US Core Implementation Guide
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US Core Implementation Guide, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 8.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/US-Core/ and changes regularly. See the Directory of published versions

Resource Profile: US Core MedicationRequest Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest Version: 8.0.0-ballot
Standards status: Trial-use Maturity Level: 3 Computable Name: USCoreMedicationRequestProfile
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.42.39

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

The US Core MedicationRequest Profile inherits from the FHIR MedicationRequest resource; refer to it for scope and usage definitions. This profile meets the requirements of the U.S. Core Data for Interoperability (USCDI) Medications Data Class. This profile sets minimum expectations for the MedicationRequest resource to record, search, and fetch a patient's medication prescriptions or orders. It specifies which core elements, extensions, vocabularies, and value sets SHALL be present in the resource and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.

Example Usage Scenarios:

The following are example usage scenarios for the US Core-MedicationRequest profile. See the Medication List section for guidance on accessing a patient's medications:

  • Fetching all medications that have been prescribed to a patient
  • Fetching all active medications that have been prescribed to a patient
  • Fetching all medications that have been prescribed to a patient during a particular encounter
  • Record or update medications that have been prescribed for a patient

Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each MedicationRequest Must Have:

  1. a status
  2. an intent code
  3. a medication*
  4. a patient

Each MedicationRequest Must Support:

  1. the category (e.g., Discharge Medication)
  2. the reported flag or reference signaling that information is from a secondary source such as a patient
  3. the encounters
  4. a prescriber
  5. a date for when written
  6. free text dosage instructions (the SIG)
  7. when medication should be administered
  8. the route of administration
  9. the dose and rate
  10. the amount dispensed and number of refills

Additional USCDI Requirements:

These Additional USCDI Requirements elements are not Mandatory or Must Support but are required for ONC Health IT certification testing and are included in the formal definition of the profile and the MedicationRequest examples.

  1. the reason or indication for the prescription*
  2. reported adherence to prescribed medication instructions*

* see guidance below

Profile Specific Implementation Guidance:

  • See the Medication List section for guidance on accessing a patient's medications, including over-the-counter (OTC) medications and other substances taken for medical and recreational use.
    • When recording "self-prescribed" medication, requester SHOULD be used to indicate the Patient or RelatedPerson as the prescriber.
  • *This Profile can represent a medication using a code or reference a Medication resource.
    • When using a code, RXNorm concepts are used. They are defined as an extensible binding to .medicationCodeableConcept. USCDI recommends the National Drug Codes (NDC) as an optional terminology. They can be supplied as an additional coding element.
      • Systems that primarily rely on NDC codes instead of RxNorm to represent medications can use the National Library of Medicine's (NLM) NDC to RxNorm mappings to aid in translations.
    • When referencing a Medication resource in .medicationReference, the resource may be contained or an external resource.
    • The Server systems are not required to support both a code and a reference, but SHALL support at least one of these methods.
    • If an external reference to a Medication resource is used, the Server SHALL support the _include parameter for searching this element.
    • The Client application SHALL support all methods.
  • The MedicationRequest resource can represent that information is from a secondary source using either a boolean flag or a reference using MedicationRequest.reportedReference.
    • Although both are marked as Must Support, the Server system is not required to support both, but SHALL support at least one of these elements.
    • The Client application SHALL support both elements.
  • *The MedicationRequest resource can communicate the reason or indication for treatment using either a code in MedicationRequest.reasonCode or a reference using MedicationRequest.reasonReference.
    • Although both MedicationRequest.reasonCode and MedicationRequest.reasonReference are marked as Additional USCDI Requirements. The certifying Server system is not required to support both, but SHALL support at least one of these elements. The certifying Client application SHALL support both elements.
      • when using MedicationRequest.reasonReference:
        • Servers SHALL support at least one target resource in MedicationRequest.reasonReference. Clients SHALL support all target resources in MedicationRequest.reasonReference.
        • The referenced resources SHOULD be a US Core Profile as documented in Referencing US Core Profiles.
  • Source EHR identifiers SHOULD be included to support deduplication across MedicationRequest resources. Exposing the EHR identifiers helps Client applications identify duplicates.

  • Servers SHALL follow the guidance on the Medication List page and return all active medications as MedicationRequest. It is always best practice to confirm this list with the Patient or Caregiver.

  • * This profile uses the US Core Medication Adherence Extension to report medication adherence. This extension communicates whether a medication has been consumed according to instructions.

Usage:

Changes since version 7.0.0:

  • The resource metadata has changed (description)
  • The data elements list has changed

    • Formal Views of Profile Content

    Description of Profiles, Differentials, Snapshots and how the different presentations work.

    This structure is derived from MedicationRequest

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. MedicationRequest C 0..* MedicationRequest Ordering of medication for patient or group
    us-core-21: requester SHALL be present if intent is "order"
    ... Slices for extension Content/Rules for all slices
    .... medicationAdherence 0..* (Complex) 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Medication Adherence Extension
    URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence
    ... status S 1..1 code active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
    Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.

    ... intent SC 1..1 code proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
    Binding: medicationRequest Intent (required): The kind of medication order.

    ... Slices for category S 0..* CodeableConcept Type of medication usage
    Slice: Unordered, Open by value:$this
    .... category:us-core S 0..* CodeableConcept Type of medication usage
    Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets

    ... reported[x] S 0..1 Reported rather than primary record
    .... reportedBoolean boolean S
    .... reportedReference Reference S(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile)
    ... medication[x] S 1..1 Medication to be taken
    Binding: Medication Clinical Drug . (extensible)
    .... medicationCodeableConcept CodeableConcept
    .... medicationReference Reference(US Core Medication Profile)
    ... subject S 1..1 Reference(US Core Patient Profile S | Group) Who or group medication request is for
    ... encounter S 0..1 Reference(US Core Encounter Profile) Encounter created as part of encounter/admission/stay
    ... authoredOn S 0..1 dateTime When request was initially authored
    ... requester SC 0..1 Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) Who/What requested the Request
    ... reasonCode 0..* CodeableConcept 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Reason or indication for ordering or not ordering the medication
    Binding: US Core Condition Codes (extensible)
    ... reasonReference 0..* Reference(Condition | Observation) 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Condition or Observation that supports the prescription
    ... dosageInstruction S 0..* Dosage How the medication should be taken
    .... text S 0..1 string Free text dosage instructions e.g. SIG
    .... timing S 0..1 Timing When medication should be administered
    .... route S 0..1 CodeableConcept How drug should enter body
    Binding: SNOMEDCTRouteCodes (extensible): ☞☞☞ Use SNOMED CT and SPL(NCI Thesaurus) values in final version to meet USCDI terminology requirements

    .... doseAndRate S 0..* Element Amount of medication administered
    ..... dose[x] S 0..1 Amount of medication per dose
    Binding: Common UCUM units (preferred)
    Additional BindingsPurpose
    UCUMCodes Max Binding
    ...... doseQuantity Quantity S(SimpleQuantity)
    ...... doseRange Range
    ... dispenseRequest S 0..1 BackboneElement Medication supply authorization
    .... numberOfRepeatsAllowed S 0..1 unsignedInt Number of refills authorized
    .... quantity S 0..1 SimpleQuantity Amount of medication to supply per dispense

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    MedicationRequest.statusrequiredmedicationrequest Status
    http://hl7.org/fhir/ValueSet/medicationrequest-status
    from the FHIR Standard
    MedicationRequest.intentrequiredmedicationRequest Intent
    http://hl7.org/fhir/ValueSet/medicationrequest-intent
    from the FHIR Standard
    MedicationRequest.category:us-corerequiredmedicationRequest Category Codes
    http://hl7.org/fhir/ValueSet/medicationrequest-category
    from the FHIR Standard
    MedicationRequest.medication[x]extensibleMedicationClinicalDrug .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
    MedicationRequest.reasonCodeextensibleUSCoreConditionCodes
    http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code
    from this IG
    MedicationRequest.dosageInstruction.routeextensibleSNOMEDCTRouteCodes
    http://hl7.org/fhir/ValueSet/route-codes
    from the FHIR Standard
    MedicationRequest.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
    http://hl7.org/fhir/ValueSet/ucum-common
    from the FHIR Standard
    Additional Bindings Purpose
    UCUMCodes Max Binding

    Constraints

    IdGradePath(s)DetailsRequirements
    us-core-21errorMedicationRequestrequester SHALL be present if intent is "order"
    : (intent='order' or intent='original-order' or intent='reflex-order'or intent='filler-order' or intent='instance-order') implies requester.exists()
    NameFlagsCard.TypeDescription & Constraintsdoco
    .. MedicationRequest C 0..* MedicationRequest Ordering of medication for patient or group
    dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    dom-6: A resource should have narrative for robust management
    us-core-21: requester SHALL be present if intent is "order"
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ele-1: All FHIR elements must have a @value or children
    ... Slices for extension Content/Rules for all slices
    .... medicationAdherence 0..* (Complex) 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Medication Adherence Extension
    URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ... status ?!SΣ 1..1 code active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
    Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.


    ele-1: All FHIR elements must have a @value or children
    ... intent ?!SΣC 1..1 code proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
    Binding: medicationRequest Intent (required): The kind of medication order.


    ele-1: All FHIR elements must have a @value or children
    ... Slices for category S 0..* CodeableConcept Type of medication usage
    Slice: Unordered, Open by value:$this
    Binding: medicationRequest Category Codes (example): 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.


    ele-1: All FHIR elements must have a @value or children
    .... category:us-core S 0..* CodeableConcept Type of medication usage
    Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets


    ele-1: All FHIR elements must have a @value or children
    ... doNotPerform ?!Σ 0..1 boolean True if request is prohibiting action
    ele-1: All FHIR elements must have a @value or children
    ... reported[x] SΣ 0..1 Reported rather than primary record
    ele-1: All FHIR elements must have a @value or children
    .... reportedBoolean boolean
    .... reportedReference Reference(US Core Practitioner Profile)
    ... medication[x] SΣ 1..1 Medication to be taken
    Binding: Medication Clinical Drug . (extensible)
    ele-1: All FHIR elements must have a @value or children
    .... medicationCodeableConcept CodeableConcept
    .... medicationReference Reference(US Core Medication Profile)
    ... subject SΣ 1..1 Reference(US Core Patient Profile) Who or group medication request is for
    ele-1: All FHIR elements must have a @value or children
    ... encounter S 0..1 Reference(US Core Encounter Profile) Encounter created as part of encounter/admission/stay
    ele-1: All FHIR elements must have a @value or children
    ... authoredOn SΣ 0..1 dateTime When request was initially authored
    ele-1: All FHIR elements must have a @value or children
    ... requester SΣC 0..1 Reference(US Core Practitioner Profile) Who/What requested the Request
    ele-1: All FHIR elements must have a @value or children
    ... reasonCode 0..* CodeableConcept 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Reason or indication for ordering or not ordering the medication
    Binding: US Core Condition Codes (extensible)
    ele-1: All FHIR elements must have a @value or children
    ... reasonReference 0..* Reference(Condition | Observation) 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Condition or Observation that supports the prescription
    ele-1: All FHIR elements must have a @value or children
    ... dosageInstruction S 0..* Dosage How the medication should be taken
    ele-1: All FHIR elements must have a @value or children
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    .... text SΣ 0..1 string Free text dosage instructions e.g. SIG
    ele-1: All FHIR elements must have a @value or children
    .... timing SΣ 0..1 Timing When medication should be administered
    ele-1: All FHIR elements must have a @value or children
    .... route SΣ 0..1 CodeableConcept How drug should enter body
    Binding: SNOMEDCTRouteCodes (extensible): ☞☞☞ Use SNOMED CT and SPL(NCI Thesaurus) values in final version to meet USCDI terminology requirements


    ele-1: All FHIR elements must have a @value or children
    .... doseAndRate SΣ 0..* Element Amount of medication administered
    ele-1: All FHIR elements must have a @value or children
    ..... dose[x] SΣ 0..1 Amount of medication per dose
    Binding: Common UCUM units (preferred)
    Additional BindingsPurpose
    UCUMCodes Max Binding

    ele-1: All FHIR elements must have a @value or children
    ...... doseQuantity Quantity(SimpleQuantity)
    ... dispenseRequest S 0..1 BackboneElement Medication supply authorization
    ele-1: All FHIR elements must have a @value or children
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    .... numberOfRepeatsAllowed S 0..1 unsignedInt Number of refills authorized
    ele-1: All FHIR elements must have a @value or children
    .... quantity S 0..1 SimpleQuantity Amount of medication to supply per dispense
    ele-1: All FHIR elements must have a @value or children

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    MedicationRequest.statusrequiredmedicationrequest Status
    http://hl7.org/fhir/ValueSet/medicationrequest-status
    from the FHIR Standard
    MedicationRequest.intentrequiredmedicationRequest Intent
    http://hl7.org/fhir/ValueSet/medicationrequest-intent
    from the FHIR Standard
    MedicationRequest.categoryexamplemedicationRequest Category Codes
    http://hl7.org/fhir/ValueSet/medicationrequest-category
    from the FHIR Standard
    MedicationRequest.category:us-corerequiredmedicationRequest Category Codes
    http://hl7.org/fhir/ValueSet/medicationrequest-category
    from the FHIR Standard
    MedicationRequest.medication[x]extensibleMedicationClinicalDrug .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
    MedicationRequest.reasonCodeextensibleUSCoreConditionCodes
    http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code
    from this IG
    MedicationRequest.dosageInstruction.routeextensibleSNOMEDCTRouteCodes
    http://hl7.org/fhir/ValueSet/route-codes
    from the FHIR Standard
    MedicationRequest.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
    http://hl7.org/fhir/ValueSet/ucum-common
    from the FHIR Standard
    Additional Bindings Purpose
    UCUMCodes Max Binding

    Constraints

    IdGradePath(s)DetailsRequirements
    us-core-21errorMedicationRequestrequester SHALL be present if intent is "order"
    : (intent='order' or intent='original-order' or intent='reflex-order'or intent='filler-order' or intent='instance-order') implies requester.exists()
    NameFlagsCard.TypeDescription & Constraintsdoco
    .. MedicationRequest C 0..* MedicationRequest Ordering of medication for patient or group
    us-core-21: requester SHALL be present if intent is "order"
    ... id Σ 0..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... language 0..1 code Language of the resource content
    Binding: CommonLanguages (preferred): A human language.

    Additional BindingsPurpose
    AllLanguages Max Binding
    ... text 0..1 Narrative Text summary of the resource, for human interpretation
    ... contained 0..* Resource Contained, inline Resources
    ... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    .... medicationAdherence 0..* (Complex) 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Medication Adherence Extension
    URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... identifier 0..* Identifier External ids for this request
    ... status ?!SΣ 1..1 code active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
    Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.

    ... statusReason 0..1 CodeableConcept Reason for current status
    Binding: medicationRequest Status Reason Codes (example): Identifies the reasons for a given status.

    ... intent ?!SΣC 1..1 code proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
    Binding: medicationRequest Intent (required): The kind of medication order.

    ... Slices for category S 0..* CodeableConcept Type of medication usage
    Slice: Unordered, Open by value:$this
    Binding: medicationRequest Category Codes (example): 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.


    .... category:us-core S 0..* CodeableConcept Type of medication usage
    Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets


    ... priority Σ 0..1 code routine | urgent | asap | stat
    Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.

    ... doNotPerform ?!Σ 0..1 boolean True if request is prohibiting action
    ... reported[x] SΣ 0..1 Reported rather than primary record
    .... reportedBoolean boolean S
    .... reportedReference Reference S(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile)
    ... medication[x] SΣ 1..1 Medication to be taken
    Binding: Medication Clinical Drug . (extensible)
    .... medicationCodeableConcept CodeableConcept
    .... medicationReference Reference(US Core Medication Profile)
    ... subject SΣ 1..1 Reference(US Core Patient Profile S | Group) Who or group medication request is for
    ... encounter S 0..1 Reference(US Core Encounter Profile) Encounter created as part of encounter/admission/stay
    ... supportingInformation 0..* Reference(Resource) Information to support ordering of the medication
    ... authoredOn SΣ 0..1 dateTime When request was initially authored
    ... requester SΣC 0..1 Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) Who/What requested the Request
    ... performer 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam) Intended performer of administration
    ... performerType Σ 0..1 CodeableConcept Desired kind of performer of the medication administration
    Binding: ProcedurePerformerRoleCodes (example): Identifies the type of individual that is desired to administer the medication.

    ... recorder 0..1 Reference(Practitioner | PractitionerRole) Person who entered the request
    ... reasonCode 0..* CodeableConcept 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Reason or indication for ordering or not ordering the medication
    Binding: US Core Condition Codes (extensible)
    ... reasonReference 0..* Reference(Condition | Observation) 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Condition or Observation that supports the prescription
    ... instantiatesCanonical Σ 0..* canonical() Instantiates FHIR protocol or definition
    ... instantiatesUri Σ 0..* uri Instantiates external protocol or definition
    ... basedOn Σ 0..* Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation) What request fulfills
    ... groupIdentifier Σ 0..1 Identifier Composite request this is part of
    ... courseOfTherapyType 0..1 CodeableConcept Overall pattern of medication administration
    Binding: medicationRequest Course of Therapy Codes (example): Identifies the overall pattern of medication administratio.

    ... insurance 0..* Reference(Coverage | ClaimResponse) Associated insurance coverage
    ... note 0..* Annotation Information about the prescription
    ... dosageInstruction S 0..* Dosage How the medication should be taken
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... sequence Σ 0..1 integer The order of the dosage instructions
    .... text SΣ 0..1 string Free text dosage instructions e.g. SIG
    .... additionalInstruction Σ 0..* CodeableConcept Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
    Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".


    .... patientInstruction Σ 0..1 string Patient or consumer oriented instructions
    .... timing SΣ 0..1 Timing When medication should be administered
    .... asNeeded[x] Σ 0..1 Take "as needed" (for x)
    Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): 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.

    ..... asNeededBoolean boolean
    ..... asNeededCodeableConcept CodeableConcept
    .... site Σ 0..1 CodeableConcept Body site to administer to
    Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.

    .... route SΣ 0..1 CodeableConcept How drug should enter body
    Binding: SNOMEDCTRouteCodes (extensible): ☞☞☞ Use SNOMED CT and SPL(NCI Thesaurus) values in final version to meet USCDI terminology requirements

    .... method Σ 0..1 CodeableConcept Technique for administering medication
    Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.

    .... doseAndRate SΣ 0..* Element Amount of medication administered
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... type Σ 0..1 CodeableConcept The kind of dose or rate specified
    Binding: DoseAndRateType (example): The kind of dose or rate specified.

    ..... dose[x] SΣ 0..1 Amount of medication per dose
    Binding: Common UCUM units (preferred)
    Additional BindingsPurpose
    UCUMCodes Max Binding
    ...... doseQuantity Quantity S(SimpleQuantity)
    ...... doseRange Range
    ..... rate[x] Σ 0..1 Amount of medication per unit of time
    ...... rateRatio Ratio
    ...... rateRange Range
    ...... rateQuantity Quantity(SimpleQuantity)
    .... maxDosePerPeriod Σ 0..1 Ratio Upper limit on medication per unit of time
    .... maxDosePerAdministration Σ 0..1 SimpleQuantity Upper limit on medication per administration
    .... maxDosePerLifetime Σ 0..1 SimpleQuantity Upper limit on medication per lifetime of the patient
    ... dispenseRequest S 0..1 BackboneElement Medication supply authorization
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... initialFill 0..1 BackboneElement First fill details
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... quantity 0..1 SimpleQuantity First fill quantity
    ..... duration 0..1 Duration First fill duration
    .... dispenseInterval 0..1 Duration Minimum period of time between dispenses
    .... validityPeriod 0..1 Period Time period supply is authorized for
    .... numberOfRepeatsAllowed S 0..1 unsignedInt Number of refills authorized
    .... quantity S 0..1 SimpleQuantity Amount of medication to supply per dispense
    .... expectedSupplyDuration 0..1 Duration Number of days supply per dispense
    .... performer 0..1 Reference(Organization) Intended dispenser
    ... substitution 0..1 BackboneElement Any restrictions on medication substitution
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... allowed[x] 1..1 Whether substitution is allowed or not
    Binding: ActSubstanceAdminSubstitutionCode (example): Identifies the type of substitution allowed.

    ..... allowedBoolean boolean
    ..... allowedCodeableConcept CodeableConcept
    .... reason 0..1 CodeableConcept Why should (not) substitution be made
    Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.

    ... priorPrescription 0..1 Reference(MedicationRequest) An order/prescription that is being replaced
    ... detectedIssue 0..* Reference(DetectedIssue) Clinical Issue with action
    ... eventHistory 0..* Reference(Provenance) A list of events of interest in the lifecycle

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    MedicationRequest.languagepreferredCommonLanguages
    http://hl7.org/fhir/ValueSet/languages
    from the FHIR Standard
    Additional Bindings Purpose
    AllLanguages Max Binding
    MedicationRequest.statusrequiredmedicationrequest Status
    http://hl7.org/fhir/ValueSet/medicationrequest-status
    from the FHIR Standard
    MedicationRequest.statusReasonexamplemedicationRequest Status Reason Codes
    http://hl7.org/fhir/ValueSet/medicationrequest-status-reason
    from the FHIR Standard
    MedicationRequest.intentrequiredmedicationRequest Intent
    http://hl7.org/fhir/ValueSet/medicationrequest-intent
    from the FHIR Standard
    MedicationRequest.categoryexamplemedicationRequest Category Codes
    http://hl7.org/fhir/ValueSet/medicationrequest-category
    from the FHIR Standard
    MedicationRequest.category:us-corerequiredmedicationRequest Category Codes
    http://hl7.org/fhir/ValueSet/medicationrequest-category
    from the FHIR Standard
    MedicationRequest.priorityrequiredRequestPriority
    http://hl7.org/fhir/ValueSet/request-priority|4.0.1
    from the FHIR Standard
    MedicationRequest.medication[x]extensibleMedicationClinicalDrug .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
    MedicationRequest.performerTypeexampleProcedurePerformerRoleCodes
    http://hl7.org/fhir/ValueSet/performer-role
    from the FHIR Standard
    MedicationRequest.reasonCodeextensibleUSCoreConditionCodes
    http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code
    from this IG
    MedicationRequest.courseOfTherapyTypeexamplemedicationRequest Course of Therapy Codes
    http://hl7.org/fhir/ValueSet/medicationrequest-course-of-therapy
    from the FHIR Standard
    MedicationRequest.dosageInstruction.additionalInstructionexampleSNOMEDCTAdditionalDosageInstructions
    http://hl7.org/fhir/ValueSet/additional-instruction-codes
    from the FHIR Standard
    MedicationRequest.dosageInstruction.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
    http://hl7.org/fhir/ValueSet/medication-as-needed-reason
    from the FHIR Standard
    MedicationRequest.dosageInstruction.siteexampleSNOMEDCTAnatomicalStructureForAdministrationSiteCodes
    http://hl7.org/fhir/ValueSet/approach-site-codes
    from the FHIR Standard
    MedicationRequest.dosageInstruction.routeextensibleSNOMEDCTRouteCodes
    http://hl7.org/fhir/ValueSet/route-codes
    from the FHIR Standard
    MedicationRequest.dosageInstruction.methodexampleSNOMEDCTAdministrationMethodCodes
    http://hl7.org/fhir/ValueSet/administration-method-codes
    from the FHIR Standard
    MedicationRequest.dosageInstruction.doseAndRate.typeexampleDoseAndRateType
    http://hl7.org/fhir/ValueSet/dose-rate-type
    from the FHIR Standard
    MedicationRequest.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
    http://hl7.org/fhir/ValueSet/ucum-common
    from the FHIR Standard
    Additional Bindings Purpose
    UCUMCodes Max Binding
    MedicationRequest.substitution.allowed[x]exampleActSubstanceAdminSubstitutionCode
    http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode
    MedicationRequest.substitution.reasonexampleSubstanceAdminSubstitutionReason
    http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason

    Constraints

    IdGradePath(s)DetailsRequirements
    us-core-21errorMedicationRequestrequester SHALL be present if intent is "order"
    : (intent='order' or intent='original-order' or intent='reflex-order'or intent='filler-order' or intent='instance-order') implies requester.exists()

    Differential View

    This structure is derived from MedicationRequest

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. MedicationRequest C 0..* MedicationRequest Ordering of medication for patient or group
    us-core-21: requester SHALL be present if intent is "order"
    ... Slices for extension Content/Rules for all slices
    .... medicationAdherence 0..* (Complex) 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Medication Adherence Extension
    URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence
    ... status S 1..1 code active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
    Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.

    ... intent SC 1..1 code proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
    Binding: medicationRequest Intent (required): The kind of medication order.

    ... Slices for category S 0..* CodeableConcept Type of medication usage
    Slice: Unordered, Open by value:$this
    .... category:us-core S 0..* CodeableConcept Type of medication usage
    Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets

    ... reported[x] S 0..1 Reported rather than primary record
    .... reportedBoolean boolean S
    .... reportedReference Reference S(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile)
    ... medication[x] S 1..1 Medication to be taken
    Binding: Medication Clinical Drug . (extensible)
    .... medicationCodeableConcept CodeableConcept
    .... medicationReference Reference(US Core Medication Profile)
    ... subject S 1..1 Reference(US Core Patient Profile S | Group) Who or group medication request is for
    ... encounter S 0..1 Reference(US Core Encounter Profile) Encounter created as part of encounter/admission/stay
    ... authoredOn S 0..1 dateTime When request was initially authored
    ... requester SC 0..1 Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) Who/What requested the Request
    ... reasonCode 0..* CodeableConcept 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Reason or indication for ordering or not ordering the medication
    Binding: US Core Condition Codes (extensible)
    ... reasonReference 0..* Reference(Condition | Observation) 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Condition or Observation that supports the prescription
    ... dosageInstruction S 0..* Dosage How the medication should be taken
    .... text S 0..1 string Free text dosage instructions e.g. SIG
    .... timing S 0..1 Timing When medication should be administered
    .... route S 0..1 CodeableConcept How drug should enter body
    Binding: SNOMEDCTRouteCodes (extensible): ☞☞☞ Use SNOMED CT and SPL(NCI Thesaurus) values in final version to meet USCDI terminology requirements

    .... doseAndRate S 0..* Element Amount of medication administered
    ..... dose[x] S 0..1 Amount of medication per dose
    Binding: Common UCUM units (preferred)
    Additional BindingsPurpose
    UCUMCodes Max Binding
    ...... doseQuantity Quantity S(SimpleQuantity)
    ...... doseRange Range
    ... dispenseRequest S 0..1 BackboneElement Medication supply authorization
    .... numberOfRepeatsAllowed S 0..1 unsignedInt Number of refills authorized
    .... quantity S 0..1 SimpleQuantity Amount of medication to supply per dispense

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    MedicationRequest.statusrequiredmedicationrequest Status
    http://hl7.org/fhir/ValueSet/medicationrequest-status
    from the FHIR Standard
    MedicationRequest.intentrequiredmedicationRequest Intent
    http://hl7.org/fhir/ValueSet/medicationrequest-intent
    from the FHIR Standard
    MedicationRequest.category:us-corerequiredmedicationRequest Category Codes
    http://hl7.org/fhir/ValueSet/medicationrequest-category
    from the FHIR Standard
    MedicationRequest.medication[x]extensibleMedicationClinicalDrug .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
    MedicationRequest.reasonCodeextensibleUSCoreConditionCodes
    http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code
    from this IG
    MedicationRequest.dosageInstruction.routeextensibleSNOMEDCTRouteCodes
    http://hl7.org/fhir/ValueSet/route-codes
    from the FHIR Standard
    MedicationRequest.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
    http://hl7.org/fhir/ValueSet/ucum-common
    from the FHIR Standard
    Additional Bindings Purpose
    UCUMCodes Max Binding

    Constraints

    IdGradePath(s)DetailsRequirements
    us-core-21errorMedicationRequestrequester SHALL be present if intent is "order"
    : (intent='order' or intent='original-order' or intent='reflex-order'or intent='filler-order' or intent='instance-order') implies requester.exists()

    Key Elements View

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. MedicationRequest C 0..* MedicationRequest Ordering of medication for patient or group
    dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    dom-6: A resource should have narrative for robust management
    us-core-21: requester SHALL be present if intent is "order"
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ele-1: All FHIR elements must have a @value or children
    ... Slices for extension Content/Rules for all slices
    .... medicationAdherence 0..* (Complex) 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Medication Adherence Extension
    URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ... status ?!SΣ 1..1 code active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
    Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.


    ele-1: All FHIR elements must have a @value or children
    ... intent ?!SΣC 1..1 code proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
    Binding: medicationRequest Intent (required): The kind of medication order.


    ele-1: All FHIR elements must have a @value or children
    ... Slices for category S 0..* CodeableConcept Type of medication usage
    Slice: Unordered, Open by value:$this
    Binding: medicationRequest Category Codes (example): 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.


    ele-1: All FHIR elements must have a @value or children
    .... category:us-core S 0..* CodeableConcept Type of medication usage
    Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets


    ele-1: All FHIR elements must have a @value or children
    ... doNotPerform ?!Σ 0..1 boolean True if request is prohibiting action
    ele-1: All FHIR elements must have a @value or children
    ... reported[x] SΣ 0..1 Reported rather than primary record
    ele-1: All FHIR elements must have a @value or children
    .... reportedBoolean boolean
    .... reportedReference Reference(US Core Practitioner Profile)
    ... medication[x] SΣ 1..1 Medication to be taken
    Binding: Medication Clinical Drug . (extensible)
    ele-1: All FHIR elements must have a @value or children
    .... medicationCodeableConcept CodeableConcept
    .... medicationReference Reference(US Core Medication Profile)
    ... subject SΣ 1..1 Reference(US Core Patient Profile) Who or group medication request is for
    ele-1: All FHIR elements must have a @value or children
    ... encounter S 0..1 Reference(US Core Encounter Profile) Encounter created as part of encounter/admission/stay
    ele-1: All FHIR elements must have a @value or children
    ... authoredOn SΣ 0..1 dateTime When request was initially authored
    ele-1: All FHIR elements must have a @value or children
    ... requester SΣC 0..1 Reference(US Core Practitioner Profile) Who/What requested the Request
    ele-1: All FHIR elements must have a @value or children
    ... reasonCode 0..* CodeableConcept 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Reason or indication for ordering or not ordering the medication
    Binding: US Core Condition Codes (extensible)
    ele-1: All FHIR elements must have a @value or children
    ... reasonReference 0..* Reference(Condition | Observation) 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Condition or Observation that supports the prescription
    ele-1: All FHIR elements must have a @value or children
    ... dosageInstruction S 0..* Dosage How the medication should be taken
    ele-1: All FHIR elements must have a @value or children
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    .... text SΣ 0..1 string Free text dosage instructions e.g. SIG
    ele-1: All FHIR elements must have a @value or children
    .... timing SΣ 0..1 Timing When medication should be administered
    ele-1: All FHIR elements must have a @value or children
    .... route SΣ 0..1 CodeableConcept How drug should enter body
    Binding: SNOMEDCTRouteCodes (extensible): ☞☞☞ Use SNOMED CT and SPL(NCI Thesaurus) values in final version to meet USCDI terminology requirements


    ele-1: All FHIR elements must have a @value or children
    .... doseAndRate SΣ 0..* Element Amount of medication administered
    ele-1: All FHIR elements must have a @value or children
    ..... dose[x] SΣ 0..1 Amount of medication per dose
    Binding: Common UCUM units (preferred)
    Additional BindingsPurpose
    UCUMCodes Max Binding

    ele-1: All FHIR elements must have a @value or children
    ...... doseQuantity Quantity(SimpleQuantity)
    ... dispenseRequest S 0..1 BackboneElement Medication supply authorization
    ele-1: All FHIR elements must have a @value or children
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    .... numberOfRepeatsAllowed S 0..1 unsignedInt Number of refills authorized
    ele-1: All FHIR elements must have a @value or children
    .... quantity S 0..1 SimpleQuantity Amount of medication to supply per dispense
    ele-1: All FHIR elements must have a @value or children

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    MedicationRequest.statusrequiredmedicationrequest Status
    http://hl7.org/fhir/ValueSet/medicationrequest-status
    from the FHIR Standard
    MedicationRequest.intentrequiredmedicationRequest Intent
    http://hl7.org/fhir/ValueSet/medicationrequest-intent
    from the FHIR Standard
    MedicationRequest.categoryexamplemedicationRequest Category Codes
    http://hl7.org/fhir/ValueSet/medicationrequest-category
    from the FHIR Standard
    MedicationRequest.category:us-corerequiredmedicationRequest Category Codes
    http://hl7.org/fhir/ValueSet/medicationrequest-category
    from the FHIR Standard
    MedicationRequest.medication[x]extensibleMedicationClinicalDrug .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
    MedicationRequest.reasonCodeextensibleUSCoreConditionCodes
    http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code
    from this IG
    MedicationRequest.dosageInstruction.routeextensibleSNOMEDCTRouteCodes
    http://hl7.org/fhir/ValueSet/route-codes
    from the FHIR Standard
    MedicationRequest.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
    http://hl7.org/fhir/ValueSet/ucum-common
    from the FHIR Standard
    Additional Bindings Purpose
    UCUMCodes Max Binding

    Constraints

    IdGradePath(s)DetailsRequirements
    us-core-21errorMedicationRequestrequester SHALL be present if intent is "order"
    : (intent='order' or intent='original-order' or intent='reflex-order'or intent='filler-order' or intent='instance-order') implies requester.exists()

    Snapshot View

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. MedicationRequest C 0..* MedicationRequest Ordering of medication for patient or group
    us-core-21: requester SHALL be present if intent is "order"
    ... id Σ 0..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... language 0..1 code Language of the resource content
    Binding: CommonLanguages (preferred): A human language.

    Additional BindingsPurpose
    AllLanguages Max Binding
    ... text 0..1 Narrative Text summary of the resource, for human interpretation
    ... contained 0..* Resource Contained, inline Resources
    ... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    .... medicationAdherence 0..* (Complex) 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Medication Adherence Extension
    URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... identifier 0..* Identifier External ids for this request
    ... status ?!SΣ 1..1 code active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
    Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.

    ... statusReason 0..1 CodeableConcept Reason for current status
    Binding: medicationRequest Status Reason Codes (example): Identifies the reasons for a given status.

    ... intent ?!SΣC 1..1 code proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
    Binding: medicationRequest Intent (required): The kind of medication order.

    ... Slices for category S 0..* CodeableConcept Type of medication usage
    Slice: Unordered, Open by value:$this
    Binding: medicationRequest Category Codes (example): 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.


    .... category:us-core S 0..* CodeableConcept Type of medication usage
    Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets


    ... priority Σ 0..1 code routine | urgent | asap | stat
    Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.

    ... doNotPerform ?!Σ 0..1 boolean True if request is prohibiting action
    ... reported[x] SΣ 0..1 Reported rather than primary record
    .... reportedBoolean boolean S
    .... reportedReference Reference S(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile)
    ... medication[x] SΣ 1..1 Medication to be taken
    Binding: Medication Clinical Drug . (extensible)
    .... medicationCodeableConcept CodeableConcept
    .... medicationReference Reference(US Core Medication Profile)
    ... subject SΣ 1..1 Reference(US Core Patient Profile S | Group) Who or group medication request is for
    ... encounter S 0..1 Reference(US Core Encounter Profile) Encounter created as part of encounter/admission/stay
    ... supportingInformation 0..* Reference(Resource) Information to support ordering of the medication
    ... authoredOn SΣ 0..1 dateTime When request was initially authored
    ... requester SΣC 0..1 Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) Who/What requested the Request
    ... performer 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam) Intended performer of administration
    ... performerType Σ 0..1 CodeableConcept Desired kind of performer of the medication administration
    Binding: ProcedurePerformerRoleCodes (example): Identifies the type of individual that is desired to administer the medication.

    ... recorder 0..1 Reference(Practitioner | PractitionerRole) Person who entered the request
    ... reasonCode 0..* CodeableConcept 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Reason or indication for ordering or not ordering the medication
    Binding: US Core Condition Codes (extensible)
    ... reasonReference 0..* Reference(Condition | Observation) 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Condition or Observation that supports the prescription
    ... instantiatesCanonical Σ 0..* canonical() Instantiates FHIR protocol or definition
    ... instantiatesUri Σ 0..* uri Instantiates external protocol or definition
    ... basedOn Σ 0..* Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation) What request fulfills
    ... groupIdentifier Σ 0..1 Identifier Composite request this is part of
    ... courseOfTherapyType 0..1 CodeableConcept Overall pattern of medication administration
    Binding: medicationRequest Course of Therapy Codes (example): Identifies the overall pattern of medication administratio.

    ... insurance 0..* Reference(Coverage | ClaimResponse) Associated insurance coverage
    ... note 0..* Annotation Information about the prescription
    ... dosageInstruction S 0..* Dosage How the medication should be taken
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... sequence Σ 0..1 integer The order of the dosage instructions
    .... text SΣ 0..1 string Free text dosage instructions e.g. SIG
    .... additionalInstruction Σ 0..* CodeableConcept Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
    Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".


    .... patientInstruction Σ 0..1 string Patient or consumer oriented instructions
    .... timing SΣ 0..1 Timing When medication should be administered
    .... asNeeded[x] Σ 0..1 Take "as needed" (for x)
    Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): 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.

    ..... asNeededBoolean boolean
    ..... asNeededCodeableConcept CodeableConcept
    .... site Σ 0..1 CodeableConcept Body site to administer to
    Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.

    .... route SΣ 0..1 CodeableConcept How drug should enter body
    Binding: SNOMEDCTRouteCodes (extensible): ☞☞☞ Use SNOMED CT and SPL(NCI Thesaurus) values in final version to meet USCDI terminology requirements

    .... method Σ 0..1 CodeableConcept Technique for administering medication
    Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.

    .... doseAndRate SΣ 0..* Element Amount of medication administered
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... type Σ 0..1 CodeableConcept The kind of dose or rate specified
    Binding: DoseAndRateType (example): The kind of dose or rate specified.

    ..... dose[x] SΣ 0..1 Amount of medication per dose
    Binding: Common UCUM units (preferred)
    Additional BindingsPurpose
    UCUMCodes Max Binding
    ...... doseQuantity Quantity S(SimpleQuantity)
    ...... doseRange Range
    ..... rate[x] Σ 0..1 Amount of medication per unit of time
    ...... rateRatio Ratio
    ...... rateRange Range
    ...... rateQuantity Quantity(SimpleQuantity)
    .... maxDosePerPeriod Σ 0..1 Ratio Upper limit on medication per unit of time
    .... maxDosePerAdministration Σ 0..1 SimpleQuantity Upper limit on medication per administration
    .... maxDosePerLifetime Σ 0..1 SimpleQuantity Upper limit on medication per lifetime of the patient
    ... dispenseRequest S 0..1 BackboneElement Medication supply authorization
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... initialFill 0..1 BackboneElement First fill details
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... quantity 0..1 SimpleQuantity First fill quantity
    ..... duration 0..1 Duration First fill duration
    .... dispenseInterval 0..1 Duration Minimum period of time between dispenses
    .... validityPeriod 0..1 Period Time period supply is authorized for
    .... numberOfRepeatsAllowed S 0..1 unsignedInt Number of refills authorized
    .... quantity S 0..1 SimpleQuantity Amount of medication to supply per dispense
    .... expectedSupplyDuration 0..1 Duration Number of days supply per dispense
    .... performer 0..1 Reference(Organization) Intended dispenser
    ... substitution 0..1 BackboneElement Any restrictions on medication substitution
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... allowed[x] 1..1 Whether substitution is allowed or not
    Binding: ActSubstanceAdminSubstitutionCode (example): Identifies the type of substitution allowed.

    ..... allowedBoolean boolean
    ..... allowedCodeableConcept CodeableConcept
    .... reason 0..1 CodeableConcept Why should (not) substitution be made
    Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.

    ... priorPrescription 0..1 Reference(MedicationRequest) An order/prescription that is being replaced
    ... detectedIssue 0..* Reference(DetectedIssue) Clinical Issue with action
    ... eventHistory 0..* Reference(Provenance) A list of events of interest in the lifecycle

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    MedicationRequest.languagepreferredCommonLanguages
    http://hl7.org/fhir/ValueSet/languages
    from the FHIR Standard
    Additional Bindings Purpose
    AllLanguages Max Binding
    MedicationRequest.statusrequiredmedicationrequest Status
    http://hl7.org/fhir/ValueSet/medicationrequest-status
    from the FHIR Standard
    MedicationRequest.statusReasonexamplemedicationRequest Status Reason Codes
    http://hl7.org/fhir/ValueSet/medicationrequest-status-reason
    from the FHIR Standard
    MedicationRequest.intentrequiredmedicationRequest Intent
    http://hl7.org/fhir/ValueSet/medicationrequest-intent
    from the FHIR Standard
    MedicationRequest.categoryexamplemedicationRequest Category Codes
    http://hl7.org/fhir/ValueSet/medicationrequest-category
    from the FHIR Standard
    MedicationRequest.category:us-corerequiredmedicationRequest Category Codes
    http://hl7.org/fhir/ValueSet/medicationrequest-category
    from the FHIR Standard
    MedicationRequest.priorityrequiredRequestPriority
    http://hl7.org/fhir/ValueSet/request-priority|4.0.1
    from the FHIR Standard
    MedicationRequest.medication[x]extensibleMedicationClinicalDrug .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
    MedicationRequest.performerTypeexampleProcedurePerformerRoleCodes
    http://hl7.org/fhir/ValueSet/performer-role
    from the FHIR Standard
    MedicationRequest.reasonCodeextensibleUSCoreConditionCodes
    http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code
    from this IG
    MedicationRequest.courseOfTherapyTypeexamplemedicationRequest Course of Therapy Codes
    http://hl7.org/fhir/ValueSet/medicationrequest-course-of-therapy
    from the FHIR Standard
    MedicationRequest.dosageInstruction.additionalInstructionexampleSNOMEDCTAdditionalDosageInstructions
    http://hl7.org/fhir/ValueSet/additional-instruction-codes
    from the FHIR Standard
    MedicationRequest.dosageInstruction.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
    http://hl7.org/fhir/ValueSet/medication-as-needed-reason
    from the FHIR Standard
    MedicationRequest.dosageInstruction.siteexampleSNOMEDCTAnatomicalStructureForAdministrationSiteCodes
    http://hl7.org/fhir/ValueSet/approach-site-codes
    from the FHIR Standard
    MedicationRequest.dosageInstruction.routeextensibleSNOMEDCTRouteCodes
    http://hl7.org/fhir/ValueSet/route-codes
    from the FHIR Standard
    MedicationRequest.dosageInstruction.methodexampleSNOMEDCTAdministrationMethodCodes
    http://hl7.org/fhir/ValueSet/administration-method-codes
    from the FHIR Standard
    MedicationRequest.dosageInstruction.doseAndRate.typeexampleDoseAndRateType
    http://hl7.org/fhir/ValueSet/dose-rate-type
    from the FHIR Standard
    MedicationRequest.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
    http://hl7.org/fhir/ValueSet/ucum-common
    from the FHIR Standard
    Additional Bindings Purpose
    UCUMCodes Max Binding
    MedicationRequest.substitution.allowed[x]exampleActSubstanceAdminSubstitutionCode
    http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode
    MedicationRequest.substitution.reasonexampleSubstanceAdminSubstitutionReason
    http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason

    Constraints

    IdGradePath(s)DetailsRequirements
    us-core-21errorMedicationRequestrequester SHALL be present if intent is "order"
    : (intent='order' or intent='original-order' or intent='reflex-order'or intent='filler-order' or intent='instance-order') implies requester.exists()

     

    Other representations of profile: CSV, Excel, Schematron

    Notes:

    Quick Start

    Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

    • See the Scopes Format section for a description of the SMART scopes syntax.
    • See the Search Syntax section for a description of the US Core search syntax.
    • See the General Requirements section for additional rules and expectations when a Server requires status parameters.
    • See the General Guidance section for additional guidance on searching for multiple patients.

    US Core Scopes

    Servers providing access to prescription data SHALL support these US Core SMART Scopes:

    Mandatory Search Parameters:

    1. SHALL support searching using the combination of the patient and intent search parameters:
      • including optional support for these _include parameters: MedicationRequest:medication
      • including support for OR search on intent (e.g.intent={system|}[code],{system|}[code],...)

      GET [base]/MedicationRequest?patient={Type/}[id]&intent=order,plan

      Example:

      1. GET [base]/MedicationRequest?patient=14676&intent=order,plan
      2. GET [base]/MedicationRequest?patient=14676&intent=order,plan&_include=MedicationRequest:medication

      Implementation Notes: Fetches a bundle of all MedicationRequest resources for the specified patient and intent code = order,plan (how to search by reference and how to search by token)

    2. SHALL support searching using the combination of the patient and intent and status search parameters:
      • including optional support for these _include parameters: MedicationRequest:medication
      • including support for OR search on intent (e.g.intent={system|}[code],{system|}[code],...)
      • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)

      GET [base]/MedicationRequest?patient={Type/}[id]&intent=order,plan&status={system|}[code]{,{system|}[code],...}

      Example:

      1. GET [base]/MedicationRequest?patient=1137192&intent=order,plan&status=active
      2. GET [base]/MedicationRequest?patient=1137192&intent=order,plan&status=active&_include=MedicationRequest:medication

      Implementation Notes: Fetches a bundle of all MedicationRequest resources for the specified patient and intent code = order,plan and status (how to search by reference and how to search by token)

    Optional Search Parameters:

    The following search parameter combinations SHOULD be supported:

    1. SHOULD support searching using the combination of the patient and intent and encounter search parameters:
      • including optional support for these _include parameters: MedicationRequest:medication
      • including support for OR search on intent (e.g.intent={system|}[code],{system|}[code],...)

      GET [base]/MedicationRequest?patient={Type/}[id]&intent=order,plan&encounter={Type/}[id]

      Example:

      1. GET [base]/MedicationRequest?patient=1137192&intent=order,plan&status=active&encounter=Encounter/123
      2. GET [base]/MedicationRequest?patient=1137192&intent=order,plan&status=active&&encounter=Encounter/123&_include=MedicationRequest:medication

      Implementation Notes: Fetches a bundle of all MedicationRequest resources for the specified patient and intent code = order,plan and encounter (how to search by reference and how to search by token)

    2. SHOULD support searching using the combination of the patient and intent and authoredon search parameters:
      • including optional support for these _include parameters: MedicationRequest:medication
      • including support for OR search on intent (e.g.intent={system|}[code],{system|}[code],...)
      • including support for these authoredon comparators: gt,lt,ge,le
      • including optional support for AND search on authoredon (e.g.authoredon=[date]&authoredon=[date]]&...)

      GET [base]/MedicationRequest?patient={Type/}[id]&intent=order,plan&authoredon={gt|lt|ge|le}[date]{&authoredon={gt|lt|ge|le}[date]&...}

      Example:

      1. GET [base]/MedicationRequest?patient=1137192&intent=order,plan&authoredon=ge2019-01-01T00:00:00Z
      2. GET [base]/MedicationRequest?patient=1137192&intent=order,plan&authoredon=ge2019-01-01T00:00:00Z&_include=MedicationRequest:medication

      Implementation Notes: Fetches a bundle of all MedicationRequest resources for the specified patient and intent code = order,plan and authoredon date (how to search by reference and how to search by token and how to search by date)