IHE Pharmacy Medication Overview
0.1.0 - ci-build International flag

IHE Pharmacy Medication Overview, published by Integrating the Healthcare Enterprise (IHE). This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IHE/pharm-meow/ and changes regularly. See the Directory of published versions

Resource Profile: MedicationTreatmentLine - Detailed Descriptions

Active as of 2024-06-16

Definitions for the MedicationTreatmentLine resource profile.

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

0. MedicationStatement
2. MedicationStatement.extension
SlicingThis element introduces a set of slices on MedicationStatement.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. MedicationStatement.extension:version
    Slice Nameversion
    Control0..1
    TypeExtension(ArtifactVersion) (Extension Type: string)
    Must Supporttrue
    6. MedicationStatement.extension:verificationInformation
    Slice NameverificationInformation
    Control0..1
    TypeExtension(MedicationStatement - Verification Information) (Complex Extension)
    Must Supporttrue
    8. MedicationStatement.extension:substitution
    Slice Namesubstitution
    Control0..1
    TypeExtension(MedicationStatement - Substitution) (Complex Extension)
    Must Supporttrue
    10. MedicationStatement.identifier
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Must Supporttrue
    12. MedicationStatement.status
    Must Supporttrue
    14. MedicationStatement.category
    Must Supporttrue
    16. MedicationStatement.medication
    Must Supporttrue
    18. MedicationStatement.subject
    Must Supporttrue
    20. MedicationStatement.effective[x]
    TypePeriod, dateTime, Timing
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Must Supporttrue
    22. MedicationStatement.dateAsserted
    Must Supporttrue
    24. MedicationStatement.informationSource
    Must Supporttrue
    26. MedicationStatement.derivedFrom
    Must Supporttrue
    28. MedicationStatement.reason
    Must Supporttrue
    30. MedicationStatement.note
    Must Supporttrue
    32. MedicationStatement.dosage
    Must Supporttrue
    34. MedicationStatement.dosage.text
    Must Supporttrue
    36. MedicationStatement.adherence
    Must Supporttrue

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

    0. MedicationStatement
    Definition

    A record of a medication that is being consumed by a patient. A MedicationStatement may indicate that the patient may be taking the medication now or has taken the medication in the past or will be taking the medication in the future. The source of this information can be the patient, significant other (such as a family member or spouse), or a clinician. A common scenario where this information is captured is during the history taking process during a patient visit or stay. The medication information may come from sources such as the patient's memory, from a prescription bottle, or from a list of medications the patient, clinician or other party maintains.

    The primary difference between a medicationstatement and a medicationadministration is that the medication administration has complete administration information and is based on actual administration information from the person who administered the medication. A medicationstatement is often, if not always, less specific. There is no required date/time when the medication was administered, in fact we only know that a source has reported the patient is taking this medication, where details such as time, quantity, or rate or even medication product may be incomplete or missing or less precise. As stated earlier, the Medication Statement information may come from the patient's memory, from a prescription bottle or from a list of medications the patient, clinician or other party maintains. Medication administration is more formal and is not missing detailed information.

    The MedicationStatement resource was previously called MedicationStatement.

    ShortRecord of medication being taken by a patient
    Control0..*
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Alternate NamesMedicationStatement
    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 in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').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. MedicationStatement.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 its 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 its 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. MedicationStatement.contained
    Definition

    These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

    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..*
    This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
    TypeResource
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Alternate Namesinline resources, anonymous resources, contained resources
    6. MedicationStatement.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 managable, 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 MedicationStatement.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 8. MedicationStatement.extension:version
      Slice Nameversion
      Definition

      The identifier that is used to identify this version of the artifact when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the artifact author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence.

      ShortBusiness version of the artifact
      Control0..1
      TypeExtension(ArtifactVersion) (Extension Type: string)
      Is Modifierfalse
      Must Supporttrue
      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())
      10. MedicationStatement.extension:verificationInformation
      Slice NameverificationInformation
      Definition

      Verification of medication line. The overview is verified as a whole, but each line is equipped with the information. The actual functional meaning and impact of this validation depends on the implementation.

      ShortMedicationStatement - Verification Information
      Control0..1
      TypeExtension(MedicationStatement - Verification Information) (Complex Extension)
      Is Modifierfalse
      Must Supporttrue
      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())
      12. MedicationStatement.extension:substitution
      Slice Namesubstitution
      Definition

      Whether and which type of substitution is allowed for this medication treatment line

      ShortMedicationStatement - Substitution
      Control0..1
      TypeExtension(MedicationStatement - Substitution) (Complex Extension)
      Is Modifierfalse
      Must Supporttrue
      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())
      14. MedicationStatement.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 managable, 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
      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
      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())
      16. MedicationStatement.identifier
      Definition

      Identifiers associated with this Medication Statement that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.

      ShortExternal identifier
      Comments

      This is a business identifier, not a resource identifier.

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

      A code representing the status of recording the medication statement.

      Shortrecorded | entered-in-error | draft
      Comments

      This status concerns just the recording of the medication statement. MedicationStatement.adherence should be used for indicating a patient's adherence to the information in this resource. Note, the statuses are different than in previous releases for MedicationStatement or MedicationStatement.

      This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

      Control1..1
      BindingThe codes SHALL be taken from MedicationStatementStatusCodeshttp://hl7.org/fhir/ValueSet/medication-statement-status|5.0.0
      (required to http://hl7.org/fhir/ValueSet/medication-statement-status|5.0.0)

      A coded concept indicating the current status of a MedicationStatement.

      Typecode
      Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. MedicationStatement.category
      Definition

      Type of medication statement (for example, drug classification like ATC, where meds would be administered, legal category of the medication.).

      ShortType of medication statement
      Control0..*
      BindingFor example codes, see MedicationRequestAdministrationLocationCodeshttp://hl7.org/fhir/ValueSet/medicationrequest-admin-location
      (example to http://hl7.org/fhir/ValueSet/medicationrequest-admin-location)

      A coded concept identifying where the medication included in the MedicationStatement is expected to be consumed or administered.

      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. MedicationStatement.medication
      Definition

      Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.

      ShortWhat medication was taken
      Comments

      If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example, if you require form or lot number, then you must reference the Medication resource.

      Control1..1
      BindingFor example codes, see SNOMEDCTMedicationCodeshttp://hl7.org/fhir/ValueSet/medication-codes
      (example to http://hl7.org/fhir/ValueSet/medication-codes)

      A coded concept identifying the substance or product being taken.

      TypeCodeableReference(Medication)
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. MedicationStatement.subject
      Definition

      The person, animal or group who is/was taking the medication.

      ShortWho is/was taking the medication
      Control1..1
      TypeReference(Patient, Group)
      Is Modifierfalse
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. MedicationStatement.effective[x]
      Definition

      The interval of time during which it is being asserted that the patient is/was/will be taking the medication (or was not taking, when the MedicationStatement.adherence element is Not Taking).

      ShortThe date/time or interval when the medication is/was/will be taken
      Comments

      This attribute reflects the period over which the patient consumed the medication and is expected to be populated on the majority of Medication Statements. If the medication is still being taken and is expected to continue indefinitely at the time the usage is recorded, the "end" date will be omitted. If the end date is known, then it is included as the "end date". The date/time attribute supports a variety of dates - year, year/month and exact date. If something more than this is required, this should be conveyed as text.

      Control0..1
      TypePeriod, dateTime, Timing
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. MedicationStatement.dateAsserted
      Definition

      The date when the Medication Statement was asserted by the information source.

      ShortWhen the usage was asserted?
      Control0..1
      TypedateTime
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. MedicationStatement.informationSource
      Definition

      The person or organization that provided the information about the taking of this medication. Note: Use derivedFrom when a MedicationStatement is derived from other resources, e.g. Claim or MedicationRequest.

      ShortPerson or organization that provided the information about the taking of this medication
      Control0..*
      TypeReference(Patient, Practitioner, PractitionerRole, RelatedPerson, Organization)
      Is Modifierfalse
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      32. MedicationStatement.derivedFrom
      Definition

      Allows linking the MedicationStatement to the underlying MedicationRequest, or to other information that supports or is used to derive the MedicationStatement.

      ShortLink to information used to derive the MedicationStatement
      Comments

      Likely references would be to MedicationRequest, MedicationDispense, Claim, Observation or QuestionnaireAnswers. The most common use cases for deriving a MedicationStatement comes from creating a MedicationStatement from a MedicationRequest or from a lab observation or a claim. it should be noted that the amount of information that is available varies from the type resource that you derive the MedicationStatement from.

      Control0..*
      TypeReference(Resource)
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. MedicationStatement.reason
      Definition

      A concept, Condition or observation that supports why the medication is being/was taken.

      ShortReason for why the medication is being/was taken
      Comments

      This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonForUseReference.

      Control0..*
      BindingFor example codes, see ConditionProblemDiagnosisCodeshttp://hl7.org/fhir/ValueSet/condition-code
      (example to http://hl7.org/fhir/ValueSet/condition-code)

      A coded concept identifying why the medication is being taken.

      TypeCodeableReference(Condition, Observation, DiagnosticReport)
      Is Modifierfalse
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. MedicationStatement.note
      Definition

      Provides extra information about the Medication Statement that is not conveyed by the other attributes.

      ShortFurther information about the usage
      Control0..*
      TypeAnnotation
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      38. MedicationStatement.dosage
      Definition

      Indicates how the medication is/was or should be taken by the patient.

      ShortDetails of how medication is/was taken or should be taken
      Comments

      The dates included in the dosage on a Medication Statement reflect the dates for a given dose. For example, "from November 1, 2016 to November 3, 2016, take one tablet daily and from November 4, 2016 to November 7, 2016, take two tablets daily." It is expected that this specificity may only be populated where the patient brings in their labeled container or where the Medication Statement is derived from a MedicationRequest.

      Control0..*
      TypeDosage
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      40. MedicationStatement.dosage.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 managable, 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())
      42. MedicationStatement.dosage.text
      Definition

      Free text dosage instructions e.g. SIG.

      ShortFree text dosage instructions e.g. SIG
      Control0..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. Additional information about administration or preparation of the medication should be included as text.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      44. MedicationStatement.adherence
      Definition

      Indicates whether the medication is or is not being consumed or administered.

      ShortIndicates whether the medication is or is not being consumed or administered
      Comments

      This element can be used to indicate whether a patient is following a course of treatment as instructed/prescribed or whether they are taking medications of their own volition. It can also be used to indicate that a patient is not taking a medication, either because they were told not to or because they decided on their own.

      Control0..1
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      46. MedicationStatement.adherence.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 managable, 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())
      48. MedicationStatement.adherence.code
      Definition

      Type of the adherence for the medication.

      ShortType of adherence
      Control1..1
      BindingFor example codes, see MedicationStatementAdherenceCodeshttp://hl7.org/fhir/ValueSet/medication-statement-adherence
      (example to http://hl7.org/fhir/ValueSet/medication-statement-adherence)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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

      0. MedicationStatement
      Definition

      A record of a medication that is being consumed by a patient. A MedicationStatement may indicate that the patient may be taking the medication now or has taken the medication in the past or will be taking the medication in the future. The source of this information can be the patient, significant other (such as a family member or spouse), or a clinician. A common scenario where this information is captured is during the history taking process during a patient visit or stay. The medication information may come from sources such as the patient's memory, from a prescription bottle, or from a list of medications the patient, clinician or other party maintains.

      The primary difference between a medicationstatement and a medicationadministration is that the medication administration has complete administration information and is based on actual administration information from the person who administered the medication. A medicationstatement is often, if not always, less specific. There is no required date/time when the medication was administered, in fact we only know that a source has reported the patient is taking this medication, where details such as time, quantity, or rate or even medication product may be incomplete or missing or less precise. As stated earlier, the Medication Statement information may come from the patient's memory, from a prescription bottle or from a list of medications the patient, clinician or other party maintains. Medication administration is more formal and is not missing detailed information.

      The MedicationStatement resource was previously called MedicationStatement.

      ShortRecord of medication being taken by a patient
      Control0..*
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Alternate NamesMedicationStatement
      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 in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').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. MedicationStatement.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

      Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

      Control0..1
      Typeid
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      4. MedicationStatement.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. MedicationStatement.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 its 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 its 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. MedicationStatement.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 SHALL be taken from AllLanguages
      (required to http://hl7.org/fhir/ValueSet/all-languages|5.0.0)

      IETF language tag for a human language

      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. MedicationStatement.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 a 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
      This element is affected by the following invariants: dom-6
      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. MedicationStatement.contained
      Definition

      These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

      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..*
      This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
      TypeResource
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Alternate Namesinline resources, anonymous resources, contained resources
      14. MedicationStatement.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 MedicationStatement.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 16. MedicationStatement.extension:version
        Slice Nameversion
        Definition

        The identifier that is used to identify this version of the artifact when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the artifact author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence.

        ShortBusiness version of the artifact
        Control0..1
        TypeExtension(ArtifactVersion) (Extension Type: string)
        Is Modifierfalse
        Must Supporttrue
        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())
        18. MedicationStatement.extension:verificationInformation
        Slice NameverificationInformation
        Definition

        Verification of medication line. The overview is verified as a whole, but each line is equipped with the information. The actual functional meaning and impact of this validation depends on the implementation.

        ShortMedicationStatement - Verification Information
        Control0..1
        TypeExtension(MedicationStatement - Verification Information) (Complex Extension)
        Is Modifierfalse
        Must Supporttrue
        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())
        20. MedicationStatement.extension:substitution
        Slice Namesubstitution
        Definition

        Whether and which type of substitution is allowed for this medication treatment line

        ShortMedicationStatement - Substitution
        Control0..1
        TypeExtension(MedicationStatement - Substitution) (Complex Extension)
        Is Modifierfalse
        Must Supporttrue
        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())
        22. MedicationStatement.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 managable, 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
        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
        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())
        24. MedicationStatement.identifier
        Definition

        Identifiers associated with this Medication Statement that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.

        ShortExternal identifier
        Comments

        This is a business identifier, not a resource identifier.

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

        A larger event of which this particular MedicationStatement is a component or step.

        ShortPart of referenced event
        Control0..*
        TypeReference(Procedure, MedicationStatement)
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. MedicationStatement.status
        Definition

        A code representing the status of recording the medication statement.

        Shortrecorded | entered-in-error | draft
        Comments

        This status concerns just the recording of the medication statement. MedicationStatement.adherence should be used for indicating a patient's adherence to the information in this resource. Note, the statuses are different than in previous releases for MedicationStatement or MedicationStatement.

        This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

        Control1..1
        BindingThe codes SHALL be taken from MedicationStatementStatusCodes
        (required to http://hl7.org/fhir/ValueSet/medication-statement-status|5.0.0)

        A coded concept indicating the current status of a MedicationStatement.

        Typecode
        Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. MedicationStatement.category
        Definition

        Type of medication statement (for example, drug classification like ATC, where meds would be administered, legal category of the medication.).

        ShortType of medication statement
        Control0..*
        BindingFor example codes, see MedicationRequestAdministrationLocationCodes
        (example to http://hl7.org/fhir/ValueSet/medicationrequest-admin-location)

        A coded concept identifying where the medication included in the MedicationStatement is expected to be consumed or administered.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        32. MedicationStatement.medication
        Definition

        Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.

        ShortWhat medication was taken
        Comments

        If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example, if you require form or lot number, then you must reference the Medication resource.

        Control1..1
        BindingFor example codes, see SNOMEDCTMedicationCodes
        (example to http://hl7.org/fhir/ValueSet/medication-codes)

        A coded concept identifying the substance or product being taken.

        TypeCodeableReference(Medication)
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. MedicationStatement.subject
        Definition

        The person, animal or group who is/was taking the medication.

        ShortWho is/was taking the medication
        Control1..1
        TypeReference(Patient, Group)
        Is Modifierfalse
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. MedicationStatement.encounter
        Definition

        The encounter that establishes the context for this MedicationStatement.

        ShortEncounter associated with MedicationStatement
        Control0..1
        TypeReference(Encounter)
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        38. MedicationStatement.effective[x]
        Definition

        The interval of time during which it is being asserted that the patient is/was/will be taking the medication (or was not taking, when the MedicationStatement.adherence element is Not Taking).

        ShortThe date/time or interval when the medication is/was/will be taken
        Comments

        This attribute reflects the period over which the patient consumed the medication and is expected to be populated on the majority of Medication Statements. If the medication is still being taken and is expected to continue indefinitely at the time the usage is recorded, the "end" date will be omitted. If the end date is known, then it is included as the "end date". The date/time attribute supports a variety of dates - year, year/month and exact date. If something more than this is required, this should be conveyed as text.

        Control0..1
        TypePeriod
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        40. MedicationStatement.dateAsserted
        Definition

        The date when the Medication Statement was asserted by the information source.

        ShortWhen the usage was asserted?
        Control0..1
        TypedateTime
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. MedicationStatement.informationSource
        Definition

        The person or organization that provided the information about the taking of this medication. Note: Use derivedFrom when a MedicationStatement is derived from other resources, e.g. Claim or MedicationRequest.

        ShortPerson or organization that provided the information about the taking of this medication
        Control0..*
        TypeReference(Patient, Practitioner, PractitionerRole, RelatedPerson, Organization)
        Is Modifierfalse
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        44. MedicationStatement.derivedFrom
        Definition

        Allows linking the MedicationStatement to the underlying MedicationRequest, or to other information that supports or is used to derive the MedicationStatement.

        ShortLink to information used to derive the MedicationStatement
        Comments

        Likely references would be to MedicationRequest, MedicationDispense, Claim, Observation or QuestionnaireAnswers. The most common use cases for deriving a MedicationStatement comes from creating a MedicationStatement from a MedicationRequest or from a lab observation or a claim. it should be noted that the amount of information that is available varies from the type resource that you derive the MedicationStatement from.

        Control0..*
        TypeReference(Resource)
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        46. MedicationStatement.reason
        Definition

        A concept, Condition or observation that supports why the medication is being/was taken.

        ShortReason for why the medication is being/was taken
        Comments

        This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonForUseReference.

        Control0..*
        BindingFor example codes, see ConditionProblemDiagnosisCodes
        (example to http://hl7.org/fhir/ValueSet/condition-code)

        A coded concept identifying why the medication is being taken.

        TypeCodeableReference(Condition, Observation, DiagnosticReport)
        Is Modifierfalse
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        48. MedicationStatement.note
        Definition

        Provides extra information about the Medication Statement that is not conveyed by the other attributes.

        ShortFurther information about the usage
        Control0..*
        TypeAnnotation
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        50. MedicationStatement.relatedClinicalInformation
        Definition

        Link to information that is relevant to a medication statement, for example, illicit drug use, gestational age, etc.

        ShortLink to information relevant to the usage of a medication
        Control0..*
        TypeReference(Observation, Condition)
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        52. MedicationStatement.renderedDosageInstruction
        Definition

        The full representation of the dose of the medication included in all dosage instructions. To be used when multiple dosage instructions are included to represent complex dosing such as increasing or tapering doses.

        ShortFull representation of the dosage instructions
        Control0..1
        Typemarkdown
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summaryfalse
        Requirements

        The content of the renderedDosageInstructions must not be different than the dose represented in the dosageInstruction content.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        54. MedicationStatement.dosage
        Definition

        Indicates how the medication is/was or should be taken by the patient.

        ShortDetails of how medication is/was taken or should be taken
        Comments

        The dates included in the dosage on a Medication Statement reflect the dates for a given dose. For example, "from November 1, 2016 to November 3, 2016, take one tablet daily and from November 4, 2016 to November 7, 2016, take two tablets daily." It is expected that this specificity may only be populated where the patient brings in their labeled container or where the Medication Statement is derived from a MedicationRequest.

        Control0..*
        TypeDosage
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        56. MedicationStatement.dosage.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
        This element is affected by the following invariants: ele-1
        Typeid
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        58. MedicationStatement.dosage.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 managable, 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())
        SlicingThis element introduces a set of slices on MedicationStatement.dosage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 60. MedicationStatement.dosage.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 managable, 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())
          62. MedicationStatement.dosage.sequence
          Definition

          Indicates the order in which the dosage instructions should be applied or interpreted.

          ShortThe order of the dosage instructions
          Control0..1
          Typeinteger
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          64. MedicationStatement.dosage.text
          Definition

          Free text dosage instructions e.g. SIG.

          ShortFree text dosage instructions e.g. SIG
          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. Additional information about administration or preparation of the medication should be included as text.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          66. MedicationStatement.dosage.additionalInstruction
          Definition

          Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").

          ShortSupplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
          Comments

          Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or take "immediately following drug x") should be populated in dosage.text.

          Control0..*
          BindingFor example codes, see SNOMEDCTAdditionalDosageInstructions
          (example to http://hl7.org/fhir/ValueSet/additional-instruction-codes)

          A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

          TypeCodeableConcept
          Is Modifierfalse
          Summarytrue
          Requirements

          Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          68. MedicationStatement.dosage.patientInstruction
          Definition

          Instructions in terms that are understood by the patient or consumer.

          ShortPatient or consumer oriented instructions
          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          70. MedicationStatement.dosage.timing
          Definition

          When medication should be administered.

          ShortWhen medication should be administered
          Comments

          This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.

          Control0..1
          TypeTiming
          Is Modifierfalse
          Summarytrue
          Requirements

          The timing schedule for giving the medication to the patient. This data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          72. MedicationStatement.dosage.asNeeded
          Definition

          Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option).

          ShortTake "as needed"
          Comments

          Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated.

          Control0..1
          This element is affected by the following invariants: dos-1
          Typeboolean
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          74. MedicationStatement.dosage.asNeededFor
          Definition

          Indicates whether the Medication is only taken based on a precondition for taking the Medication (CodeableConcept).

          ShortTake "as needed" (for x)
          Comments

          Can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be False, then the dose is given according to the schedule and is not "prn" or "as needed".

          Control0..*
          This element is affected by the following invariants: dos-1
          BindingFor example codes, see SNOMEDCTMedicationAsNeededReasonCodes
          (example to http://hl7.org/fhir/ValueSet/medication-as-needed-reason)

          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.

          TypeCodeableConcept
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          76. MedicationStatement.dosage.site
          Definition

          Body site to administer to.

          ShortBody site to administer to
          Comments

          If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension http://hl7.org/fhir/StructureDefinition/bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

          Control0..1
          BindingFor example codes, see SNOMEDCTAnatomicalStructureAdministrationSites
          (example to http://hl7.org/fhir/ValueSet/approach-site-codes)

          A coded concept describing the site location the medicine enters into or onto the body.

          TypeCodeableConcept
          Is Modifierfalse
          Summarytrue
          Requirements

          A coded specification of the anatomic site where the medication first enters the body.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          78. MedicationStatement.dosage.route
          Definition

          How drug should enter body.

          ShortHow drug should enter body
          Control0..1
          BindingFor example codes, see SNOMEDCTRouteCodes
          (example to http://hl7.org/fhir/ValueSet/route-codes)

          A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

          TypeCodeableConcept
          Is Modifierfalse
          Summarytrue
          Requirements

          A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          80. MedicationStatement.dosage.method
          Definition

          Technique for administering medication.

          ShortTechnique for administering medication
          Comments

          Terminologies used often pre-coordinate this term with the route and or form of administration.

          Control0..1
          BindingFor example codes, see SNOMEDCTAdministrationMethodCodes
          (example to http://hl7.org/fhir/ValueSet/administration-method-codes)

          A coded concept describing the technique by which the medicine is administered.

          TypeCodeableConcept
          Is Modifierfalse
          Summarytrue
          Requirements

          A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          82. MedicationStatement.dosage.doseAndRate
          Definition

          Depending on the resource,this is the amount of medication administered, to be administered or typical amount to be administered.

          ShortAmount of medication administered, to be administered or typical amount to be administered
          Control0..*
          TypeElement
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          84. MedicationStatement.dosage.doseAndRate.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
          This element is affected by the following invariants: ele-1
          Typestring
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          86. MedicationStatement.dosage.doseAndRate.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 managable, 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())
          SlicingThis element introduces a set of slices on MedicationStatement.dosage.doseAndRate.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 88. MedicationStatement.dosage.doseAndRate.type
            Definition

            The kind of dose or rate specified, for example, ordered or calculated.

            ShortThe kind of dose or rate specified
            Control0..1
            BindingFor example codes, see DoseAndRateType
            (example to http://terminology.hl7.org/ValueSet/dose-rate-type)

            The kind of dose or rate specified.

            TypeCodeableConcept
            Is Modifierfalse
            Summarytrue
            Requirements

            If the type is not populated, assume to be "ordered".

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            90. MedicationStatement.dosage.doseAndRate.dose[x]
            Definition

            Amount of medication per dose.

            ShortAmount of medication per dose
            Comments

            Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

            Control0..1
            TypeChoice of: Range, Quantity(SimpleQuantity)
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Summarytrue
            Requirements

            The amount of therapeutic or other substance given at one administration event.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            92. MedicationStatement.dosage.doseAndRate.rate[x]
            Definition

            Amount of medication per unit of time.

            ShortAmount of medication per unit of time
            Comments

            It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.

            It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammar where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.

            Control0..1
            TypeChoice of: Ratio, Range, Quantity(SimpleQuantity)
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Summarytrue
            Requirements

            Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            94. MedicationStatement.dosage.maxDosePerPeriod
            Definition

            Upper limit on medication per unit of time.

            ShortUpper limit on medication per unit of time
            Comments

            This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

            Control0..*
            TypeRatio
            Is Modifierfalse
            Summarytrue
            Requirements

            The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            96. MedicationStatement.dosage.maxDosePerAdministration
            Definition

            Upper limit on medication per administration.

            ShortUpper limit on medication per administration
            Comments

            This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.

            Control0..1
            TypeQuantity(SimpleQuantity)
            Is Modifierfalse
            Summarytrue
            Requirements

            The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            98. MedicationStatement.dosage.maxDosePerLifetime
            Definition

            Upper limit on medication per lifetime of the patient.

            ShortUpper limit on medication per lifetime of the patient
            Control0..1
            TypeQuantity(SimpleQuantity)
            Is Modifierfalse
            Summarytrue
            Requirements

            The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            100. MedicationStatement.adherence
            Definition

            Indicates whether the medication is or is not being consumed or administered.

            ShortIndicates whether the medication is or is not being consumed or administered
            Comments

            This element can be used to indicate whether a patient is following a course of treatment as instructed/prescribed or whether they are taking medications of their own volition. It can also be used to indicate that a patient is not taking a medication, either because they were told not to or because they decided on their own.

            Control0..1
            TypeBackboneElement
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            102. MedicationStatement.adherence.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
            This element is affected by the following invariants: ele-1
            Typestring
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            104. MedicationStatement.adherence.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 managable, 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())
            106. MedicationStatement.adherence.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 managable, 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())
            108. MedicationStatement.adherence.code
            Definition

            Type of the adherence for the medication.

            ShortType of adherence
            Control1..1
            BindingFor example codes, see MedicationStatementAdherenceCodes
            (example to http://hl7.org/fhir/ValueSet/medication-statement-adherence)
            TypeCodeableConcept
            Is Modifierfalse
            Must Supportfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            110. MedicationStatement.adherence.reason
            Definition

            Captures the reason for the current use or adherence of a medication.

            ShortDetails of the reason for the current use of the medication
            Comments

            This is generally only used for "exception" statuses such as "entered-in-error". The reason for performing the event at all is captured in reasonCode, not here.

            Control0..1
            BindingFor example codes, see SNOMEDCTDrugTherapyStatusCodes
            (example to http://hl7.org/fhir/ValueSet/reason-medication-status-codes)
            TypeCodeableConcept
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))