![](\"https://github.com/NHSDigital/NHSDigital-FHIR-ImplementationGuide/blob/master/Diagams/medication-request-status-flow.png?raw=true\")
",
"comment": "This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.",
"min": 1,
"max": "1",
"base": {
"path": "MedicationRequest.status",
"min": 1,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport": true,
"isModifier": true,
"isModifierReason": "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid",
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationRequestStatus"
}
],
"strength": "required",
"description": "A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.",
"valueSet": "http://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "workflow",
"map": "Request.status"
},
{
"identity": "script10.6",
"map": "no mapping"
},
{
"identity": "w5",
"map": "FiveWs.status"
},
{
"identity": "rim",
"map": ".statusCode"
}
]
},
{
"id": "MedicationRequest.statusReason",
"path": "MedicationRequest.statusReason",
"short": "Reason for current status",
"definition": "This is generally only used for exception statuses such as `suspended` or `cancelled`. It is the clinical status reason for the cancellation.\r\n\r\nThis is mandatory for 'prescription-order-update' messages.\r\n\r\n```json\r\n\"statusReason\": {\r\n \"coding\": [\r\n {\r\n \"system\": \"https://fhir.nhs.uk/CodeSystem/medicationrequest-status-reason\",\r\n \"code\": \"0001\",\r\n \"display\": \"Prescribing Error\"\r\n }\r\n ]\r\n},\r\n```",
"comment": "This is generally only used for \"exception\" statuses such as \"suspended\" or \"cancelled\". The reason why the MedicationRequest was created at all is captured in reasonCode, not here.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.statusReason",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationRequestStatusReason"
}
],
"strength": "required",
"description": "Identifies the reasons for a given status.",
"valueSet": "https://fhir.nhs.uk/ValueSet/DM-medicationrequest-status-reason"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "CE/CNE/CWE"
},
{
"identity": "rim",
"map": "CD"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
},
{
"identity": "workflow",
"map": "Request.statusReason"
},
{
"identity": "rim",
"map": ".inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde"
}
]
},
{
"id": "MedicationRequest.statusReason.id",
"path": "MedicationRequest.statusReason.id",
"representation": [
"xmlAttr"
],
"short": "Unique id for inter-element referencing",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
}
],
"code": "http://hl7.org/fhirpath/System.String"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "MedicationRequest.statusReason.extension",
"path": "MedicationRequest.statusReason.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.statusReason.coding",
"path": "MedicationRequest.statusReason.coding",
"short": "Code defined by a terminology system",
"definition": "A reference to a code defined by a terminology system.",
"comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.",
"requirements": "Allows for alternative encodings within a code system, and translations to other code systems.",
"min": 1,
"max": "1",
"base": {
"path": "CodeableConcept.coding",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Coding"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6"
},
{
"identity": "rim",
"map": "CV"
},
{
"identity": "orim",
"map": "fhir:Coding rdfs:subClassOf dt:CDCoding"
},
{
"identity": "v2",
"map": "C*E.1-8, C*E.10-22"
},
{
"identity": "rim",
"map": "union(., ./translation)"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding"
}
]
},
{
"id": "MedicationRequest.statusReason.coding.id",
"path": "MedicationRequest.statusReason.coding.id",
"representation": [
"xmlAttr"
],
"short": "Unique id for inter-element referencing",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
}
],
"code": "http://hl7.org/fhirpath/System.String"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "MedicationRequest.statusReason.coding.extension",
"path": "MedicationRequest.statusReason.coding.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.statusReason.coding.system",
"path": "MedicationRequest.statusReason.coding.system",
"short": "Identity of the terminology system",
"definition": "The identification of the code system that defines the meaning of the symbol in the code.",
"comment": "The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.",
"requirements": "Need to be unambiguous about the source of the definition of the symbol.",
"min": 1,
"max": "1",
"base": {
"path": "Coding.system",
"min": 0,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "C*E.3"
},
{
"identity": "rim",
"map": "./codeSystem"
},
{
"identity": "orim",
"map": "fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem"
}
]
},
{
"id": "MedicationRequest.statusReason.coding.version",
"path": "MedicationRequest.statusReason.coding.version",
"short": "Version of the system - if relevant",
"definition": "The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.",
"comment": "Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.",
"min": 0,
"max": "1",
"base": {
"path": "Coding.version",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "C*E.7"
},
{
"identity": "rim",
"map": "./codeSystemVersion"
},
{
"identity": "orim",
"map": "fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion"
}
]
},
{
"id": "MedicationRequest.statusReason.coding.code",
"path": "MedicationRequest.statusReason.coding.code",
"short": "Symbol in syntax defined by the system",
"definition": "A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).",
"comment": "Note that FHIR strings SHALL NOT exceed 1MB in size",
"requirements": "Need to refer to a particular code in the system.",
"min": 1,
"max": "1",
"base": {
"path": "Coding.code",
"min": 0,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "C*E.1"
},
{
"identity": "rim",
"map": "./code"
},
{
"identity": "orim",
"map": "fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code"
}
]
},
{
"id": "MedicationRequest.statusReason.coding.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "MedicationRequest.statusReason.coding.display",
"short": "Representation defined by the system",
"definition": "A representation of the meaning of the code in the system, following the rules of the system.",
"comment": "Note that FHIR strings SHALL NOT exceed 1MB in size",
"requirements": "Need to be able to carry a human-readable meaning of the code for readers that do not know the system.",
"min": 1,
"max": "1",
"base": {
"path": "Coding.display",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "C*E.2 - but note this is not well followed"
},
{
"identity": "rim",
"map": "CV.displayName"
},
{
"identity": "orim",
"map": "fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName"
}
]
},
{
"id": "MedicationRequest.statusReason.coding.userSelected",
"path": "MedicationRequest.statusReason.coding.userSelected",
"short": "If this coding was chosen directly by the user",
"definition": "Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).",
"comment": "Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.",
"requirements": "This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.",
"min": 0,
"max": "1",
"base": {
"path": "Coding.userSelected",
"min": 0,
"max": "1"
},
"type": [
{
"code": "boolean"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "Sometimes implied by being first"
},
{
"identity": "rim",
"map": "CD.codingRationale"
},
{
"identity": "orim",
"map": "fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\\#true a [ fhir:source \"true\"; fhir:target dt:CDCoding.codingRationale\\#O ]"
}
]
},
{
"id": "MedicationRequest.statusReason.text",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "MedicationRequest.statusReason.text",
"short": "Plain text representation of the concept",
"definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.",
"comment": "Very often the text is the same as a displayName of one of the codings.",
"requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.",
"min": 0,
"max": "1",
"base": {
"path": "CodeableConcept.text",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "C*E.9. But note many systems use C*E.2 for this"
},
{
"identity": "rim",
"map": "./originalText[mediaType/code=\"text/plain\"]/data"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText"
}
]
},
{
"id": "MedicationRequest.intent",
"path": "MedicationRequest.intent",
"short": "proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option",
"definition": "Whether the request is a proposal, plan, or an original order.",
"comment": "Indicates the type of order. A code specifying the current state of the order. Generally, this will be active or completed state. \r\n\r\n| code | display | courseOfTherapyType | Definition |\r\n|---|---|\r\n| order | Order | acute | The request represents a request/demand and authorization for action |\r\n| original-order | Original Order | continuous-repeat-dispensing continuous | The request represents the original authorization for the medication request. |\r\n| reflex-order |Reflex Order | continuous-repeat-dispensing | The request represents an automatically generated supplemental authorization (by EPS) for action based on a parent authorization together with initial results of the action taken against that parent authorization. |\r\n| instance-order | Instance Order | continuous | The request represents an instance for the particular order. |",
"min": 1,
"max": "1",
"base": {
"path": "MedicationRequest.intent",
"min": 1,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": true,
"isModifierReason": "This element changes the interpretation of all descriptive attributes. For example \"the time the request is recommended to occur\" vs. \"the time the request is authorized to occur\" or \"who is recommended to perform the request\" vs. \"who is authorized to perform the request",
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationRequestIntent"
}
],
"strength": "required",
"description": "The kind of medication order.",
"valueSet": "http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "workflow",
"map": "Request.intent"
},
{
"identity": "w5",
"map": "FiveWs.class"
},
{
"identity": "rim",
"map": ".moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)"
}
]
},
{
"id": "MedicationRequest.category",
"path": "MedicationRequest.category",
"short": "Type of medication usage",
"definition": "In primary care the code of `community` should be used. In secondary care the category will often match the Episode/Spell type.\r\n\r\n| Code | System | Display |\r\n|---|---|\r\n| leave | https://fhir.nhs.uk/CodeSystem/medicationrequest-category | Leave |\r\n|outpatient | http://terminology.hl7.org/CodeSystem/medicationrequest-category |Outpatient |\r\n| discharge | http://terminology.hl7.org/CodeSystem/medicationrequest-category | Discharge |\r\n| community |http://terminology.hl7.org/CodeSystem/medicationrequest-category | Community |\r\n| inpatient |http://terminology.hl7.org/CodeSystem/medicationrequest-category | Inpatient |\r\n\r\n```json\r\n\"category\": [\r\n {\r\n \"coding\": [\r\n {\r\n \"system\": \"http://terminology.hl7.org/CodeSystem/medicationrequest-category\",\r\n \"code\": \"outpatient\",\r\n \"display\": \"Outpatient\"\r\n }\r\n ]\r\n }\r\n],\r\n```",
"comment": "The category can be used to include where the medication is expected to be consumed or other types of requests.",
"min": 0,
"max": "*",
"base": {
"path": "MedicationRequest.category",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationRequestCategory"
}
],
"strength": "extensible",
"description": "A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.",
"valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationRequestCategory"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "CE/CNE/CWE"
},
{
"identity": "rim",
"map": "CD"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
},
{
"identity": "script10.6",
"map": "Message/Body/NewRx/MedicationPrescribed/Directions\r\ror \r\rMessage/Body/NewRx/MedicationPrescribed/StructuredSIG"
},
{
"identity": "w5",
"map": "FiveWs.class"
},
{
"identity": "rim",
"map": ".inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code=\"type of medication usage\"].value"
}
]
},
{
"id": "MedicationRequest.category.id",
"path": "MedicationRequest.category.id",
"representation": [
"xmlAttr"
],
"short": "Unique id for inter-element referencing",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
}
],
"code": "http://hl7.org/fhirpath/System.String"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "MedicationRequest.category.extension",
"path": "MedicationRequest.category.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "MedicationRequest.category.coding",
"path": "MedicationRequest.category.coding",
"short": "Code defined by a terminology system",
"definition": "A reference to a code defined by a terminology system.",
"comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.",
"requirements": "Allows for alternative encodings within a code system, and translations to other code systems.",
"min": 1,
"max": "1",
"base": {
"path": "CodeableConcept.coding",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Coding"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"binding": {
"strength": "required",
"valueSet": "https://fhir.nhs.uk/ValueSet/DM-medicationrequest-category"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6"
},
{
"identity": "rim",
"map": "CV"
},
{
"identity": "orim",
"map": "fhir:Coding rdfs:subClassOf dt:CDCoding"
},
{
"identity": "v2",
"map": "C*E.1-8, C*E.10-22"
},
{
"identity": "rim",
"map": "union(., ./translation)"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding"
}
]
},
{
"id": "MedicationRequest.category.text",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "MedicationRequest.category.text",
"short": "Plain text representation of the concept",
"definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.",
"comment": "Very often the text is the same as a displayName of one of the codings.",
"requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.",
"min": 0,
"max": "1",
"base": {
"path": "CodeableConcept.text",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "C*E.9. But note many systems use C*E.2 for this"
},
{
"identity": "rim",
"map": "./originalText[mediaType/code=\"text/plain\"]/data"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText"
}
]
},
{
"id": "MedicationRequest.priority",
"path": "MedicationRequest.priority",
"short": "routine | urgent | asap | stat",
"definition": "Indicates how quickly the Medication Request should be addressed with respect to other requests.",
"comment": "Note that FHIR strings SHALL NOT exceed 1MB in size",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.priority",
"min": 0,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationRequestPriority"
}
],
"strength": "required",
"description": "Identifies the level of importance to be assigned to actioning the request.",
"valueSet": "http://hl7.org/fhir/ValueSet/request-priority|4.0.1"
},
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "workflow",
"map": "Request.priority"
},
{
"identity": "w5",
"map": "FiveWs.grade"
},
{
"identity": "rim",
"map": ".priorityCode"
}
]
},
{
"id": "MedicationRequest.doNotPerform",
"path": "MedicationRequest.doNotPerform",
"short": "True if request is prohibiting action",
"definition": "If true indicates that the provider is asking for the medication request not to occur.",
"comment": "If do not perform is not specified, the request is a positive request e.g. \"do perform\".",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.doNotPerform",
"min": 0,
"max": "1"
},
"type": [
{
"code": "boolean"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": true,
"isModifierReason": "This element is labeled as a modifier because this element negates the request to occur (ie, this is a request for the medication not to be ordered or prescribed, etc)",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": "SubstanceAdministration.actionNegationInd"
}
]
},
{
"id": "MedicationRequest.reported[x]",
"path": "MedicationRequest.reported[x]",
"short": "Reported rather than primary record",
"definition": "Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the report.",
"min": 0,
"max": "1",
"base": {
"path": "MedicationRequest.reported[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "boolean"
},
{
"code": "Reference",
"targetProfile": [
"https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient",
"https://fhir.hl7.org.uk/StructureDefinition/UKCore-Practitioner",
"https://fhir.hl7.org.uk/StructureDefinition/UKCore-PractitionerRole",
"https://fhir.hl7.org.uk/StructureDefinition/UKCore-RelatedPerson",
"https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": ".participation[typeCode=INF].role"
}
]
},
{
"id": "MedicationRequest.medication[x]",
"path": "MedicationRequest.medication[x]",
"short": "Medication to be taken",
"definition": "Only Virtual Medical Products (VMP) and Actual Medical Products (AMP) can be used.",
"comment": "Any code from the SnomedCT UK DMD subset for VMP, AMP and VTM concepts\r\n\r\n| \r\ndm+d Category\r\n | \r\n\r\ndm+d Description\r\n | \r\n\r\nUK SNOMED Members Of\r\n | \r\n\r\n\r\n
|---|---|---|
| \r\nVMP\r\n | \r\n\r\nVirtual Medical Product\r\n | \r\n\r\n999000561000001109\r\n | \r\n
| \r\nAMP\r\n | \r\n\r\nActual Medical Product\r\n | \r\n\r\n999000541000001108\r\n | \r\n
\r\n Recommendation: Use the translation algorithm published within this guide to create a string from the coded Dosage elements. It is planned for this translation algorithm to be available as an API.\r\n
\r\n\r\nFor example;\r\n\r\n```xml\r\n\r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n\r\n \r\n \r\n \r\n Used to define a maxiumum dose over a given time period.\r\n
\r\n\r\nAn example would be a Sumatriptan 6mg injection which can be repeated after an hour but not again over a 24 hour period. The `maxDosePerPeriod` is defined as 12mg/24hours.\r\n\r\nThe `maxDosePerPeriod` is defined for each dosage instruction. For a multi-sequence instruction it would therefore be possible to define different maximum dosing periods within different sequences of the complete instruction.\r\n\r\n\r\n A real-world example of where this would be required has not yet been identified.\r\n
\r\n\r\n**Maximum dose per period of 12mg/24 hour**\r\n\r\n```xml\r\n\r\n \r\n \r\n Used to define a maximum dose for a single administration.\r\n
\r\n\r\nAn example would be Anagrelide for which a single dose should not exceed 2.5 mg. The `maxDosePerAdministration` is defined as 2.5mg.\r\n\r\nIn many scenarios it is expected that the `dosage.doseRange` would be used instead of `maxDosePerAdministration`.\r\n\r\nThe `maxDosePerAdministration` is defined for each dosage instruction. For a multi-sequence instruction it would therefore be possible to define different maximum dose administrations within different sequences of the complete instruction. \r\n\r\n\r\n A real-world example of where this would be required has not yet been identified.\r\n
\r\n\r\n\r\n**Maximum dose per administration of 2.5mg**\r\n\r\n```xml\r\n\r\n\r\n Used to define the maximum cumulative dose over the lifetime of a patient.\r\n
\r\n\r\nAn example would be Daunorubicin which may have a maximum cumulative dose of 600mg/m2 (based on the size of the patient). The `maxDosePerLifetime` is defined as 600 mg/m2.\r\n\r\nThe `maxDosePerLifetime` can be defined for each dosage instruction; which, for a multi-sequence instruction is illogical, as any `maxDosePerLifetime` is equally applicable to all dosage sequence that relate to the single medication coded concept.\r\n\r\n\r\n Note: If a
\r\n\r\n\r\n**Maximum dose over lifetime of the patient of 600 mg/m2**\r\n\r\n```xml\r\nmaxDosePerLifetime statement is required with a multi-sequence instruction, it is recommended to define it within the last / final sequence to ensure that the information is presented at the end of a the complete instruction, rather than th middle which could be overlooked.\r\n\r\nMUST be present where a `continuous` or `continuous-repeat-dispensing` is authorised for a defined number of issues.
MUST NOT be specified where the number of repeat issues has not been defined. Therefore, the numberOfRepeats allowed is the total number of allowed issues. See also extension repeatInformation\r\n\r\nFor `continuous` orders and `continuous-repeat-dispensing` with intent=`reflex-order` (i.e., orders sent from EPS to pharmacists) this MUST be zero. The `numberOfRepeatsAllowed` in the extension to `basedOn` can be used to convey this information to inform patients that they need to re-order the medication.\r\n\r\nExample for a `continuous` issue:\r\n\r\n```json\r\n\r\n\"dispenseRequest\": {\r\n \"numberOfRepeatsAllowed\": 0\r\n }\r\n\r\n```\r\n\r\nExample for a `continuous-repeat-dispensing` issue with intent of `original-order`:\r\n\r\n```json\r\n\r\n\"dispenseRequest\": {\r\n \"numberOfRepeatsAllowed\": 2\r\n }\r\n```\r\n\r\nThis will result in a total of three issues of the medication.", "comment": "If displaying \"number of authorized fills\", add 1 to this number.", "min": 0, "max": "1", "base": { "path": "MedicationRequest.dispenseRequest.numberOfRepeatsAllowed", "min": 0, "max": "1" }, "type": [ { "code": "unsignedInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "script10.6", "map": "Message/Body/NewRx/MedicationPrescribed/Quantity" }, { "identity": "v2", "map": "RXE-12-Number of Refills" }, { "identity": "rim", "map": "repeatNumber" } ] }, { "id": "MedicationRequest.dispenseRequest.quantity", "path": "MedicationRequest.dispenseRequest.quantity", "short": "Amount of medication to supply per dispense", "definition": "The amount that is to be dispensed for one fill.", "comment": "The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.", "min": 1, "max": "1", "base": { "path": "MedicationRequest.dispenseRequest.quantity", "min": 0, "max": "1" }, "type": [ { "code": "Quantity", "profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "xpath": "not(exists(f:code)) or exists(f:system)", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "sqty-1", "severity": "error", "human": "The comparator is not used on a SimpleQuantity", "expression": "comparator.empty()", "xpath": "not(exists(f:comparator))", "source": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" } ], "mustSupport": true, "isModifier": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL
Important Note:
\r\nWithin UK healthcare, substitution is not the norm so the international FHIR definition where \"_If nothing is specified substitution may be done._\" does not align with UK healthcare prescribing best practice.\r\n
It could be unwise to assume all UK implementations will prevent substitution if not explicitly stated, especially if the same clinical system has been previously implemented outside the UK.
UK Core has profiled this element as MANDATORY and MUST have a default boolean value of false to denote substitution is not allowed.
Allowing substitution
\r\nWhere substitution to be be allowed, set to true. The inclusion of the coded reason is optional as the valueset defined in FHIR is of limited benefit to UK healthcare.