QI-Core Implementation Guide
8.0.0-ballot - STU 8 - ballot

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 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/fhir-qi-core/ and changes regularly. See the Directory of published versions

## Resource Profile: QICore Medication Prohibited

Official URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationprohibited | Version: 8.0.0-ballot
Standards status: Trial-use Active as of 2018-08-22 | Maturity Level: 4 | Computable Name: QICoreMedicationProhibited

Negation profile of MedicationRequest for decision support/quality metrics. Indicates a proposal, plan, or order not to provide a medication.

"Must Have", "QI Elements" and "primary code path" are defined in the QI-Core Must Support section.
Must Have:

- subject: (QI) Who or group medication request is for
- authoredOn: (QI) When request was initially authored
- status: (QI) active | on-hold | cancelled | completed | stopped | draft
- intent: (QI) proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
- medication[x]: (QI) Medication to be taken

QI Elements:

- doNotPerform: (QI) True if medication was not requested
- requester: (QI) Who/What requested the Request
- extension(medicationAdherence): (QI) Reported adherence to prescribed medication instructions.
- reasonCode: (QI) Reason or indication for not ordering the medication
- encounter: (QI) Encounter created as part of encounter/admission/stay
- dispenseRequest: (QI) Medication supply authorization
- reasonReference: (QI) QI-Core Condition or Observation that supports the prescription
- dosageInstruction: (QI) How medication should be taken
- reported[x]: (QI) Reported rather than primary record

Primary code path: medication
(PCPath) This element is the primary code path for this resource CQL Retrieve
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 expression retrieves instances meet measure intent for exclusion:

    define "Reason for Not Ordering Antithrombotic":
      ["MedicationProhibited": "Antithrombotic Therapy"] NoAntithromboticDischarge
        where (NoAntithromboticDischarge.reasonCode in "Medical Reason"
          or NoAntithromboticDischarge.reasonCode in "Patient Refusal")
          and (NoAntithromboticDischarge.isCommunity() or NoAntithromboticDischarge.isDischarge())
          and NoAntithromboticDischarge.intent = 'order'

For a more complete discussion of representation of negation within QI-Core and quality improvement artifacts, see the Negation in QI-Core topic.

See the patterns page for implementation and usage patterns.

### Examples

Negation Example using Valueset | Medication not indicated; indicates that none of the medications in the given `codeOptions` value set were requested.
Negation Example using code | Medication not indicated; indicates that the medication specified by code was not requested.

Usages:

- Examples for this Profile: MedicationRequest/negation-example-code and MedicationRequest/negation-example

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationRequest | C | 0..* | QICoreMedicationRequest | Ordering of medication for patient or group Constraints: us-core-21, mrq-1
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  |  |  | Content/Rules for all slices
extension:medicationAdherence |  | 0..* | (Complex) | (QI) 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
status | ?!S Σ | 1..1 | code | (QI) active | on-hold | cancelled | completed | stopped | draft Binding: Positive MedicationRequest Status (required)
intent | ?!S Σ C | 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 | 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
doNotPerform | ?!Σ | 1..1 | boolean | (QI) True if medication was not requested Fixed Value: true
reported[x] | S Σ | 0..1 |  | (QI) Reported rather than primary record
reportedBoolean |  |  | boolean S |
reportedReference |  |  | Reference S(QICore Practitioner | QICore PractitionerRole | QICore Patient | QICore RelatedPerson) |
medication[x] | S Σ C | 1..1 |  | (QI) Medication to be taken Binding: Medication Clinical Drug (preferred)
medication[x]All Types |  |  |  | Content/Rules for all Types
Slices for extension |  |  |  | Content/Rules for all slices
extension: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 | S Σ | 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
authoredOn | S Σ | 1..1 | dateTime | (QI) When request was initially authored
requester | S Σ C | 0..1 | Reference(QICore Practitioner | QICore PractitionerRole | QICore Patient) | (QI) Who/What requested the Request
reasonCode |  | 1..1 | CodeableConcept | (QI) Reason or indication for not ordering the medication Binding: QICore Negation Reason Codes (extensible): The reason the medication was prohibited
dosageInstruction | S | 0..* | Dosage | (QI) How medication should be taken
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
text | S Σ | 0..1 | string | Free text dosage instructions e.g. SIG
timing | S Σ | 0..1 | Timing | (QI) When medication should be administered
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
route | S Σ | 0..1 | CodeableConcept | How drug should enter body Binding: Route of Administration of Therapeutic Agents (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes
doseAndRate | S Σ | 0..* | Element | (QI) Amount of medication administered
dose[x] | S Σ | 0..1 |  | (QI) Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S(SimpleQuantity) |
doseRange |  |  | Range |
dispenseRequest | S | 0..1 | BackboneElement | (QI) Medication supply authorization
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
numberOfRepeatsAllowed | S | 0..1 | unsignedInt | (QI) Number of refills authorized
quantity | S | 0..1 | SimpleQuantity | (QI) Amount of medication to supply per dispense
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationRequest.status | Base | required | Positive MedicationRequest Status | 📦8.0.0-ballot | This IG
MedicationRequest.intent | Base | required | Medication request intent | 📦4.0.1 | FHIR Std.
MedicationRequest.category | Base | example | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.category:us-core | Base | required | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.medication[x] | Base | preferred | Medication Clinical Drug | 📦20240606 | VSAC v0.23
MedicationRequest.reasonCode | Base | extensible | QICore Negation Reason Codes | 📦8.0.0-ballot | This IG
MedicationRequest.dosageInstruction.​route | Base | extensible | Route of Administration of Therapeutic Agents | 📦20241015 | VSAC v0.23
MedicationRequest.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | MedicationRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | MedicationRequest | 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 | `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-4 | error | MedicationRequest | If 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-5 | error | MedicationRequest | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | MedicationRequest | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
mrq-1 | error | MedicationRequest | 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 | `(medication is Reference).not() implies medication.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor medication.coding.exists()`
us-core-21 | error | MedicationRequest | requester 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()`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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)
doNotPerform |  | 1..1 | boolean | (QI) True if medication was not requested Fixed Value: true
authoredOn |  | 1..1 | dateTime | (QI) When request was initially authored
reasonCode |  | 1..1 | CodeableConcept | (QI) Reason or indication for not ordering the medication Binding: QICore Negation Reason Codes (extensible): The reason the medication was prohibited
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
MedicationRequest.status | Base | required | Positive MedicationRequest Status | 📦8.0.0-ballot | This IG
MedicationRequest.reasonCode | Base | extensible | QICore Negation Reason Codes | 📦8.0.0-ballot | This IG

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationRequest | C | 0..* | QICoreMedicationRequest | Ordering of medication for patient or group Constraints: us-core-21, mrq-1
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 Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:medicationAdherence |  | 0..* | (Complex) | (QI) 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 | ?!S Σ | 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 | ?!S Σ C | 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 | 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 | 1..1 | boolean | (QI) True if medication was not requested Fixed Value: true
reported[x] | S Σ | 0..1 |  | (QI) Reported rather than primary record
reportedBoolean |  |  | boolean S |
reportedReference |  |  | Reference S(QICore Practitioner | QICore PractitionerRole | QICore Patient | QICore RelatedPerson) |
medication[x] | S Σ C | 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
extension: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 | S Σ | 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 | S Σ | 1..1 | dateTime | (QI) When request was initially authored
requester | S Σ C | 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 |  | 1..1 | CodeableConcept | (QI) Reason or indication for not ordering the medication Binding: QICore Negation Reason Codes (extensible): The reason the medication was prohibited
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 | S Σ | 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 | S Σ | 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 | Σ C | 0..1 | Element | (QI) When the event is to occur Constraints: tim-1, tim-2, tim-4, tim-5, tim-6, tim-7, tim-8, tim-9, tim-10
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 | S Σ | 0..1 | CodeableConcept | How drug should enter body Binding: Route of Administration of Therapeutic Agents (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes
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 | S Σ | 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] | S Σ | 0..1 |  | (QI) Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
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
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationRequest.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
MedicationRequest.status | Base | required | Positive MedicationRequest Status | 📦8.0.0-ballot | This IG
MedicationRequest.statusReason | Base | example | Medication request status reason codes | 📦4.0.1 | FHIR Std.
MedicationRequest.intent | Base | required | Medication request intent | 📦4.0.1 | FHIR Std.
MedicationRequest.category | Base | example | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.category:us-core | Base | required | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.priority | Base | required | Request priority | 📍4.0.1 | FHIR Std.
MedicationRequest.medication[x] | Base | preferred | Medication Clinical Drug | 📦20240606 | VSAC v0.23
MedicationRequest.performerType | Base | example | Procedure Performer Role Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.reasonCode | Base | extensible | QICore Negation Reason Codes | 📦8.0.0-ballot | This IG
MedicationRequest.courseOfTherapyType | Base | example | Medication request course of therapy codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​additionalInstruction | Base | example | SNOMED CT Additional Dosage Instructions | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​timing.repeat.durationUnit | Base | required | UnitsOfTime | 📍4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​timing.repeat.periodUnit | Base | required | UnitsOfTime | 📍4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​timing.repeat.dayOfWeek | Base | required | DaysOfWeek | 📍4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​timing.repeat.when | Base | required | EventTiming | 📍4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​timing.code | Base | preferred | TimingAbbreviation | 📍4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​asNeeded[x] | Base | example | SNOMED CT Medication As Needed Reason Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​site | Base | example | SNOMED CT Anatomical Structure for Administration Site Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​route | Base | extensible | Route of Administration of Therapeutic Agents | 📦20241015 | VSAC v0.23
MedicationRequest.dosageInstruction.​method | Base | example | SNOMED CT Administration Method Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​doseAndRate.type | Base | example | DoseAndRateType | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationRequest.substitution.​allowed[x] | Base | example | ActSubstanceAdminSubstitutionCode | 📦3.0.0 | THO v6.5
MedicationRequest.substitution.​reason | Base | example | SubstanceAdminSubstitutionReason | 📦3.0.0 | THO v6.5

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | MedicationRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | MedicationRequest | 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 | `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-4 | error | MedicationRequest | If 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-5 | error | MedicationRequest | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | MedicationRequest | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
mrq-1 | error | MedicationRequest | 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 | `(medication is Reference).not() implies medication.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor medication.coding.exists()`
tim-1 | error | MedicationRequest.dosageInstruction.timing.repeat | if there's a duration, there needs to be duration units | `duration.empty() or durationUnit.exists()`
tim-2 | error | MedicationRequest.dosageInstruction.timing.repeat | if there's a period, there needs to be period units | `period.empty() or periodUnit.exists()`
tim-4 | error | MedicationRequest.dosageInstruction.timing.repeat | duration SHALL be a non-negative value | `duration.exists() implies duration >= 0`
tim-5 | error | MedicationRequest.dosageInstruction.timing.repeat | period SHALL be a non-negative value | `period.exists() implies period >= 0`
tim-6 | error | MedicationRequest.dosageInstruction.timing.repeat | If there's a periodMax, there must be a period | `periodMax.empty() or period.exists()`
tim-7 | error | MedicationRequest.dosageInstruction.timing.repeat | If there's a durationMax, there must be a duration | `durationMax.empty() or duration.exists()`
tim-8 | error | MedicationRequest.dosageInstruction.timing.repeat | If there's a countMax, there must be a count | `countMax.empty() or count.exists()`
tim-9 | error | MedicationRequest.dosageInstruction.timing.repeat | If 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-10 | error | MedicationRequest.dosageInstruction.timing.repeat | If there's a timeOfDay, there cannot be a when, or vice versa | `timeOfDay.empty() or when.empty()`
us-core-21 | error | MedicationRequest | requester 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()`

Summary

Mandatory: 3 elements
Fixed: 1 element

Maturity: 4

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationRequest | C | 0..* | QICoreMedicationRequest | Ordering of medication for patient or group Constraints: us-core-21, mrq-1
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  |  |  | Content/Rules for all slices
extension:medicationAdherence |  | 0..* | (Complex) | (QI) 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
status | ?!S Σ | 1..1 | code | (QI) active | on-hold | cancelled | completed | stopped | draft Binding: Positive MedicationRequest Status (required)
intent | ?!S Σ C | 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 | 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
doNotPerform | ?!Σ | 1..1 | boolean | (QI) True if medication was not requested Fixed Value: true
reported[x] | S Σ | 0..1 |  | (QI) Reported rather than primary record
reportedBoolean |  |  | boolean S |
reportedReference |  |  | Reference S(QICore Practitioner | QICore PractitionerRole | QICore Patient | QICore RelatedPerson) |
medication[x] | S Σ C | 1..1 |  | (QI) Medication to be taken Binding: Medication Clinical Drug (preferred)
medication[x]All Types |  |  |  | Content/Rules for all Types
Slices for extension |  |  |  | Content/Rules for all slices
extension: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 | S Σ | 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
authoredOn | S Σ | 1..1 | dateTime | (QI) When request was initially authored
requester | S Σ C | 0..1 | Reference(QICore Practitioner | QICore PractitionerRole | QICore Patient) | (QI) Who/What requested the Request
reasonCode |  | 1..1 | CodeableConcept | (QI) Reason or indication for not ordering the medication Binding: QICore Negation Reason Codes (extensible): The reason the medication was prohibited
dosageInstruction | S | 0..* | Dosage | (QI) How medication should be taken
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
text | S Σ | 0..1 | string | Free text dosage instructions e.g. SIG
timing | S Σ | 0..1 | Timing | (QI) When medication should be administered
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
route | S Σ | 0..1 | CodeableConcept | How drug should enter body Binding: Route of Administration of Therapeutic Agents (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes
doseAndRate | S Σ | 0..* | Element | (QI) Amount of medication administered
dose[x] | S Σ | 0..1 |  | (QI) Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S(SimpleQuantity) |
doseRange |  |  | Range |
dispenseRequest | S | 0..1 | BackboneElement | (QI) Medication supply authorization
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
numberOfRepeatsAllowed | S | 0..1 | unsignedInt | (QI) Number of refills authorized
quantity | S | 0..1 | SimpleQuantity | (QI) Amount of medication to supply per dispense
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationRequest.status | Base | required | Positive MedicationRequest Status | 📦8.0.0-ballot | This IG
MedicationRequest.intent | Base | required | Medication request intent | 📦4.0.1 | FHIR Std.
MedicationRequest.category | Base | example | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.category:us-core | Base | required | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.medication[x] | Base | preferred | Medication Clinical Drug | 📦20240606 | VSAC v0.23
MedicationRequest.reasonCode | Base | extensible | QICore Negation Reason Codes | 📦8.0.0-ballot | This IG
MedicationRequest.dosageInstruction.​route | Base | extensible | Route of Administration of Therapeutic Agents | 📦20241015 | VSAC v0.23
MedicationRequest.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | MedicationRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | MedicationRequest | 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 | `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-4 | error | MedicationRequest | If 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-5 | error | MedicationRequest | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | MedicationRequest | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
mrq-1 | error | MedicationRequest | 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 | `(medication is Reference).not() implies medication.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor medication.coding.exists()`
us-core-21 | error | MedicationRequest | requester 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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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)
doNotPerform |  | 1..1 | boolean | (QI) True if medication was not requested Fixed Value: true
authoredOn |  | 1..1 | dateTime | (QI) When request was initially authored
reasonCode |  | 1..1 | CodeableConcept | (QI) Reason or indication for not ordering the medication Binding: QICore Negation Reason Codes (extensible): The reason the medication was prohibited
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
MedicationRequest.status | Base | required | Positive MedicationRequest Status | 📦8.0.0-ballot | This IG
MedicationRequest.reasonCode | Base | extensible | QICore Negation Reason Codes | 📦8.0.0-ballot | This IG

Snapshot ViewView

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationRequest | C | 0..* | QICoreMedicationRequest | Ordering of medication for patient or group Constraints: us-core-21, mrq-1
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 Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:medicationAdherence |  | 0..* | (Complex) | (QI) 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 | ?!S Σ | 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 | ?!S Σ C | 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 | 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 | 1..1 | boolean | (QI) True if medication was not requested Fixed Value: true
reported[x] | S Σ | 0..1 |  | (QI) Reported rather than primary record
reportedBoolean |  |  | boolean S |
reportedReference |  |  | Reference S(QICore Practitioner | QICore PractitionerRole | QICore Patient | QICore RelatedPerson) |
medication[x] | S Σ C | 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
extension: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 | S Σ | 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 | S Σ | 1..1 | dateTime | (QI) When request was initially authored
requester | S Σ C | 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 |  | 1..1 | CodeableConcept | (QI) Reason or indication for not ordering the medication Binding: QICore Negation Reason Codes (extensible): The reason the medication was prohibited
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 | S Σ | 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 | S Σ | 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 | Σ C | 0..1 | Element | (QI) When the event is to occur Constraints: tim-1, tim-2, tim-4, tim-5, tim-6, tim-7, tim-8, tim-9, tim-10
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 | S Σ | 0..1 | CodeableConcept | How drug should enter body Binding: Route of Administration of Therapeutic Agents (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes
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 | S Σ | 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] | S Σ | 0..1 |  | (QI) Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
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
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationRequest.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
MedicationRequest.status | Base | required | Positive MedicationRequest Status | 📦8.0.0-ballot | This IG
MedicationRequest.statusReason | Base | example | Medication request status reason codes | 📦4.0.1 | FHIR Std.
MedicationRequest.intent | Base | required | Medication request intent | 📦4.0.1 | FHIR Std.
MedicationRequest.category | Base | example | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.category:us-core | Base | required | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.priority | Base | required | Request priority | 📍4.0.1 | FHIR Std.
MedicationRequest.medication[x] | Base | preferred | Medication Clinical Drug | 📦20240606 | VSAC v0.23
MedicationRequest.performerType | Base | example | Procedure Performer Role Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.reasonCode | Base | extensible | QICore Negation Reason Codes | 📦8.0.0-ballot | This IG
MedicationRequest.courseOfTherapyType | Base | example | Medication request course of therapy codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​additionalInstruction | Base | example | SNOMED CT Additional Dosage Instructions | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​timing.repeat.durationUnit | Base | required | UnitsOfTime | 📍4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​timing.repeat.periodUnit | Base | required | UnitsOfTime | 📍4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​timing.repeat.dayOfWeek | Base | required | DaysOfWeek | 📍4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​timing.repeat.when | Base | required | EventTiming | 📍4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​timing.code | Base | preferred | TimingAbbreviation | 📍4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​asNeeded[x] | Base | example | SNOMED CT Medication As Needed Reason Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​site | Base | example | SNOMED CT Anatomical Structure for Administration Site Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​route | Base | extensible | Route of Administration of Therapeutic Agents | 📦20241015 | VSAC v0.23
MedicationRequest.dosageInstruction.​method | Base | example | SNOMED CT Administration Method Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​doseAndRate.type | Base | example | DoseAndRateType | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationRequest.substitution.​allowed[x] | Base | example | ActSubstanceAdminSubstitutionCode | 📦3.0.0 | THO v6.5
MedicationRequest.substitution.​reason | Base | example | SubstanceAdminSubstitutionReason | 📦3.0.0 | THO v6.5

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | MedicationRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | MedicationRequest | 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 | `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-4 | error | MedicationRequest | If 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-5 | error | MedicationRequest | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | MedicationRequest | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
mrq-1 | error | MedicationRequest | 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 | `(medication is Reference).not() implies medication.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor medication.coding.exists()`
tim-1 | error | MedicationRequest.dosageInstruction.timing.repeat | if there's a duration, there needs to be duration units | `duration.empty() or durationUnit.exists()`
tim-2 | error | MedicationRequest.dosageInstruction.timing.repeat | if there's a period, there needs to be period units | `period.empty() or periodUnit.exists()`
tim-4 | error | MedicationRequest.dosageInstruction.timing.repeat | duration SHALL be a non-negative value | `duration.exists() implies duration >= 0`
tim-5 | error | MedicationRequest.dosageInstruction.timing.repeat | period SHALL be a non-negative value | `period.exists() implies period >= 0`
tim-6 | error | MedicationRequest.dosageInstruction.timing.repeat | If there's a periodMax, there must be a period | `periodMax.empty() or period.exists()`
tim-7 | error | MedicationRequest.dosageInstruction.timing.repeat | If there's a durationMax, there must be a duration | `durationMax.empty() or duration.exists()`
tim-8 | error | MedicationRequest.dosageInstruction.timing.repeat | If there's a countMax, there must be a count | `countMax.empty() or count.exists()`
tim-9 | error | MedicationRequest.dosageInstruction.timing.repeat | If 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-10 | error | MedicationRequest.dosageInstruction.timing.repeat | If there's a timeOfDay, there cannot be a when, or vice versa | `timeOfDay.empty() or when.empty()`
us-core-21 | error | MedicationRequest | requester 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()`

Summary

Mandatory: 3 elements
Fixed: 1 element

Maturity: 4

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