicationRepeatInformation | Optional | To support repeat prescribing processes used in Primary Care. |
| status | Mandatory | Use active to instruct the dispensing system to action the medication plan or order.Use cancelled to instruct the dispensing system to cancel the medication plan or order.Use stopped to instruct the dispensing system to stop the medication plan or order.Use on-hold as per stopped but expected to continue later (restart with active). |
| intent | Mandatory | Use order to denote this is an order for medication to be dispensed.Use plan to configure a patient's medication plan as a schedule within an ADC. |
| category | Required | Use inpatient for dispensing as part of a ward round.Use discharge or leave for medication to be prepared and labelled for the patient to take away, often as complete packs, opposed to dispensing a unit dose. |
| priority | Optional | Use stat to identify a STAT dose. |
| medication[x] | Mandatory | The dm+d concept for the medication required by the patient. For Trusts that have implemented prodct-based orders this will be a VMP or AMP concept. For Trusts that have implemented dose-based orders this will be a VTM. If additional qualifiers like form are required then a referenced Medication resource will be required. |
| subject | Mandatory | Reference to a Patient resource. Likely that two identifiers will be used; the NHS number (when known) and the local MRN (hospital number). |
| authoredOn | Required | To timestamp the event. |
| encounter | Required | Reference to an Encounter resource, which may include a local encounter identifier. Note: An ADC will typically require this element as they operate using a combination of the patient and encounter identifiers to support transfer of care workflows e.g. if the patient is transferred from emergency department to an inpatient ward. |
| requester | Required | The clinician via a reference to either a Practitioner or PractitionerRole resource. Note: Some ADCs have user-based interfaces. For example if nurse A is the requester, then nurse A is expected to be the dispenser (unless dispenseRequest.performer states otherwise). |
| performer | Optional | A reference to a Practitioner resource. Note: Required by the Omnicell ADC when the intent is order. |
| basedOn | Optional | When the intent is plan this could reference a CarePlan.When the intent is order this could reference the MedicationRequest of intent plan. |
| dosageInstruction | Required | Structured dosage instruction for the medication order. Note: Complex dosages (titrations) can be split into separate dosages to send to an ADC. A typical ADC will support dose ranges with the clinician asked to select the dose from within the given range. |
| dispenseRequest.quantity | Optional | To instruct the dispensing system that a specific quantity of medication should be dispensed. Some Trusts will have standard operating procedures that may dictate supply quantities. May only be applicable where an EPMA knows about pack sizes to instruct a whole pack to be dispensed by the dispensing system, e.g. "28 tablets". Dispensing systems will typically allow flexibility to dispense the required quantity, e.g. 1 x 28 tablet pack or 2 x 14 tablet packs, etc. Where an EPMA does not know about pack sizes this can be omitted as the dispensing system user interface will typically allow either a unit dose or whole pack to be dispensed. |
| dispenseRequest.validityPeriod | Optional | To instruct the dispensing system with a schedule for the medication either as a period of time, e.g for 7 days, or a date/time period, e.g. from X to Y. Can also be used to define a period when a medication is put on-hold. |
| substitution | Mandatory | Should always be set to false unless local prescribing guidelines permit substitution. |
| priorPrescription | Optional | To reference a previous MedicationRequest. This may be useful when the status is changing, e.g. moving an active medication to an on-hold medication. |
Examples
Examples to be added...