HL7 FHIR Implementation Guide - New Zealand Formulary/NZULM IG
1.0.0 - ci-build

HL7 FHIR Implementation Guide - New Zealand Formulary/NZULM IG, published by New Zealand Medicines Formulary LP. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7NZ/nzf/ and changes regularly. See the Directory of published versions

Resource Profile: NzfMedication - Detailed Descriptions

Active as of 2024-05-06

Definitions for the NzfMedication resource profile.

Guidance on how to interpret the contents of this table can be found here

0. Medication
2. Medication.extension
SlicingThis element introduces a set of slices on Medication.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. Medication.extension:nzmtType
    Slice NamenzmtType
    ShortThe NZ Medicines Terminology (NZMT) Data Class – MP (Medicinal Product), MPUU (Medicinal Product Unit of Use), MPP (Medicinal Product Pack), TP (Trade Product), TPUU (Trade Product Unit of Use), TPP (Trade Product Pack) or CTPP (Containered Trade Product Pack) – that the Medication is a member of.
    Control0..1
    TypeExtension(NzmtType) (Extension Type: CodeableConcept)
    6. Medication.extension:atc
    Slice Nameatc
    ShortAnatomical Therapeutic Chemical (ATC) Classification
    Control0..*
    TypeExtension(Atc) (Extension Type: CodeableConcept)
    8. Medication.extension:link
    Slice Namelink
    ShortLinks to other information about this medication
    Control0..*
    TypeExtension(Link) (Extension Type: Reference(DocumentReference))
    10. Medication.extension:cal
    Slice Namecal
    ShortCautionary and Advisory Label
    Control0..*
    TypeExtension(Cautionary and Advisory Label) (Complex Extension)
    12. Medication.extension:funding
    Slice Namefunding
    ShortGeneral Funding details
    Control0..*
    TypeExtension(Funding) (Complex Extension)
    14. Medication.extension:fundingRule
    Slice NamefundingRule
    ShortFunding constraints and requirements
    Control0..*
    TypeExtension(FundingRule) (Complex Extension)
    16. Medication.extension:description
    Slice Namedescription
    ShortNZMT descriptions for the medicine
    Control0..*
    TypeExtension(NzmtDescription) (Complex Extension)
    18. Medication.extension:unapproved
    Slice Nameunapproved
    ShortWhether the medication can be used under section29
    Control0..1
    TypeExtension(Unapproved) (Extension Type: boolean)
    20. Medication.extension:legalclass
    Slice Namelegalclass
    ShortLegal classification of the medication
    Control0..1
    TypeExtension(LegalClass) (Complex Extension)
    22. Medication.extension:medsafe
    Slice Namemedsafe
    ShortMedsafe details of the medication
    Control0..1
    TypeExtension(Medsafe) (Complex Extension)
    24. Medication.extension:prescribebybrand
    Slice Nameprescribebybrand
    ShortTrue if can be prescribed by brand
    Control0..1
    TypeExtension(PrescribeByBrand) (Extension Type: boolean)
    26. Medication.extension:supplyinformation
    Slice Namesupplyinformation
    ShortSupply information
    Control0..*
    TypeExtension(SupplyInformation) (Complex Extension)
    28. Medication.extension:nzfpack
    Slice Namenzfpack
    ShortNZF Pack details
    Control0..1
    TypeExtension(NzfPack) (Complex Extension)
    30. Medication.extension:relatedmedication
    Slice Namerelatedmedication
    ShortRelated medication
    Control0..*
    TypeExtension(RelatedMedication) (Complex Extension)
    32. Medication.code
    BindingThe codes SHOULD be taken from http://nzmt.org.nz/vs
    (preferred to http://nzmt.org.nz/vs)
    34. Medication.manufacturer
    Control0..0
    36. Medication.amount
    Control0..0
    38. Medication.batch
    Control0..0

    Guidance on how to interpret the contents of this table can be found here

    0. Medication
    Definition

    This resource is primarily used for the identification and definition of a medication for the purposes of prescribing, dispensing, and administering a medication as well as for making statements about medication use.

    ShortDefinition of a Medication
    Control0..*
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
    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 (contained.where(((id.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty())
    dom-4: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    2. Medication.implicitRules
    Definition

    A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

    ShortA set of rules under which this content was created
    Comments

    Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

    Control0..1
    Typeuri
    Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    4. Medication.extension
    Definition

    An Extension


    May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

    ShortExtensionAdditional content defined by implementations
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    SlicingThis element introduces a set of slices on Medication.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 6. Medication.extension:nzmtType
      Slice NamenzmtType
      Definition

      The NZ Medicines Terminology (NZMT) Data Class – MP (Medicinal Product), MPUU (Medicinal Product Unit of Use), MPP (Medicinal Product Pack), TP (Trade Product), TPUU (Trade Product Unit of Use), TPP (Trade Product Pack) or CTPP (Containered Trade Product Pack) – that the Medication is a member of.

      ShortThe NZ Medicines Terminology (NZMT) Data Class – MP (Medicinal Product), MPUU (Medicinal Product Unit of Use), MPP (Medicinal Product Pack), TP (Trade Product), TPUU (Trade Product Unit of Use), TPP (Trade Product Pack) or CTPP (Containered Trade Product Pack) – that the Medication is a member of.
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(NzmtType) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      8. Medication.extension:atc
      Slice Nameatc
      Definition

      Anatomical Therapeutic Chemical (ATC) Classification - see https://www.who.int/tools/atc-ddd-toolkit/atc-classification

      ShortAnatomical Therapeutic Chemical (ATC) Classification
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(Atc) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      10. Medication.extension:link
      Slice Namelink
      Definition

      Reference to other information about this medication

      ShortLinks to other information about this medication
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(Link) (Extension Type: Reference(DocumentReference))
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      12. Medication.extension:cal
      Slice Namecal
      Definition

      Cautionary and Advisory Label

      ShortCautionary and Advisory Label
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(Cautionary and Advisory Label) (Complex Extension)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      14. Medication.extension:funding
      Slice Namefunding
      Definition

      Core funding information specific to NZ. The extension can be added multiple times to a product for each PHARMAC schedule. These can be differentiated via the scheduleDate field.

      ShortGeneral Funding details
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(Funding) (Complex Extension)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      16. Medication.extension:fundingRule
      Slice NamefundingRule
      Definition

      Funding restriction information which complements the general funding information provided in the nzf-funding extension. The extension can be added multiple times to a product for each given rule as well as for each PHARMAC schedule. These can be differentiated via the scheduleDate field.

      ShortFunding constraints and requirements
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(FundingRule) (Complex Extension)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      18. Medication.extension:description
      Slice Namedescription
      Definition

      Specific NZMT descriptions that apply to this medication

      ShortNZMT descriptions for the medicine
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(NzmtDescription) (Complex Extension)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      20. Medication.extension:unapproved
      Slice Nameunapproved
      Definition

      True if this medication has not been approved by Medsafe and can be prescribed under section 29

      ShortWhether the medication can be used under section29
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(Unapproved) (Extension Type: boolean)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      22. Medication.extension:legalclass
      Slice Namelegalclass
      Definition

      Legal classification

      ShortLegal classification of the medication
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(LegalClass) (Complex Extension)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      24. Medication.extension:medsafe
      Slice Namemedsafe
      Definition

      Medsafe package, reg situation and administration route details

      ShortMedsafe details of the medication
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(Medsafe) (Complex Extension)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      26. Medication.extension:prescribebybrand
      Slice Nameprescribebybrand
      Definition

      True if can be prescribed by brand

      ShortTrue if can be prescribed by brand
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(PrescribeByBrand) (Extension Type: boolean)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      28. Medication.extension:supplyinformation
      Slice Namesupplyinformation
      Definition

      Information around the supply and availability of medications applied at each NZMT level. For example, when paracetamol tablets are in short supply an alert may be attached to the MP level medication along with the relevant details.

      ShortSupply information
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(SupplyInformation) (Complex Extension)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      30. Medication.extension:nzfpack
      Slice Namenzfpack
      Definition

      NZF Pack detail

      ShortNZF Pack details
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(NzfPack) (Complex Extension)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      32. Medication.extension:relatedmedication
      Slice Namerelatedmedication
      Definition

      A related medication within the NZMT hierarchy

      ShortRelated medication
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(RelatedMedication) (Complex Extension)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      34. Medication.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
      Must Supportfalse
      Summaryfalse
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      36. Medication.code
      Definition

      A code (or set of codes) that specify this medication, or a textual description if no code is available. Usage note: This could be a standard medication code such as a code from RxNorm, SNOMED CT, IDMP etc. It could also be a national or local formulary code, optionally with translations to other code systems.

      ShortCodes that identify this medication
      Comments

      Depending on the context of use, the code that was actually selected by the user (prescriber, dispenser, etc.) will have the coding.userSelected set to true. As described in the coding datatype: "A coding may be marked as a "userSelected" if a user selected the particular coded value in a user interface (e.g. the user selects an item in a pick-list). If a user selected coding exists, it is the preferred choice for performing translations etc. Other codes can only be literal translations to alternative code systems, or codes at a lower level of granularity (e.g. a generic code for a vendor-specific primary one).

      Control0..1
      BindingThe codes SHOULD be taken from For example codes, see http://nzmt.org.nz/vshttp://hl7.org/fhir/ValueSet/medication-codes
      (preferred to http://nzmt.org.nz/vs)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      38. Medication.status
      Definition

      A code to indicate if the medication is in active use.

      Shortactive | inactive | entered-in-error
      Comments

      This status is intended to identify if the medication in a local system is in active use within a drug database or inventory. For example, a pharmacy system may create a new drug file record for a compounded product "ABC Hospital Special Cream" with an active status. At some point in the future, it may be determined that the drug record was created with an error and the status is changed to "entered in error". This status is not intended to specify if a medication is part of a particular formulary. It is possible that the drug record may be referenced by multiple formularies or catalogues and each of those entries would have a separate status.

      Control0..1
      BindingThe codes SHALL be taken from Medication Status Codeshttp://hl7.org/fhir/ValueSet/medication-status|4.3.0
      (required to http://hl7.org/fhir/ValueSet/medication-status|4.3.0)

      A coded concept defining if the medication is in active use.

      Typecode
      Is Modifiertrue because This element changes the interpretation of all descriptive attributes.
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      40. Medication.manufacturer
      Definition

      Describes the details of the manufacturer of the medication product. This is not intended to represent the distributor of a medication product.

      ShortManufacturer of the item
      Control0..01
      TypeReference(Organization)
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      42. Medication.amount
      Definition

      Specific amount of the drug in the packaged product. For example, when specifying a product that has the same strength (For example, Insulin glargine 100 unit per mL solution for injection), this attribute provides additional clarification of the package amount (For example, 3 mL, 10mL, etc.).

      ShortAmount of drug in package
      Control0..01
      TypeRatio
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      44. Medication.batch
      Definition

      Information that only applies to packages (not products).

      ShortDetails about packaged medications
      Control0..01
      TypeBackboneElement
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)

      Guidance on how to interpret the contents of this table can be found here

      0. Medication
      Definition

      This resource is primarily used for the identification and definition of a medication for the purposes of prescribing, dispensing, and administering a medication as well as for making statements about medication use.

      ShortDefinition of a Medication
      Control0..*
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      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 (contained.where(((id.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty())
      dom-4: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      2. Medication.id
      Definition

      The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

      ShortLogical id of this artifact
      Comments

      The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

      Control0..1
      Typeid
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      4. Medication.meta
      Definition

      The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

      ShortMetadata about the resource
      Control0..1
      TypeMeta
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      6. Medication.implicitRules
      Definition

      A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

      ShortA set of rules under which this content was created
      Comments

      Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

      Control0..1
      Typeuri
      Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      8. Medication.language
      Definition

      The base language in which the resource is written.

      ShortLanguage of the resource content
      Comments

      Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

      Control0..1
      BindingThe codes SHOULD be taken from CommonLanguages
      (preferred to http://hl7.org/fhir/ValueSet/languages)

      IETF language tag

      Additional BindingsPurpose
      AllLanguagesMax Binding
      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      10. Medication.text
      Definition

      A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

      ShortText summary of the resource, for human interpretation
      Comments

      Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

      Control0..1
      TypeNarrative
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Alternate Namesnarrative, html, xhtml, display
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      12. Medication.contained
      Definition

      These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

      ShortContained, inline Resources
      Comments

      This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

      Control0..*
      TypeResource
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Alternate Namesinline resources, anonymous resources, contained resources
      Invariantsdom-r4b: Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems (($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic))
      14. Medication.extension
      Definition

      An Extension

      ShortExtension
      Control0..*
      TypeExtension
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on Medication.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 16. Medication.extension:nzmtType
        Slice NamenzmtType
        Definition

        The NZ Medicines Terminology (NZMT) Data Class – MP (Medicinal Product), MPUU (Medicinal Product Unit of Use), MPP (Medicinal Product Pack), TP (Trade Product), TPUU (Trade Product Unit of Use), TPP (Trade Product Pack) or CTPP (Containered Trade Product Pack) – that the Medication is a member of.

        ShortThe NZ Medicines Terminology (NZMT) Data Class – MP (Medicinal Product), MPUU (Medicinal Product Unit of Use), MPP (Medicinal Product Pack), TP (Trade Product), TPUU (Trade Product Unit of Use), TPP (Trade Product Pack) or CTPP (Containered Trade Product Pack) – that the Medication is a member of.
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(NzmtType) (Extension Type: CodeableConcept)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        18. Medication.extension:atc
        Slice Nameatc
        Definition

        Anatomical Therapeutic Chemical (ATC) Classification - see https://www.who.int/tools/atc-ddd-toolkit/atc-classification

        ShortAnatomical Therapeutic Chemical (ATC) Classification
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(Atc) (Extension Type: CodeableConcept)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        20. Medication.extension:link
        Slice Namelink
        Definition

        Reference to other information about this medication

        ShortLinks to other information about this medication
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(Link) (Extension Type: Reference(DocumentReference))
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        22. Medication.extension:cal
        Slice Namecal
        Definition

        Cautionary and Advisory Label

        ShortCautionary and Advisory Label
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(Cautionary and Advisory Label) (Complex Extension)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        24. Medication.extension:funding
        Slice Namefunding
        Definition

        Core funding information specific to NZ. The extension can be added multiple times to a product for each PHARMAC schedule. These can be differentiated via the scheduleDate field.

        ShortGeneral Funding details
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(Funding) (Complex Extension)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        26. Medication.extension:fundingRule
        Slice NamefundingRule
        Definition

        Funding restriction information which complements the general funding information provided in the nzf-funding extension. The extension can be added multiple times to a product for each given rule as well as for each PHARMAC schedule. These can be differentiated via the scheduleDate field.

        ShortFunding constraints and requirements
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(FundingRule) (Complex Extension)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        28. Medication.extension:description
        Slice Namedescription
        Definition

        Specific NZMT descriptions that apply to this medication

        ShortNZMT descriptions for the medicine
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(NzmtDescription) (Complex Extension)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        30. Medication.extension:unapproved
        Slice Nameunapproved
        Definition

        True if this medication has not been approved by Medsafe and can be prescribed under section 29

        ShortWhether the medication can be used under section29
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(Unapproved) (Extension Type: boolean)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        32. Medication.extension:legalclass
        Slice Namelegalclass
        Definition

        Legal classification

        ShortLegal classification of the medication
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(LegalClass) (Complex Extension)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        34. Medication.extension:medsafe
        Slice Namemedsafe
        Definition

        Medsafe package, reg situation and administration route details

        ShortMedsafe details of the medication
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(Medsafe) (Complex Extension)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        36. Medication.extension:prescribebybrand
        Slice Nameprescribebybrand
        Definition

        True if can be prescribed by brand

        ShortTrue if can be prescribed by brand
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(PrescribeByBrand) (Extension Type: boolean)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        38. Medication.extension:supplyinformation
        Slice Namesupplyinformation
        Definition

        Information around the supply and availability of medications applied at each NZMT level. For example, when paracetamol tablets are in short supply an alert may be attached to the MP level medication along with the relevant details.

        ShortSupply information
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(SupplyInformation) (Complex Extension)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        40. Medication.extension:nzfpack
        Slice Namenzfpack
        Definition

        NZF Pack detail

        ShortNZF Pack details
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(NzfPack) (Complex Extension)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        42. Medication.extension:relatedmedication
        Slice Namerelatedmedication
        Definition

        A related medication within the NZMT hierarchy

        ShortRelated medication
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(RelatedMedication) (Complex Extension)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        44. Medication.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Must Supportfalse
        Summaryfalse
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        46. Medication.identifier
        Definition

        Business identifier for this medication.

        ShortBusiness identifier for this medication
        Comments

        The serial number could be included as an identifier.

        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..*
        TypeIdentifier
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        48. Medication.code
        Definition

        A code (or set of codes) that specify this medication, or a textual description if no code is available. Usage note: This could be a standard medication code such as a code from RxNorm, SNOMED CT, IDMP etc. It could also be a national or local formulary code, optionally with translations to other code systems.

        ShortCodes that identify this medication
        Comments

        Depending on the context of use, the code that was actually selected by the user (prescriber, dispenser, etc.) will have the coding.userSelected set to true. As described in the coding datatype: "A coding may be marked as a "userSelected" if a user selected the particular coded value in a user interface (e.g. the user selects an item in a pick-list). If a user selected coding exists, it is the preferred choice for performing translations etc. Other codes can only be literal translations to alternative code systems, or codes at a lower level of granularity (e.g. a generic code for a vendor-specific primary one).

        Control0..1
        BindingThe codes SHOULD be taken from http://nzmt.org.nz/vs
        (preferred to http://nzmt.org.nz/vs)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        50. Medication.status
        Definition

        A code to indicate if the medication is in active use.

        Shortactive | inactive | entered-in-error
        Comments

        This status is intended to identify if the medication in a local system is in active use within a drug database or inventory. For example, a pharmacy system may create a new drug file record for a compounded product "ABC Hospital Special Cream" with an active status. At some point in the future, it may be determined that the drug record was created with an error and the status is changed to "entered in error". This status is not intended to specify if a medication is part of a particular formulary. It is possible that the drug record may be referenced by multiple formularies or catalogues and each of those entries would have a separate status.

        Control0..1
        BindingThe codes SHALL be taken from Medication Status Codes
        (required to http://hl7.org/fhir/ValueSet/medication-status|4.3.0)

        A coded concept defining if the medication is in active use.

        Typecode
        Is Modifiertrue because This element changes the interpretation of all descriptive attributes.
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        52. Medication.manufacturer
        Definition

        Describes the details of the manufacturer of the medication product. This is not intended to represent the distributor of a medication product.

        ShortManufacturer of the item
        Control0..0
        TypeReference(Organization)
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        54. Medication.form
        Definition

        Describes the form of the item. Powder; tablets; capsule.

        Shortpowder | tablets | capsule +
        Comments

        When Medication is referenced from MedicationRequest, this is the ordered form. When Medication is referenced within MedicationDispense, this is the dispensed form. When Medication is referenced within MedicationAdministration, this is administered form.

        Control0..1
        BindingFor example codes, see SNOMEDCTFormCodes
        (example to http://hl7.org/fhir/ValueSet/medication-form-codes)

        A coded concept defining the form of a medication.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        56. Medication.amount
        Definition

        Specific amount of the drug in the packaged product. For example, when specifying a product that has the same strength (For example, Insulin glargine 100 unit per mL solution for injection), this attribute provides additional clarification of the package amount (For example, 3 mL, 10mL, etc.).

        ShortAmount of drug in package
        Control0..0
        TypeRatio
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        58. Medication.ingredient
        Definition

        Identifies a particular constituent of interest in the product.

        ShortActive or inactive ingredient
        Comments

        The ingredients need not be a complete list. If an ingredient is not specified, this does not indicate whether an ingredient is present or absent. If an ingredient is specified it does not mean that all ingredients are specified. It is possible to specify both inactive and active ingredients.

        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        60. Medication.ingredient.id
        Definition

        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

        ShortUnique id for inter-element referencing
        Control0..1
        Typestring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        62. Medication.ingredient.extension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        ShortAdditional content defined by implementations
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        64. Medication.ingredient.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        66. Medication.ingredient.item[x]
        Definition

        The actual ingredient - either a substance (simple ingredient) or another medication of a medication.

        ShortThe actual ingredient or content
        Control1..1
        TypeChoice of: CodeableConcept, Reference(Substance, Medication)
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        The ingredient may reference a substance (for example, amoxicillin) or another medication (for example in the case of a compounded product, Glaxal Base).

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        68. Medication.ingredient.isActive
        Definition

        Indication of whether this ingredient affects the therapeutic action of the drug.

        ShortActive ingredient indicator
        Control0..1
        Typeboolean
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summaryfalse
        Requirements

        True indicates that the ingredient affects the therapeutic action of the drug (i.e. active). False indicates that the ingredient does not affect the therapeutic action of the drug (i.e. inactive).

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        70. Medication.ingredient.strength
        Definition

        Specifies how many (or how much) of the items there are in this Medication. For example, 250 mg per tablet. This is expressed as a ratio where the numerator is 250mg and the denominator is 1 tablet.

        ShortQuantity of ingredient present
        Control0..1
        TypeRatio
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        72. Medication.batch
        Definition

        Information that only applies to packages (not products).

        ShortDetails about packaged medications
        Control0..0
        TypeBackboneElement
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)