<status value="active" /> <publisher value="Nictiz" /> <contact> <name value="Nictiz" /> <telecom> <system value="url" /> <value value="https://www.nictiz.nl" /> <use value="work" /> </telecom> </contact> <description value="The variable dosing regimen provides concrete details for the InstructionsForUse section of a medication agreement. The dosing regimen can be modified at any time without having to change the medication agreement." /> <purpose value="This MedicationRequest resource represents the VariableDosingRegimen building block for implementations following the information standard [MP9](https://informatiestandaarden.nictiz.nl/wiki/Landingspagina_Medicatieproces). The VariableDosingRegimen has a strong relationship with [mp-MedicationAgreement](http://nictiz.nl/fhir/StructureDefinition/mp-MedicationAgreement). This VariableDosingRegimen profile describes (additional) instructions for MedicationAgreements and is used when it is expected that the MedicationAgreement instructions will need to be adjusted frequently. By separating this into two resources, the original MedicationAgreement does not have to be adjusted as often. Unfortunately, a derived profile can not be made because of a fixed and mandatory `.category` code. Also, some concepts are not used. This profile reuses extensions made for the MedicationAgreement." /> <copyright value="Copyright and related rights waived via CC0, https://creativecommons.org/publicdomain/zero/1.0/. This does not apply to information from third parties, for example a medical terminology system. The implementer alone is responsible for identifying and obtaining any necessary licenses or authorizations to utilize third party IP in connection with the specification or otherwise." /> <fhirVersion value="4.0.1" /> <mapping> <identity value="zib-instructionsforuse-v1.2.1-2020EN" /> <uri value="https://zibs.nl/wiki/InstructionsForUse-v1.2.1(2020EN)" /> <name value="zib InstructionsForUse-v1.2.1(2020EN)" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc1-20250522" /> <uri value="https://decor.nictiz.nl/pub/medicatieproces/mp-html-20250522T132618/ds-2.16.840.1.113883.2.4.3.11.60.20.77.1.4-2022-06-30T000000.html" /> <name value="ART-DECOR Dataset MP9 3.0.0-rc.1 20250522" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc2-20260213" /> <uri value="https://decor.nictiz.nl/pub/medicatieproces/mp-html-20260213T112547/ds-2.16.840.1.113883.2.4.3.11.60.20.77.1.4-2022-06-30T000000.html" /> <name value="ART-DECOR Dataset MP9 3.0.0-rc.2 20260213" /> </mapping> <kind value="resource" /> <abstract value="false" /> <type value="MedicationRequest" /> <baseDefinition value="http://hl7.org/fhir/StructureDefinition/MedicationRequest" /> <derivation value="constraint" /> <differential> <element id="MedicationRequest"> <path value="MedicationRequest" /> <short value="VariableDosingRegimen" /> <alias value="WisselendDoseerschema" /> <mapping> <identity value="mp-dataset-mp9-300-rc1-20250522" /> <map value="mp-dataelement9x-632" /> <comment value="VariableDosingRegimen" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc2-20260213" /> <map value="mp-dataelement9x-632" /> <comment value="VariableDosingRegimen" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc1-20250522" /> <map value="mp-dataelement9x-646" /> <comment value="InstructionsForUse" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc2-20260213" /> <map value="mp-dataelement9x-646" /> <comment value="InstructionsForUse" /> </mapping> </element> <element id="MedicationRequest.extension:pharmaceuticalTreatmentIdentifier"> <path value="MedicationRequest.extension" /> <sliceName value="pharmaceuticalTreatmentIdentifier" /> <type> <code value="Extension" /> <profile value="http://nictiz.nl/fhir/StructureDefinition/ext-PharmaceuticalTreatment.Identifier" /> </type> </element> <element id="MedicationRequest.extension:pharmaceuticalTreatmentIdentifier.value[x]"> <path value="MedicationRequest.extension.value[x]" /> <mapping> <identity value="mp-dataset-mp9-300-rc1-20250522" /> <map value="mp-dataelement9x-42" /> <comment value="Identification" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc2-20260213" /> <map value="mp-dataelement9x-42" /> <comment value="Identification" /> </mapping> </element> <element id="MedicationRequest.extension:relationEpisodeOfCare"> <path value="MedicationRequest.extension" /> <sliceName value="relationEpisodeOfCare" /> <type> <code value="Extension" /> <profile value="http://nictiz.nl/fhir/StructureDefinition/ext-Context-EpisodeOfCare" /> </type> </element> <element id="MedicationRequest.extension:relationEpisodeOfCare.value[x]"> <path value="MedicationRequest.extension.value[x]" /> <short value="RelationEpisodeOfCare" /> <alias value="RelatieZorgepisode" /> <mapping> <identity value="mp-dataset-mp9-300-rc1-20250522" /> <map value="mp-dataelement9x-1343" /> <comment value="RelationEpisodeOfCare" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc2-20260213" /> <map value="mp-dataelement9x-1343" /> <comment value="RelationEpisodeOfCare" /> </mapping> </element> <element id="MedicationRequest.extension:renderedDosageInstruction"> <path value="MedicationRequest.extension" /> <sliceName value="renderedDosageInstruction" /> <type> <code value="Extension" /> <profile value="http://nictiz.nl/fhir/StructureDefinition/ext-RenderedDosageInstruction" /> </type> </element> <element id="MedicationRequest.extension:renderedDosageInstruction.value[x]"> <path value="MedicationRequest.extension.value[x]" /> <short value="Description" /> <definition value="Textual description of the complete instructions for use." /> <alias value="Omschrijving" /> <mapping> <identity value="mp-dataset-mp9-300-rc1-20250522" /> <map value="mp-dataelement9x-647" /> <comment value="Description" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc2-20260213" /> <map value="mp-dataelement9x-647" /> <comment value="Description" /> </mapping> </element> <element id="MedicationRequest.extension:periodOfUse"> <path value="MedicationRequest.extension" /> <sliceName value="periodOfUse" /> <max value="1" /> <type> <code value="Extension" /> <profile value="http://nictiz.nl/fhir/StructureDefinition/ext-TimeInterval.Period" /> </type> </element> <element id="MedicationRequest.extension:periodOfUse.value[x]"> <path value="MedicationRequest.extension.value[x]" /> <short value="PeriodOfUse" /> <definition value="**Start date**: This is the time at which the agreement was to take effect (or took effect or will take effect). This is the time at which the instructions for use in this agreement start. In the case of an agreement to discontinue use, this is the start date of the original medication agreement. The end date indicates from when the medication is to be discontinued. **End date**: The time at which the period of use ends (or ended or will end). In the case of an agreement to discontinue use, this is the time at which the medication is to be discontinued. To avoid confusion between 'to' and 'up to', the submission of time is always mandatory for the end date. With medication for an indefinite period only a start date is indicated." /> <alias value="Gebruiksperiode" /> <type> <code value="Period" /> <profile value="http://nictiz.nl/fhir/StructureDefinition/nl-core-TimeInterval" /> </type> <mapping> <identity value="mp-dataset-mp9-300-rc1-20250522" /> <map value="mp-dataelement9x-635" /> <comment value="PeriodOfUse" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc2-20260213" /> <map value="mp-dataelement9x-635" /> <comment value="PeriodOfUse" /> </mapping> </element> <element id="MedicationRequest.extension:registrationDateTime"> <path value="MedicationRequest.extension" /> <sliceName value="registrationDateTime" /> <type> <code value="Extension" /> <profile value="http://nictiz.nl/fhir/StructureDefinition/ext-RegistrationDateTime" /> </type> </element> <element id="MedicationRequest.extension:registrationDateTime.value[x]"> <path value="MedicationRequest.extension.value[x]" /> <definition value="The date and time when the VariableDosingRegimen was recorded. RegistrationDateTime is used to accurately determine the chronological order of agreements. Therefore, the date and time are mandatory. These values are immutable. When consulting or receiving this VariableDosingRegimen, the original RegistrationDateTime remains unchanged. Note: This data element differs from the data element RegistrationDateTime in zib RegistratieGegevens-v1.1.1 (2024NL). In zib RegistratieGegevens-v1.1.1 (2024NL), RegistrationDateTime refers to the date and time when the data was recorded. This may be the initial registration or the date and time when data was transferred. The zib concept RegistrationDateTime is not applied in MP9." /> <mapping> <identity value="mp-dataset-mp9-300-rc1-20250522" /> <map value="mp-dataelement9x-1483" /> <comment value="RegistrationDateTime" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc2-20260213" /> <map value="mp-dataelement9x-1483" /> <comment value="RegistrationDateTime" /> </mapping> </element> <element id="MedicationRequest.modifierExtension:stopType"> <path value="MedicationRequest.modifierExtension" /> <sliceName value="stopType" /> <type> <code value="Extension" /> <profile value="http://nictiz.nl/fhir/StructureDefinition/ext-StopType" /> </type> </element> <element id="MedicationRequest.modifierExtension:stopType.value[x]"> <path value="MedicationRequest.modifierExtension.value[x]" /> <short value="VariableDosingRegimenStopType" /> <alias value="WisselendDoseerschemaStopType" /> <binding> <strength value="required" /> <description value="WisselendDoseerschemaStopTypeCodelijst restricts StopType values, based on the ValueSet StopTypeCodelijst, which are applicable for StopType in MedicationAgreement and AdministrationAgreement." /> <valueSet value="http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.48--20230112155455" /> </binding> <mapping> <identity value="mp-dataset-mp9-300-rc1-20250522" /> <map value="mp-dataelement9x-1171" /> <comment value="VariableDosingRegimenStopType" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc2-20260213" /> <map value="mp-dataelement9x-1171" /> <comment value="VariableDosingRegimenStopType" /> </mapping> </element> <element id="MedicationRequest.modifierExtension:repeatPeriodCyclicalSchedule"> <path value="MedicationRequest.modifierExtension" /> <sliceName value="repeatPeriodCyclicalSchedule" /> <type> <code value="Extension" /> <profile value="http://nictiz.nl/fhir/StructureDefinition/ext-InstructionsForUse.RepeatPeriodCyclicalSchedule" /> </type> </element> <element id="MedicationRequest.modifierExtension:repeatPeriodCyclicalSchedule.value[x]"> <path value="MedicationRequest.modifierExtension.value[x]" /> <mapping> <identity value="zib-instructionsforuse-v1.2.1-2020EN" /> <map value="NL-CM:9.12.22505" /> <comment value="RepeatPeriodCyclicalSchedule" /> </mapping> </element> <element id="MedicationRequest.identifier"> <path value="MedicationRequest.identifier" /> <short value="Identification" /> <definition value="Identification of the variable-dosing regimen. This is generated by the system of the prescriber and is globally unique and eternally persistent." /> <alias value="Identificatie" /> <mapping> <identity value="mp-dataset-mp9-300-rc1-20250522" /> <map value="mp-dataelement9x-633" /> <comment value="Identification" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc2-20260213" /> <map value="mp-dataelement9x-633" /> <comment value="Identification" /> </mapping> </element> <element id="MedicationRequest.status"> <path value="MedicationRequest.status" /> <comment value="This element is implictly mapped to the concepts mp-dataelement9x-635 (PeriodOfUse) and mp-dataelement9x-1171 (VariableDosingRegimenStopType). Unless the status is explicitly recorded, the following guidance applies: * When the value of PeriodOfUse.startDateTime is in the past and PeriodOfUse.endDateTime exists and its value is in the future, `.status` will usually be set to _active_. * When the value of PeriodOfUse.startDateTime is in the future, `.status` will usually be set to _active_. * When PeriodOfUse.endDateTime exists and its value is in the past and VariableDosingRegimenStopType has no value, `.status` will usually be set to _completed_. * When PeriodOfUse.endDateTime exists and its value is in the past and the value of VariableDosingRegimenStopType is _410546004_, `.status` will usually be set to _stopped_. * When PeriodOfUse.Duration and PeriodOfUse.startDateTime are known, PeriodOfUse.endDateTime can be deduced and the previous rules apply. * When a system is unable to infer the status, `.status` will be set to _unknown_. The _unknown_ code is not to be used to convey other statuses. The _unknown_ code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the VariableDosingRegimen." /> <mapping> <identity value="mp-dataset-mp9-300-rc1-20250522" /> <map value="mp-dataelement9x-635" /> <comment value="PeriodOfUse (implicit, main mapping is on the extensions ext-TimeInterval.Period and ext-TimeInterval.Duration)" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc2-20260213" /> <map value="mp-dataelement9x-635" /> <comment value="PeriodOfUse (implicit, main mapping is on the extensions ext-TimeInterval.Period and ext-TimeInterval.Duration)" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc1-20250522" /> <map value="mp-dataelement9x-1171" /> <comment value="VariableDosingRegimenStopType (implicit, main mapping is on the modifier extension ext-StopType)" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc2-20260213" /> <map value="mp-dataelement9x-1171" /> <comment value="VariableDosingRegimenStopType (implicit, main mapping is on the modifier extension ext-StopType)" /> </mapping> </element> <element id="MedicationRequest.intent"> <path value="MedicationRequest.intent" /> <definition value="Unless `.intent` is explicitly recorded and a more appropriate code is known, the value can be set to _order_ because a VariableDosingRegimen should authorize an action for a patient, pharmacist, professional administrator et cetera." /> </element> <element id="MedicationRequest.category"> <path value="MedicationRequest.category" /> <slicing> <discriminator> <type value="value" /> <path value="$this" /> </discriminator> <rules value="open" /> </slicing> <min value="1" /> </element> <element id="MedicationRequest.category:variableDosingRegimenCode"> <path value="MedicationRequest.category" /> <sliceName value="variableDosingRegimenCode" /> <min value="1" /> <max value="1" /> <patternCodeableConcept> <coding> <system value="http://snomed.info/sct" /> <code value="395067002" /> </coding> </patternCodeableConcept> </element> <element id="MedicationRequest.medication[x]"> <path value="MedicationRequest.medication[x]" /> <slicing> <discriminator> <type value="type" /> <path value="$this" /> </discriminator> <rules value="open" /> </slicing> </element> <element id="MedicationRequest.medication[x]:medicationReference"> <path value="MedicationRequest.medication[x]" /> <sliceName value="medicationReference" /> <short value="AgreedMedicine" /> <definition value="The medicine agreed upon to be used." /> <alias value="AfgesprokenGeneesmiddel" /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Medication" /> <targetProfile value="http://nictiz.nl/fhir/StructureDefinition/mp-PharmaceuticalProduct" /> </type> <mapping> <identity value="mp-dataset-mp9-300-rc1-20250522" /> <map value="mp-dataelement9x-1362" /> <comment value="AgreedMedicine" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc2-20260213" /> <map value="mp-dataelement9x-1362" /> <comment value="AgreedMedicine" /> </mapping> </element> <element id="MedicationRequest.subject"> <path value="MedicationRequest.subject" /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Group" /> <targetProfile value="http://nictiz.nl/fhir/StructureDefinition/nl-core-Patient" /> </type> </element> <element id="MedicationRequest.encounter"> <path value="MedicationRequest.encounter" /> <short value="RelationEncounter" /> <alias value="RelatieContact" /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Encounter" /> <targetProfile value="http://nictiz.nl/fhir/StructureDefinition/nl-core-Encounter" /> </type> <mapping> <identity value="mp-dataset-mp9-300-rc1-20250522" /> <map value="mp-dataelement9x-1341" /> <comment value="RelationEncounter" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc2-20260213" /> <map value="mp-dataelement9x-1341" /> <comment value="RelationEncounter" /> </mapping> </element> <element id="MedicationRequest.authoredOn"> <path value="MedicationRequest.authoredOn" /> <short value="VariableDosingRegimenDateTime" /> <definition value="Date and time the variable-dosing regimen was created. Appointment date + time are required (order of the appointments must be clear in cases with multiple appointments on one day)." /> <alias value="WisselendDoseerschemaDatumTijd" /> <mapping> <identity value="mp-dataset-mp9-300-rc1-20250522" /> <map value="mp-dataelement9x-634" /> <comment value="VariableDosingRegimenDateTime" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc2-20260213" /> <map value="mp-dataelement9x-634" /> <comment value="VariableDosingRegimenDateTime" /> </mapping> </element> <element id="MedicationRequest.requester"> <path value="MedicationRequest.requester" /> <short value="Author" /> <definition value="Author who entered the variable-dosing regimen." /> <alias value="Auteur" /> <type> <code value="Reference" /> <profile value="http://nictiz.nl/fhir/StructureDefinition/pattern-NlCoreHealthProfessionalReference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device" /> <targetProfile value="http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthProfessional-PractitionerRole" /> </type> <mapping> <identity value="mp-dataset-mp9-300-rc1-20250522" /> <map value="mp-dataelement9x-642" /> <comment value="Author" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc2-20260213" /> <map value="mp-dataelement9x-642" /> <comment value="Author" /> </mapping> </element> <element id="MedicationRequest.reasonCode"> <path value="MedicationRequest.reasonCode" /> <short value="ReasonModificationOrDiscontinuation" /> <definition value="Reason for this agreement. This can be the reason to start, change or stop the medication treatment." /> <alias value="RedenWijzigenOfStaken" /> <max value="1" /> <binding> <strength value="required" /> <valueSet value="http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.54--20221114181621" /> </binding> <mapping> <identity value="mp-dataset-mp9-300-rc1-20250522" /> <map value="mp-dataelement9x-639" /> <comment value="ReasonModificationOrDiscontinuation" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc2-20260213" /> <map value="mp-dataelement9x-639" /> <comment value="ReasonModificationOrDiscontinuation" /> </mapping> </element> <element id="MedicationRequest.basedOn"> <path value="MedicationRequest.basedOn" /> <slicing> <discriminator> <type value="profile" /> <path value="resolve()" /> </discriminator> <rules value="open" /> </slicing> </element> <element id="MedicationRequest.basedOn:relationMedicationAgreement"> <path value="MedicationRequest.basedOn" /> <sliceName value="relationMedicationAgreement" /> <short value="RelationMedicationAgreement" /> <definition value="Relation to the medication agreement which is specified in this dosing schedule." /> <alias value="RelatieMedicatieafspraak" /> <max value="1" /> <type> <code value="Reference" /> <targetProfile value="http://nictiz.nl/fhir/StructureDefinition/mp-MedicationAgreement" /> </type> <mapping> <identity value="mp-dataset-mp9-300-rc1-20250522" /> <map value="mp-dataelement9x-640" /> <comment value="RelationMedicationAgreement" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc2-20260213" /> <map value="mp-dataelement9x-640" /> <comment value="RelationMedicationAgreement" /> </mapping> </element> <element id="MedicationRequest.note"> <path value="MedicationRequest.note" /> <max value="1" /> </element> <element id="MedicationRequest.note.text"> <path value="MedicationRequest.note.text" /> <short value="Comment" /> <definition value="Comments on the variable-dosing regimen." /> <alias value="Toelichting" /> <mapping> <identity value="mp-dataset-mp9-300-rc1-20250522" /> <map value="mp-dataelement9x-694" /> <comment value="Comment" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc2-20260213" /> <map value="mp-dataelement9x-694" /> <comment value="Comment" /> </mapping> </element> <element id="MedicationRequest.dosageInstruction"> <path value="MedicationRequest.dosageInstruction" /> <short value="DosingInstructions / InstructionsForUse" /> <definition value="Instructions for the use of the medication, e.g. dose and route of administration." /> <alias value="Gebruiksinstructie" /> <type> <code value="Dosage" /> <profile value="http://nictiz.nl/fhir/StructureDefinition/mp-InstructionsForUse.DosageInstructions" /> </type> </element> <element id="MedicationRequest.priorPrescription"> <path value="MedicationRequest.priorPrescription" /> <short value="RelationVariableDosingRegimen" /> <definition value="Relation to the previous version of the dosing schedule." /> <alias value="RelatieWisselendDoseerschema" /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationRequest" /> <targetProfile value="http://nictiz.nl/fhir/StructureDefinition/mp-VariableDosingRegimen" /> </type> <mapping> <identity value="mp-dataset-mp9-300-rc1-20250522" /> <map value="mp-dataelement9x-1319" /> <comment value="RelationVariableDosingRegimen" /> </mapping> <mapping> <identity value="mp-dataset-mp9-300-rc2-20260213" /> <map value="mp-dataelement9x-1319" /> <comment value="RelationVariableDosingRegimen" /> </mapping> </element> </differential> </StructureDefinition>