{ "resourceType": "StructureDefinition", "id": "MedicationRequest-verto", "url": "http://verto.ca/fhir/StructureDefinition/MedicationRequest-custom", "version": "1.0.0", "name": "MedicationRequest", "title": "Verto's MedicationRequest Profile", "status": "active", "experimental": true, "date": "2025-01-13", "publisher": "Verto Health", "description": "Medication Request constrained by Verto's Digital Twin, based on the International and Canadian Patient Summaries", "fhirVersion": "5.0.0", "kind": "resource", "abstract": false, "type": "MedicationRequest", "baseDefinition": "http://hl7.org/fhir/R4/StructureDefinition/MedicationRequest", "derivation": "constraint", "differential": { "element": [ { "id": "MedicationRequest", "path": "MedicationRequest", "short": "Verto's MedicationRequest Profile", "definition": "An order or request for both supply of the medication and the instruction for administration of the medication to a patient..", "type": [ { "code": "MedicationRequest" } ] }, { "id": "MedicationRequest.id", "path": "MedicationRequest.id", "short": "Logical id of this artifact", "definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.", "comment": "The id is auto-generated as a UUID by Verto when the resource is created, and is used as an internal identifier within the Digital Twin. It has no business meaning outside of the Digital Twin's context.", "min": 0, "max": "1", "base": { "path": "Resource.id", "min": 0, "max": "1" }, "isModifier": false, "isSummary": true }, { "id": "MedicationRequest.identifier", "path": "MedicationRequest.identifier", "short": "External ids from the source system of record", "definition": "Identifiers 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.", "comment": "This is a business identifier, not a resource identifier.", "min": 0, "max": "*", "base": { "path": "MedicationRequest.identifier", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "isModifier": false, "isSummary": false }, { "id": "MedicationRequest.status", "path": "MedicationRequest.status", "short": "The current state of the order", "definition": "A code specifying the current state of the order. Generally, this will be active or completed state.", "min": 1, "max": "1", "base": { "path": "MedicationRequest.status", "min": 1, "max": "1" }, "type": [ { "code": "code" } ], "isModifier": true, "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" } }, { "id": "MedicationRequest.statusReason", "path": "MedicationRequest.statusReason", "short": "Reason for current status", "definition": "Captures the reason for the current state of the MedicationRequest.", "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" } ], "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "MedicationRequestStatusReason" } ], "strength": "example", "description": "Identifies the reasons for a given status.", "valueSet": "http://hl7.org/fhir/ValueSet/medicationrequest-status-reason" } }, { "id": "MedicationRequest.intent", "path": "MedicationRequest.intent", "short": "Whether the request is a proposal, plan, or an original order.", "definition": "Whether the request is a proposal, plan, or an original order.", "min": 1, "max": "1", "base": { "path": "MedicationRequest.intent", "min": 1, "max": "1" }, "type": [ { "code": "code" } ], "isModifier": true, "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" } }, { "id": "MedicationRequest.priority", "path": "MedicationRequest.priority", "short": "How quickly the request should be addressed", "definition": "Indicates how quickly the Medication Request should be addressed with respect to other requests.", "min": 0, "max": "1", "base": { "path": "MedicationRequest.priority", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "isModifier": false, "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" } }, { "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" } ], "isModifier": true, "isSummary": true }, { "id": "MedicationRequest.medication", "path": "MedicationRequest.medication", "short": "Medication to be taken", "definition": "Provides a link to the record in the medication table which represents the medication to be taken.", "min": 1, "max": "1", "type": [ { "code": "CodeableReference", "targetProfile": [ "http://verto.ca/fhir/StructureDefinition/medication-custom" ] } ], "mustSupport": true, "isModifier": false, "isSummary": true }, { "id": "MedicationRequest.subject", "path": "MedicationRequest.subject", "short": "Who the medication request is for", "min": 1, "max": "1", "base": { "path": "MedicationRequest.subject", "min": 1, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ] } ], "mustSupport": true, "isModifier": false, "isSummary": true }, { "id": "MedicationRequest.informationSource", "path": "MedicationRequest.informationSource", "short": "The person or organization who provided information about this request, if the source is someone other than the requestor", "min": 0, "max": "*", "base": { "path": "MedicationRequest.informationSource", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/patient", "https://hl7.org/fhir/StructureDefinition/practitioner", "https://hl7.org/fhir/StructureDefinition/organization" ] } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "MedicationRequest.supportingInformation", "path": "MedicationRequest.supportingInformation", "short": "The information (specifically, a past medication statement) to support this new request", "min": 0, "max": "1", "base": { "path": "MedicationRequest.supportingInformation", "min": 1, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/MedicationStatement" ] } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "MedicationRequest.encounter", "path": "MedicationRequest.encounter", "short": "The encounter the medication request occurred under", "min": 0, "max": "1", "base": { "path": "MedicationRequest.encounter", "min": 1, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/encounter" ] } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "MedicationRequest.authoredOn", "path": "MedicationRequest.authoredOn", "short": "When request was initially authored", "definition": "The date (and perhaps time) when the prescription was initially written or authored on.", "min": 0, "max": "1", "base": { "path": "MedicationRequest.authoredOn", "min": 0, "max": "1" }, "type": [ { "code": "dateTime" } ], "mustSupport": false, "isModifier": false, "isSummary": true }, { "id": "MedicationRequest.requester", "path": "MedicationRequest.requester", "short": "The persom who made the request", "min": 0, "max": "1", "base": { "path": "MedicationRequest.requester", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "https://hl7.org/fhir/StructureDefinition/practitioner", "https://hl7.org/fhir/StructureDefinition/organization", "https://hl7.org/fhir/StructureDefinition/patient" ] } ], "mustSupport": false, "isModifier": false, "isSummary": true }, { "id": "MedicationRequest.performer", "path": "MedicationRequest.performer", "short": "Intended performer of administration", "min": 0, "max": "1", "base": { "path": "MedicationRequest.performer", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "https://hl7.org/fhir/StructureDefinition/practitioner", "https://hl7.org/fhir/StructureDefinition/organization", "https://hl7.org/fhir/StructureDefinition/patient" ] } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "MedicationRequest.performerType", "path": "MedicationRequest.performerType", "short": "Desired kind of performer for the medication administration", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "binding": { "strength": "preferred", "description": "Identifies the type of individual that is desired to administer the medication.", "valueSet": "http://hl7.org/fhir/ValueSet/performer-role" } }, { "id": "MedicationRequest.recorder", "path": "MedicationRequest.recorder", "short": "Person who entered the request", "min": 0, "max": "1", "base": { "path": "MedicationRequest.recorder", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "https://hl7.org/fhir/StructureDefinition/practitioner" ] } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "MedicationRequest.reasonCode", "path": "MedicationRequest.reasonCode", "short": "Reason or indication for ordering or not ordering the medication", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "strength": "example", "description": "Identifies the type of individual that is desired to administer the medication.", "valueSet": "http://hl7.org/fhir/ValueSet/condition-code" } }, { "id": "MedicationRequest.reasonReference", "path": "MedicationRequest.reasonReference", "short": "Condition or Observation that supports why the prescription is being written", "comment": "Verto's digital twin constrains this field to only one of both the Condition or the Observation resource.", "min": 0, "max": "*", "base": { "path": "MedicationRequest.reasonReference", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "https://hl7.org/fhir/StructureDefinition/practitioner", "https://hl7.org/fhir/StructureDefinition/organization", "https://hl7.org/fhir/StructureDefinition/patient" ] } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "MedicationRequest.groupIdentifier", "path": "MedicationRequest.groupIdentifier", "short": "Composite request this is part of", "definition": "A 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.", "requirements": "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.", "min": 0, "max": "1", "base": { "path": "MedicationRequest.groupIdentifier", "min": 0, "max": "1" }, "type": [ { "code": "Identifier" } ], "isSummary": true }, { "id": "MedicationRequest.note", "path": "MedicationRequest.note", "short": "Information about the prescription", "definition": "Extra information about the prescription that could not be conveyed by the other attributes.", "min": 0, "max": "*", "base": { "path": "MedicationRequest.note", "min": 0, "max": "*" }, "type": [ { "code": "Annotation" } ] }, { "id": "MedicationRequest.dosageInstruction", "path": "MedicationRequest.dosageInstruction", "short": "How the medication should be taken", "min": 0, "max": "*", "type": [ { "code": "Dosage" } ], "mustSupport": true, "isModifier": false, "isSummary": false }, { "id": "MedicationRequest.dosageInstruction.id", "path": "MedicationRequest.dosageInstruction.id", "short": "Unique, Verto-specific id for inter-element referencing", "min": 0, "max": "1", "type": [ { "code": "string" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "MedicationRequest.dosageInstruction.sequence", "path": "MedicationRequest.dosageInstruction.sequence", "short": "The order of the dosage instructions", "definition": "Indicates the order in which the dosage instructions should be applied or interpreted.", "requirements": "If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.", "min": 0, "max": "1", "base": { "path": "Dosage.sequence", "min": 0, "max": "1" }, "type": [ { "code": "integer" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "MedicationRequest.dosageInstruction.text", "path": "MedicationRequest.dosageInstruction.text", "short": "Free text dosage instructions e.g. SIG", "definition": "Free text dosage instructions e.g. SIG", "comment": "Free text dosage instructions can be used for cases where the instructions are too complex to code.", "min": 0, "max": "1", "base": { "path": "Dosage.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "MedicationRequest.dosageInstruction.additionalInstruction", "path": "MedicationRequest.dosageInstruction.additionalInstruction", "short": "Supplemental instruction or warnings to the patient - e.g. \"take with meals\"", "definition": "Supplemental instructions to the patient on how to take the medication or warnings for the patient about the medication.", "min": 0, "max": "*", "base": { "path": "Dosage.additionalInstruction", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AdditionalInstruction" } ], "strength": "example", "valueSet": "http://hl7.org/fhir/ValueSet/additional-instruction-codes" } }, { "id": "MedicationRequest.dosageInstruction.patientInstruction", "path": "MedicationRequest.dosageInstruction.patientInstruction", "short": "Patient or consumer oriented instructions", "definition": "Instructions in terms that are understood by the patient or consumer.", "min": 0, "max": "1", "base": { "path": "Dosage.patientInstruction", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "isModifier": false, "isSummary": true }, { "id": "MedicationRequest.dosageInstruction.timing", "path": "MedicationRequest.dosageInstruction.timing", "short": "When medication should be administered", "definition": "When medication should be administered.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "Dosage.timing", "min": 0, "max": "1" }, "type": [ { "code": "Timing" } ], "mustSupport": true, "isModifier": false, "isSummary": true }, { "id": "MedicationRequest.dosageInstruction.asNeeded[x]", "path": "MedicationRequest.dosageInstruction.asNeeded[x]", "short": "Take \"as needed\" (for x)", "definition": "Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).", "comment": "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\".", "min": 0, "max": "1", "base": { "path": "Dosage.asNeeded[x]", "min": 0, "max": "1" }, "type": [ { "code": "boolean" }, { "code": "CodeableConcept" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "MedicationAsNeededReason" } ], "strength": "example", "description": "A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose.", "valueSet": "http://hl7.org/fhir/ValueSet/medication-as-needed-reason" } }, { "id": "MedicationRequest.dosageInstruction.site", "path": "MedicationRequest.dosageInstruction.site", "short": "Body site to administer to", "definition": "Anatomic site where the medication should be administered.", "min": 0, "max": "1", "base": { "path": "Dosage.site", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "MedicationAdministrationSite" } ], "strength": "example", "description": "A coded concept describing the site location the medicine enters into or onto the body.", "valueSet": "http://hl7.org/fhir/ValueSet/approach-site-codes" } }, { "id": "MedicationRequest.dosageInstruction.route", "path": "MedicationRequest.dosageInstruction.route", "short": "How drug should enter body", "definition": "How drug should enter body.", "min": 0, "max": "1", "base": { "path": "Dosage.route", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept", "profile": [ "http://hl7.org/fhir/uv/ips/StructureDefinition/CodeableConcept-uv-ips" ] } ], "isModifier": false, "isSummary": true, "binding": { "strength": "preferred", "description": "EDQM Standards Terms", "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/medicine-route-of-administration" } }, { "id": "MedicationRequest.dosageInstruction.method", "path": "MedicationRequest.dosageInstruction.method", "short": "Technique for administering medication", "definition": "Technique for administering medication.", "min": 0, "max": "1", "base": { "path": "Dosage.method", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "MedicationAdministrationMethod" } ], "strength": "example", "description": "A coded concept describing the technique by which the medicine is administered.", "valueSet": "http://hl7.org/fhir/ValueSet/administration-method-codes" } }, { "id": "MedicationRequest.dosageInstruction.doseAndRate", "path": "MedicationRequest.dosageInstruction.doseAndRate", "short": "Amount of medication administered", "definition": "The amount of medication administered.", "min": 0, "max": "*", "base": { "path": "Dosage.doseAndRate", "min": 0, "max": "*" }, "type": [ { "code": "Element" } ], "isModifier": false, "isSummary": true }, { "id": "MedicationRequest.dosageInstruction.doseAndRate.id", "path": "MedicationRequest.dosageInstruction.doseAndRate.id", "short": "Unique, Verto-specific id for inter-element referencing", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "isModifier": false, "isSummary": false }, { "id": "MedicationRequest.dosageInstruction.doseAndRate.dose[x]", "path": "MedicationRequest.dosageInstruction.doseAndRate.dose[x]", "short": "Amount of medication per dose", "definition": "Amount of medication per dose.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "Dosage.doseAndRate.dose[x]", "min": 0, "max": "1" }, "type": [ { "code": "Range" }, { "code": "Quantity", "profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] } ], "isModifier": false, "isSummary": true }, { "id": "MedicationRequest.dosageInstruction.doseAndRate.rate[x]", "path": "MedicationRequest.dosageInstruction.doseAndRate.rate[x]", "short": "Amount of medication per unit of time", "definition": "Amount of medication per unit of time.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "Dosage.doseAndRate.rate[x]", "min": 0, "max": "1" }, "type": [ { "code": "Ratio" }, { "code": "Range" }, { "code": "Quantity", "profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] } ], "isModifier": false, "isSummary": true }, { "id": "MedicationRequest.dosageInstruction.maxDosePerPeriod", "path": "MedicationRequest.dosageInstruction.maxDosePerPeriod", "short": "Upper limit on medication per unit of time", "definition": "Upper limit on medication per unit of time.", "comment": "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\".", "min": 0, "max": "1", "base": { "path": "Dosage.maxDosePerPeriod", "min": 0, "max": "1" }, "type": [ { "code": "Ratio" } ], "isModifier": false, "isSummary": true }, { "id": "MedicationRequest.dosageInstruction.maxDosePerAdministration", "path": "MedicationRequest.dosageInstruction.maxDosePerAdministration", "short": "Upper limit on medication per administration", "definition": "Upper limit on medication per administration.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "Dosage.maxDosePerAdministration", "min": 0, "max": "1" }, "type": [ { "code": "Quantity", "profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] } ], "isModifier": false, "isSummary": true }, { "id": "MedicationRequest.dosageInstruction.maxDosePerLifetime", "path": "MedicationRequest.dosageInstruction.maxDosePerLifetime", "short": "Upper limit on medication per lifetime of the patient", "definition": "Upper limit on medication per lifetime of the patient.", "requirements": "The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.", "min": 0, "max": "1", "base": { "path": "Dosage.maxDosePerLifetime", "min": 0, "max": "1" }, "type": [ { "code": "Quantity", "profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] } ], "isModifier": false, "isSummary": true } ] } }