QI-Core Implementation Guide
7.0.0 - STU7 United States of America flag

QI-Core Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 7.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-qi-core/ and changes regularly. See the Directory of published versions

Resource Profile: QICore MedicationRequested

Official URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequested Version: 7.0.0
Active as of 2018-08-22 Computable Name: QICoreMedicationRequested

Positive profile of MedicationRequest for decision support/quality metrics. Indicates that a medication was proposed, planned, or ordered.

Must Have:
  • status: (QI) active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
  • intent: (QI) proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
  • medication[x]: (QI) Medication to be taken
  • subject: (QI) Who or group medication request is for
QI Elements:
  • doNotPerform: (QI) True if medication was not requested
  • reported[x]: (QI) Reported rather than primary record
  • encounter: (QI) Encounter created as part of encounter/admission/stay
  • authoredOn: (QI) When request was initially authored
  • requester: (QI) Who/What requested the Request
  • reasonCode: (QI) Reason or indication for ordering or not ordering the medication
  • reasonReference: (QI) QI-Core Condition or Observation that supports the prescription
  • dosageInstruction: (QI) How medication should be taken
  • dosageInstruction.timing: (QI) When medication should be administered
  • dosageInstruction.timing.repeat: (QI) When the event is to occur
  • dosageInstruction.timing.repeat.bounds[x]: (QI) Length/Range of lengths, or (Start and/or end) limits
  • dosageInstruction.timing.repeat.frequency: (QI) Event occurs frequency times per period
  • dosageInstruction.timing.repeat.frequencyMax: (QI) Event occurs frequencyMax times per period
  • dosageInstruction.timing.repeat.period: (QI) Event occurs frequency times per period
  • dosageInstruction.timing.repeat.periodMax: (QI) Upper limit of period (3-4 hours)
  • dosageInstruction.timing.repeat.periodUnit: (QI) s | min | h | d | wk | mo | a - unit of time (UCUM)
  • dosageInstruction.asNeeded[x]: (QI) Take "as needed" (for x)
  • dosageInstruction.doseAndRate: (QI) Amount of medication administered
  • dosageInstruction.doseAndRate.dose[x]: (QI) Amount of medication per dose
  • dispenseRequest: (QI) Medication supply authorization
  • dispenseRequest.dispenseInterval: (QI) Minimum period of time between dispenses
  • dispenseRequest.validityPeriod: (QI) Time period supply is authorized for
  • dispenseRequest.numberOfRepeatsAllowed: (QI) Number of refills authorized
  • dispenseRequest.quantity: (QI) Amount of medication to supply per dispense
  • dispenseRequest.expectedSupplyDuration: (QI) Number of days supply per dispense
Primary code path: medication
(PCPath) This element is the primary code path for this resource CQL Retrieve


NOTE TO BALLOT REVIEWERS:
  • US Core 7.0, and thus QI-Core 7.0, has a new approach to USCDI requirements.
    • As noted in the US Core 7.0 Must Support section, US Core 7.0 no longer highlights mandatory (cardinality 1..* or 1..1) and Must Support elements with a (USCDI) indicator as such items must be supported for interoperability.
    • Those USCDI elements that are not mandatory or Must Support now include an indicator (ADDITIONAL USCDI) in US Core. QI-Core 7.0 does not reference USCDI elements; rather, users should access US Core 7.0 to understand its implementation of USCDI version 4.
  • We invite comments about the approach and suggestions for other options that would also avoid unnecessary noise or reading load to the QI-Core profile representation.
  • Further, QI-Core 7.0 does not discuss USCDI+Quality because at the time of ballot preparation, no published version of USCDI+Quality is available. We seek reviewer advice regarding how QI-Core might address future USCDI+Quality.

Usage

The MedicationRequest profile defines the conformance expectations for a MedicationRequest, regardless of whether it is a positive or negative statement. The MedicationRequested and MedicationNotRequested profiles represent the positive and negative statements for a medication order.

To create an expression indicating the existence of a medication request, use the profile QICoreMedicationRequested; to specifically request information that a MedicationRequest intentionally did not occur for a medical, patient or system reason, use the profile QICoreMedicationProhibited.

The following example illustrates the use of the MedicationRequest profile:

define "Antithrombotic Therapy at Discharge":
  ["MedicationRequested": medication in "Antithrombotic Therapy"] Antithrombotic
    where (Antithrombotic.isCommunity() or Antithrombotic.isDischarge())
      and Antithrombotic.intent = 'order'

Note that the doNotPerform and statuses indicating positive intent are implied by the use of the MedicationRequested profile.

See the patterns page for implementation and usage patterns.

Examples

Penicillin MedicationRequest Example

Usage:

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest C 0..* QICoreMedicationRequest 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"
mrq-1: To indicate what medication, either a reference to a Medication, or either at least one coding in the medication or a codeOperations extension shall be provided
... 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) Reported adherence to prescribed medication instructions.
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
... intent ?!SΣC 1..1 code (QI) 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 (QI) Type of medication usage
Slice: Unordered, Open by pattern:$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 (QI) True if medication was not requested
ele-1: All FHIR elements must have a @value or children
Fixed Value: false
... reported[x] SΣ 0..1 (QI) Reported rather than primary record
ele-1: All FHIR elements must have a @value or children
.... reportedBoolean boolean
.... reportedReference Reference(QICore Practitioner | QICore PractitionerRole | QICore Patient | QICore RelatedPerson)
... medication[x] SΣC 1..1 (QI) Medication to be taken
Binding: Medication Clinical Drug . (preferred)
ele-1: All FHIR elements must have a @value or children
.... medication[x]All Types Content/Rules for all Types
..... Slices for extension Content/Rules for all slices
...... codeOptions C 0..1 canonical(ValueSet) (QI) Url of a value set of candidate medications
URL: http://hl7.org/fhir/StructureDefinition/codeOptions
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(US Core Medication Profile)
... subject SΣ 1..1 Reference(QICore Patient) (QI) Who or group medication request is for
ele-1: All FHIR elements must have a @value or children
... encounter S 0..1 Reference(QICore Encounter) (QI) Encounter created as part of encounter/admission/stay
ele-1: All FHIR elements must have a @value or children
... authoredOn SΣ 0..1 dateTime (QI) When request was initially authored
ele-1: All FHIR elements must have a @value or children
... requester SΣC 0..1 Reference(QICore Practitioner | QICore PractitionerRole | QICore Patient) (QI) Who/What requested the Request
ele-1: All FHIR elements must have a @value or children
... dosageInstruction S 0..* Dosage (QI) How 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 (QI) When medication should be administered
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
.... doseAndRate SΣ 0..* Element (QI) Amount of medication administered
ele-1: All FHIR elements must have a @value or children
..... dose[x] SΣ 0..1 (QI) 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 (QI) 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 (QI) Number of refills authorized
ele-1: All FHIR elements must have a @value or children
.... quantity S 0..1 SimpleQuantity (QI) 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.statusrequiredPositiveMedicationRequestStatus
http://hl7.org/fhir/us/qicore/ValueSet/qicore-positive-medicationrequest-status
from this IG
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]preferredMedicationClinicalDrug .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
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
dom-2errorMedicationRequestIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationRequestIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorMedicationRequestIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorMedicationRequestIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationRequestA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
mrq-1errorMedicationRequestTo indicate what medication, either a reference to a Medication, or either at least one coding in the medication or a codeOperations extension shall be provided
: (medication is Reference).not() implies medication.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor medication.coding.exists()
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()

This structure is derived from QICoreMedicationRequest

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest 0..* QICoreMedicationRequest Ordering of medication for patient or group
... status 1..1 code (QI) active | on-hold | cancelled | completed | stopped | draft
Binding: Positive MedicationRequest Status (required)
... category S 0..* CodeableConcept (QI) Type of medication usage
Slice: Unordered, Open by pattern:$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.


... doNotPerform 0..1 boolean (QI) True if medication was not requested
Fixed Value: false

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
MedicationRequest.statusrequiredPositiveMedicationRequestStatus
http://hl7.org/fhir/us/qicore/ValueSet/qicore-positive-medicationrequest-status
from this IG
MedicationRequest.categoryexamplemedicationRequest Category Codes
http://hl7.org/fhir/ValueSet/medicationrequest-category
from the FHIR Standard
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest C 0..* QICoreMedicationRequest Ordering of medication for patient or group
us-core-21: requester SHALL be present if intent is "order"
mrq-1: To indicate what medication, either a reference to a Medication, or either at least one coding in the medication or a codeOperations extension shall be provided
... 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) Reported adherence to prescribed medication instructions.
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 (QI) active | on-hold | cancelled | completed | stopped | draft
Binding: Positive MedicationRequest Status (required)
... 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 (QI) 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 (QI) Type of medication usage
Slice: Unordered, Open by pattern:$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 (QI) True if medication was not requested
Fixed Value: false
... reported[x] SΣ 0..1 (QI) Reported rather than primary record
.... reportedBoolean boolean S
.... reportedReference Reference S(QICore Practitioner | QICore PractitionerRole | QICore Patient | QICore RelatedPerson)
... medication[x] SΣC 1..1 (QI) Medication to be taken
Binding: Medication Clinical Drug . (preferred)
.... medication[x]All Types Content/Rules for all Types
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... codeOptions C 0..1 canonical(ValueSet) (QI) Url of a value set of candidate medications
URL: http://hl7.org/fhir/StructureDefinition/codeOptions
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(US Core Medication Profile)
... subject SΣ 1..1 Reference(QICore Patient) (QI) Who or group medication request is for
... encounter S 0..1 Reference(QICore Encounter) (QI) Encounter created as part of encounter/admission/stay
... supportingInformation 0..* Reference(Resource) Information to support ordering of the medication
... authoredOn SΣ 0..1 dateTime (QI) When request was initially authored
... requester SΣC 0..1 Reference(QICore Practitioner | QICore PractitionerRole | QICore Patient) (QI) 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 (QI) Reason or indication for ordering or not ordering the medication
Binding: US Core Condition Codes (extensible)
... reasonReference 0..* Reference(QICore Condition Encounter Diagnosis | QICore Condition Problems Health Concerns | QICore Simple Observation) (QI) QI-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 (QI) How 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 (QI) When medication should be 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
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... event Σ 0..* dateTime When the event occurs
..... repeat ΣC 0..1 Element (QI) When the event is to occur
tim-1: if there's a duration, there needs to be duration units
tim-2: if there's a period, there needs to be period units
tim-4: duration SHALL be a non-negative value
tim-5: period SHALL be a non-negative value
tim-6: If there's a periodMax, there must be a period
tim-7: If there's a durationMax, there must be a duration
tim-8: If there's a countMax, there must be a count
tim-9: If there's an offset, there must be a when (and not C, CM, CD, CV)
tim-10: If there's a timeOfDay, there cannot be a when, or vice versa
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... bounds[x] Σ 0..1 (QI) Length/Range of lengths, or (Start and/or end) limits
....... boundsDuration Duration
....... boundsRange Range
....... boundsPeriod Period
...... count Σ 0..1 positiveInt Number of times to repeat
...... countMax Σ 0..1 positiveInt Maximum number of times to repeat
...... duration Σ 0..1 decimal How long when it happens
...... durationMax Σ 0..1 decimal How long when it happens (Max)
...... durationUnit Σ 0..1 code s | min | h | d | wk | mo | a - unit of time (UCUM)
Binding: UnitsOfTime (required): A unit of time (units from UCUM).

...... frequency Σ 0..1 positiveInt (QI) Event occurs frequency times per period
...... frequencyMax Σ 0..1 positiveInt (QI) Event occurs frequencyMax times per period
...... period Σ 0..1 decimal (QI) Event occurs frequency times per period
...... periodMax Σ 0..1 decimal (QI) Upper limit of period (3-4 hours)
...... periodUnit Σ 0..1 code (QI) s | min | h | d | wk | mo | a - unit of time (UCUM)
Binding: UnitsOfTime (required): A unit of time (units from UCUM).

...... dayOfWeek Σ 0..* code mon | tue | wed | thu | fri | sat | sun
Binding: DaysOfWeek (required)
...... timeOfDay Σ 0..* time Time of day for action
...... when Σ 0..* code Code for time period of occurrence
Binding: EventTiming (required): Real world event relating to the schedule.


...... offset Σ 0..1 unsignedInt Minutes from event (before or after)
..... code Σ 0..1 CodeableConcept BID | TID | QID | AM | PM | QD | QOD | +
Binding: TimingAbbreviation (preferred): Code for a known / defined timing pattern.

.... asNeeded[x] Σ 0..1 (QI) 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 Σ 0..1 CodeableConcept How drug should enter body
Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

.... 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 (QI) 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 (QI) 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 (QI) 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
.... dispenseInterval 0..1 Duration (QI) Minimum period of time between dispenses
.... validityPeriod 0..1 Period (QI) Time period supply is authorized for
.... numberOfRepeatsAllowed S 0..1 unsignedInt (QI) Number of refills authorized
.... quantity S 0..1 SimpleQuantity (QI) Amount of medication to supply per dispense
.... expectedSupplyDuration 0..1 Duration (QI) 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.statusrequiredPositiveMedicationRequestStatus
http://hl7.org/fhir/us/qicore/ValueSet/qicore-positive-medicationrequest-status
from this IG
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]preferredMedicationClinicalDrug .
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
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.timing.repeat.durationUnitrequiredUnitsOfTime
http://hl7.org/fhir/ValueSet/units-of-time|4.0.1
from the FHIR Standard
MedicationRequest.dosageInstruction.timing.repeat.periodUnitrequiredUnitsOfTime
http://hl7.org/fhir/ValueSet/units-of-time|4.0.1
from the FHIR Standard
MedicationRequest.dosageInstruction.timing.repeat.dayOfWeekrequiredDaysOfWeek
http://hl7.org/fhir/ValueSet/days-of-week|4.0.1
from the FHIR Standard
MedicationRequest.dosageInstruction.timing.repeat.whenrequiredEventTiming
http://hl7.org/fhir/ValueSet/event-timing|4.0.1
from the FHIR Standard
MedicationRequest.dosageInstruction.timing.codepreferredTimingAbbreviation
http://hl7.org/fhir/ValueSet/timing-abbreviation
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.routeexampleSNOMEDCTRouteCodes
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
dom-2errorMedicationRequestIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationRequestIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorMedicationRequestIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorMedicationRequestIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationRequestA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
mrq-1errorMedicationRequestTo indicate what medication, either a reference to a Medication, or either at least one coding in the medication or a codeOperations extension shall be provided
: (medication is Reference).not() implies medication.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor medication.coding.exists()
tim-1errorMedicationRequest.dosageInstruction.timing.repeatif there's a duration, there needs to be duration units
: duration.empty() or durationUnit.exists()
tim-2errorMedicationRequest.dosageInstruction.timing.repeatif there's a period, there needs to be period units
: period.empty() or periodUnit.exists()
tim-4errorMedicationRequest.dosageInstruction.timing.repeatduration SHALL be a non-negative value
: duration.exists() implies duration >= 0
tim-5errorMedicationRequest.dosageInstruction.timing.repeatperiod SHALL be a non-negative value
: period.exists() implies period >= 0
tim-6errorMedicationRequest.dosageInstruction.timing.repeatIf there's a periodMax, there must be a period
: periodMax.empty() or period.exists()
tim-7errorMedicationRequest.dosageInstruction.timing.repeatIf there's a durationMax, there must be a duration
: durationMax.empty() or duration.exists()
tim-8errorMedicationRequest.dosageInstruction.timing.repeatIf there's a countMax, there must be a count
: countMax.empty() or count.exists()
tim-9errorMedicationRequest.dosageInstruction.timing.repeatIf there's an offset, there must be a when (and not C, CM, CD, CV)
: offset.empty() or (when.exists() and ((when in ('C' | 'CM' | 'CD' | 'CV')).not()))
tim-10errorMedicationRequest.dosageInstruction.timing.repeatIf there's a timeOfDay, there cannot be a when, or vice versa
: timeOfDay.empty() or when.empty()
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()

This structure is derived from QICoreMedicationRequest

Summary

Must-Support: 1 element
Fixed: 1 element

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of MedicationRequest.category

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest C 0..* QICoreMedicationRequest 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"
mrq-1: To indicate what medication, either a reference to a Medication, or either at least one coding in the medication or a codeOperations extension shall be provided
... 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) Reported adherence to prescribed medication instructions.
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
... intent ?!SΣC 1..1 code (QI) 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 (QI) Type of medication usage
Slice: Unordered, Open by pattern:$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 (QI) True if medication was not requested
ele-1: All FHIR elements must have a @value or children
Fixed Value: false
... reported[x] SΣ 0..1 (QI) Reported rather than primary record
ele-1: All FHIR elements must have a @value or children
.... reportedBoolean boolean
.... reportedReference Reference(QICore Practitioner | QICore PractitionerRole | QICore Patient | QICore RelatedPerson)
... medication[x] SΣC 1..1 (QI) Medication to be taken
Binding: Medication Clinical Drug . (preferred)
ele-1: All FHIR elements must have a @value or children
.... medication[x]All Types Content/Rules for all Types
..... Slices for extension Content/Rules for all slices
...... codeOptions C 0..1 canonical(ValueSet) (QI) Url of a value set of candidate medications
URL: http://hl7.org/fhir/StructureDefinition/codeOptions
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(US Core Medication Profile)
... subject SΣ 1..1 Reference(QICore Patient) (QI) Who or group medication request is for
ele-1: All FHIR elements must have a @value or children
... encounter S 0..1 Reference(QICore Encounter) (QI) Encounter created as part of encounter/admission/stay
ele-1: All FHIR elements must have a @value or children
... authoredOn SΣ 0..1 dateTime (QI) When request was initially authored
ele-1: All FHIR elements must have a @value or children
... requester SΣC 0..1 Reference(QICore Practitioner | QICore PractitionerRole | QICore Patient) (QI) Who/What requested the Request
ele-1: All FHIR elements must have a @value or children
... dosageInstruction S 0..* Dosage (QI) How 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 (QI) When medication should be administered
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
.... doseAndRate SΣ 0..* Element (QI) Amount of medication administered
ele-1: All FHIR elements must have a @value or children
..... dose[x] SΣ 0..1 (QI) 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 (QI) 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 (QI) Number of refills authorized
ele-1: All FHIR elements must have a @value or children
.... quantity S 0..1 SimpleQuantity (QI) 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.statusrequiredPositiveMedicationRequestStatus
http://hl7.org/fhir/us/qicore/ValueSet/qicore-positive-medicationrequest-status
from this IG
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]preferredMedicationClinicalDrug .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
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
dom-2errorMedicationRequestIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationRequestIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorMedicationRequestIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorMedicationRequestIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationRequestA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
mrq-1errorMedicationRequestTo indicate what medication, either a reference to a Medication, or either at least one coding in the medication or a codeOperations extension shall be provided
: (medication is Reference).not() implies medication.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor medication.coding.exists()
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 QICoreMedicationRequest

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest 0..* QICoreMedicationRequest Ordering of medication for patient or group
... status 1..1 code (QI) active | on-hold | cancelled | completed | stopped | draft
Binding: Positive MedicationRequest Status (required)
... category S 0..* CodeableConcept (QI) Type of medication usage
Slice: Unordered, Open by pattern:$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.


... doNotPerform 0..1 boolean (QI) True if medication was not requested
Fixed Value: false

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
MedicationRequest.statusrequiredPositiveMedicationRequestStatus
http://hl7.org/fhir/us/qicore/ValueSet/qicore-positive-medicationrequest-status
from this IG
MedicationRequest.categoryexamplemedicationRequest Category Codes
http://hl7.org/fhir/ValueSet/medicationrequest-category
from the FHIR Standard

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest C 0..* QICoreMedicationRequest Ordering of medication for patient or group
us-core-21: requester SHALL be present if intent is "order"
mrq-1: To indicate what medication, either a reference to a Medication, or either at least one coding in the medication or a codeOperations extension shall be provided
... 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) Reported adherence to prescribed medication instructions.
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 (QI) active | on-hold | cancelled | completed | stopped | draft
Binding: Positive MedicationRequest Status (required)
... 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 (QI) 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 (QI) Type of medication usage
Slice: Unordered, Open by pattern:$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 (QI) True if medication was not requested
Fixed Value: false
... reported[x] SΣ 0..1 (QI) Reported rather than primary record
.... reportedBoolean boolean S
.... reportedReference Reference S(QICore Practitioner | QICore PractitionerRole | QICore Patient | QICore RelatedPerson)
... medication[x] SΣC 1..1 (QI) Medication to be taken
Binding: Medication Clinical Drug . (preferred)
.... medication[x]All Types Content/Rules for all Types
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... codeOptions C 0..1 canonical(ValueSet) (QI) Url of a value set of candidate medications
URL: http://hl7.org/fhir/StructureDefinition/codeOptions
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(US Core Medication Profile)
... subject SΣ 1..1 Reference(QICore Patient) (QI) Who or group medication request is for
... encounter S 0..1 Reference(QICore Encounter) (QI) Encounter created as part of encounter/admission/stay
... supportingInformation 0..* Reference(Resource) Information to support ordering of the medication
... authoredOn SΣ 0..1 dateTime (QI) When request was initially authored
... requester SΣC 0..1 Reference(QICore Practitioner | QICore PractitionerRole | QICore Patient) (QI) 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 (QI) Reason or indication for ordering or not ordering the medication
Binding: US Core Condition Codes (extensible)
... reasonReference 0..* Reference(QICore Condition Encounter Diagnosis | QICore Condition Problems Health Concerns | QICore Simple Observation) (QI) QI-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 (QI) How 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 (QI) When medication should be 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
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... event Σ 0..* dateTime When the event occurs
..... repeat ΣC 0..1 Element (QI) When the event is to occur
tim-1: if there's a duration, there needs to be duration units
tim-2: if there's a period, there needs to be period units
tim-4: duration SHALL be a non-negative value
tim-5: period SHALL be a non-negative value
tim-6: If there's a periodMax, there must be a period
tim-7: If there's a durationMax, there must be a duration
tim-8: If there's a countMax, there must be a count
tim-9: If there's an offset, there must be a when (and not C, CM, CD, CV)
tim-10: If there's a timeOfDay, there cannot be a when, or vice versa
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... bounds[x] Σ 0..1 (QI) Length/Range of lengths, or (Start and/or end) limits
....... boundsDuration Duration
....... boundsRange Range
....... boundsPeriod Period
...... count Σ 0..1 positiveInt Number of times to repeat
...... countMax Σ 0..1 positiveInt Maximum number of times to repeat
...... duration Σ 0..1 decimal How long when it happens
...... durationMax Σ 0..1 decimal How long when it happens (Max)
...... durationUnit Σ 0..1 code s | min | h | d | wk | mo | a - unit of time (UCUM)
Binding: UnitsOfTime (required): A unit of time (units from UCUM).

...... frequency Σ 0..1 positiveInt (QI) Event occurs frequency times per period
...... frequencyMax Σ 0..1 positiveInt (QI) Event occurs frequencyMax times per period
...... period Σ 0..1 decimal (QI) Event occurs frequency times per period
...... periodMax Σ 0..1 decimal (QI) Upper limit of period (3-4 hours)
...... periodUnit Σ 0..1 code (QI) s | min | h | d | wk | mo | a - unit of time (UCUM)
Binding: UnitsOfTime (required): A unit of time (units from UCUM).

...... dayOfWeek Σ 0..* code mon | tue | wed | thu | fri | sat | sun
Binding: DaysOfWeek (required)
...... timeOfDay Σ 0..* time Time of day for action
...... when Σ 0..* code Code for time period of occurrence
Binding: EventTiming (required): Real world event relating to the schedule.


...... offset Σ 0..1 unsignedInt Minutes from event (before or after)
..... code Σ 0..1 CodeableConcept BID | TID | QID | AM | PM | QD | QOD | +
Binding: TimingAbbreviation (preferred): Code for a known / defined timing pattern.

.... asNeeded[x] Σ 0..1 (QI) 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 Σ 0..1 CodeableConcept How drug should enter body
Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

.... 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 (QI) 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 (QI) 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 (QI) 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
.... dispenseInterval 0..1 Duration (QI) Minimum period of time between dispenses
.... validityPeriod 0..1 Period (QI) Time period supply is authorized for
.... numberOfRepeatsAllowed S 0..1 unsignedInt (QI) Number of refills authorized
.... quantity S 0..1 SimpleQuantity (QI) Amount of medication to supply per dispense
.... expectedSupplyDuration 0..1 Duration (QI) 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.statusrequiredPositiveMedicationRequestStatus
http://hl7.org/fhir/us/qicore/ValueSet/qicore-positive-medicationrequest-status
from this IG
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]preferredMedicationClinicalDrug .
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
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.timing.repeat.durationUnitrequiredUnitsOfTime
http://hl7.org/fhir/ValueSet/units-of-time|4.0.1
from the FHIR Standard
MedicationRequest.dosageInstruction.timing.repeat.periodUnitrequiredUnitsOfTime
http://hl7.org/fhir/ValueSet/units-of-time|4.0.1
from the FHIR Standard
MedicationRequest.dosageInstruction.timing.repeat.dayOfWeekrequiredDaysOfWeek
http://hl7.org/fhir/ValueSet/days-of-week|4.0.1
from the FHIR Standard
MedicationRequest.dosageInstruction.timing.repeat.whenrequiredEventTiming
http://hl7.org/fhir/ValueSet/event-timing|4.0.1
from the FHIR Standard
MedicationRequest.dosageInstruction.timing.codepreferredTimingAbbreviation
http://hl7.org/fhir/ValueSet/timing-abbreviation
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.routeexampleSNOMEDCTRouteCodes
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
dom-2errorMedicationRequestIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationRequestIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorMedicationRequestIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorMedicationRequestIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationRequestA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
mrq-1errorMedicationRequestTo indicate what medication, either a reference to a Medication, or either at least one coding in the medication or a codeOperations extension shall be provided
: (medication is Reference).not() implies medication.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor medication.coding.exists()
tim-1errorMedicationRequest.dosageInstruction.timing.repeatif there's a duration, there needs to be duration units
: duration.empty() or durationUnit.exists()
tim-2errorMedicationRequest.dosageInstruction.timing.repeatif there's a period, there needs to be period units
: period.empty() or periodUnit.exists()
tim-4errorMedicationRequest.dosageInstruction.timing.repeatduration SHALL be a non-negative value
: duration.exists() implies duration >= 0
tim-5errorMedicationRequest.dosageInstruction.timing.repeatperiod SHALL be a non-negative value
: period.exists() implies period >= 0
tim-6errorMedicationRequest.dosageInstruction.timing.repeatIf there's a periodMax, there must be a period
: periodMax.empty() or period.exists()
tim-7errorMedicationRequest.dosageInstruction.timing.repeatIf there's a durationMax, there must be a duration
: durationMax.empty() or duration.exists()
tim-8errorMedicationRequest.dosageInstruction.timing.repeatIf there's a countMax, there must be a count
: countMax.empty() or count.exists()
tim-9errorMedicationRequest.dosageInstruction.timing.repeatIf there's an offset, there must be a when (and not C, CM, CD, CV)
: offset.empty() or (when.exists() and ((when in ('C' | 'CM' | 'CD' | 'CV')).not()))
tim-10errorMedicationRequest.dosageInstruction.timing.repeatIf there's a timeOfDay, there cannot be a when, or vice versa
: timeOfDay.empty() or when.empty()
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()

This structure is derived from QICoreMedicationRequest

Summary

Must-Support: 1 element
Fixed: 1 element

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of MedicationRequest.category

 

Other representations of profile: CSV, Excel, Schematron