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Pharmacy Work GroupMaturity Level: 3 Trial UseSecurity Category: Patient Compartments: Encounter, Patient, Practitioner

Detailed Descriptions for the elements in the MedicationRequest resource.

MedicationRequest
Element IdMedicationRequest
Definition

An order or request for both supply of the medication and the instructions for administration of the medication to a patient. The resource is called "MedicationRequest" rather than "MedicationPrescription" or "MedicationOrder" to generalize the use across inpatient and outpatient settings, including care plans, etc., and to harmonize with workflow patterns.

Cardinality0..*
TypeDomainResource
Alternate NamesPrescription; Order
MedicationRequest.identifier
Element IdMedicationRequest.identifier
Definition

Identifiers associated with this medication request 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.

NoteThis is a business identifier, not a resource identifier (see discussion)
Cardinality0..*
TypeIdentifier
Comments

This is a business identifier, not a resource identifier.

MedicationRequest.status
Element IdMedicationRequest.status
Definition

A code specifying the current state of the order. Generally, this will be active or completed state.

Cardinality1..1
Terminology BindingMedicationrequest status (Required)
Typecode
Is Modifiertrue (Reason: This element is labeled 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)
Summarytrue
Comments

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

MedicationRequest.statusReason
Element IdMedicationRequest.statusReason
Definition

Captures the reason for the current state of the MedicationRequest.

Cardinality0..1
Terminology BindingMedication request status reason codes (Example)
TypeCodeableConcept
Comments

This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the MedicationRequest was created at all is captured in reasonCode, not here.

MedicationRequest.intent
Element IdMedicationRequest.intent
Definition

Whether the request is a proposal, plan, or an original order.

Cardinality1..1
Terminology BindingMedication request intent (Required)
Typecode
Is Modifiertrue (Reason: This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request)
Summarytrue
Comments

It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only.

An instance-order is an instantiation of a request or order and may be used to populate Medication Administration Record.

This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.

MedicationRequest.category
Element IdMedicationRequest.category
Definition

Indicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).

Cardinality0..*
Terminology BindingMedication request category codes (Example)
TypeCodeableConcept
Comments

The category can be used to include where the medication is expected to be consumed or other types of requests.

MedicationRequest.priority
Element IdMedicationRequest.priority
Definition

Indicates how quickly the Medication Request should be addressed with respect to other requests.

Cardinality0..1
Terminology BindingRequest priority (Required)
Typecode
Summarytrue
MedicationRequest.doNotPerform
Element IdMedicationRequest.doNotPerform
Definition

If true indicates that the provider is asking for the medication request not to occur.

Cardinality0..1
Typeboolean
Is Modifiertrue (Reason: This element is labeled as a modifier because this element negates the request to occur (ie, this is a request for the medication not to be ordered or prescribed, etc))
Summarytrue
Comments

If do not perform is not specified, the request is a positive request e.g. "do perform".

MedicationRequest.reported[x]
Element IdMedicationRequest.reported[x]
Definition

Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the report.

Cardinality0..1
Typeboolean|Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
MedicationRequest.medication[x]
Element IdMedicationRequest.medication[x]
Definition

Identifies the medication being requested. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medications.

Cardinality1..1
Terminology BindingSNOMED CT Medication Codes (Example)
TypeCodeableConcept|Reference(Medication)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
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 or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource.

MedicationRequest.subject
Element IdMedicationRequest.subject
Definition

A link to a resource representing the person or set of individuals to whom the medication will be given.

Cardinality1..1
TypeReference(Patient | Group)
Summarytrue
Comments

The subject on a medication request is mandatory. For the secondary use case where the actual subject is not provided, there still must be an anonymized subject specified.

MedicationRequest.encounter
Element IdMedicationRequest.encounter
Definition

The Encounter during which this [x] was created or to which the creation of this record is tightly associated.

Cardinality0..1
TypeReference(Encounter)
Comments

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter." If there is a need to link to episodes of care they will be handled with an extension.

MedicationRequest.supportingInformation
Element IdMedicationRequest.supportingInformation
Definition

Include additional information (for example, patient height and weight, a medicationStatement for the patient) that supports the ordering of the medication.

Cardinality0..*
TypeReference(Any)
Comments

This attribute can be used to reference a MedicationStatement about the patients' medication use.

MedicationRequest.authoredOn
Element IdMedicationRequest.authoredOn
Definition

The date (and perhaps time) when the prescription was initially written or authored on.

Cardinality0..1
TypedateTime
Summarytrue
MedicationRequest.requester
Element IdMedicationRequest.requester
Definition

The individual, organization, or device that initiated the request and has responsibility for its activation.

Cardinality0..1
TypeReference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)
Summarytrue
MedicationRequest.performer
Element IdMedicationRequest.performer
Definition

The specified desired performer of the medication treatment (e.g. the performer of the medication administration).

Cardinality0..1
TypeReference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam)
MedicationRequest.performerType
Element IdMedicationRequest.performerType
Definition

Indicates the type of performer of the administration of the medication.

Cardinality0..1
Terminology BindingProcedure Performer Role Codes (Example)
TypeCodeableConcept
Summarytrue
Comments

If specified without indicating a performer, this indicates that the performer must be of the specified type. If specified with a performer then it indicates the requirements of the performer if the designated performer is not available.

MedicationRequest.recorder
Element IdMedicationRequest.recorder
Definition

The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order.

Cardinality0..1
TypeReference(Practitioner | PractitionerRole)
MedicationRequest.reasonCode
Element IdMedicationRequest.reasonCode
Definition

The reason or the indication for ordering or not ordering the medication.

Cardinality0..*
Terminology BindingCondition/Problem/Diagnosis Codes (Example)
TypeCodeableConcept
Comments

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

MedicationRequest.reasonReference
Element IdMedicationRequest.reasonReference
Definition

Condition or observation that supports why the medication was ordered.

Cardinality0..*
TypeReference(Condition | Observation)
Comments

This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode.

MedicationRequest.instantiatesCanonical
Element IdMedicationRequest.instantiatesCanonical
Definition

The URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest.

Cardinality0..*
Typecanonical
Summarytrue
MedicationRequest.instantiatesUri
Element IdMedicationRequest.instantiatesUri
Definition

The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this MedicationRequest.

Cardinality0..*
Typeuri
Summarytrue
MedicationRequest.basedOn
Element IdMedicationRequest.basedOn
Definition

A plan or request that is fulfilled in whole or in part by this medication request.

Cardinality0..*
TypeReference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation)
Summarytrue
MedicationRequest.groupIdentifier
Element IdMedicationRequest.groupIdentifier
Definition

A shared identifier common to all requests that were authorized more or less simultaneously by a single author, representing the identifier of the requisition or prescription.

Cardinality0..1
TypeIdentifier
Requirements

Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.

Summarytrue
MedicationRequest.courseOfTherapyType
Element IdMedicationRequest.courseOfTherapyType
Definition

The description of the overall pattern of the administration of the medication to the patient.

Cardinality0..1
Terminology BindingMedication request course of therapy codes (Example)
TypeCodeableConcept
Comments

This attribute should not be confused with the protocol of the medication.

MedicationRequest.insurance
Element IdMedicationRequest.insurance
Definition

Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service.

Cardinality0..*
TypeReference(Coverage | ClaimResponse)
MedicationRequest.note
Element IdMedicationRequest.note
Definition

Extra information about the prescription that could not be conveyed by the other attributes.

Cardinality0..*
TypeAnnotation
MedicationRequest.dosageInstruction
Element IdMedicationRequest.dosageInstruction
Definition

Indicates how the medication is to be used by the patient.

Cardinality0..*
TypeDosage
Comments

There are examples where a medication request may include the option of an oral dose or an Intravenous or Intramuscular dose. For example, "Ondansetron 8mg orally or IV twice a day as needed for nausea" or "Compazine® (prochlorperazine) 5-10mg PO or 25mg PR bid prn nausea or vomiting". In these cases, two medication requests would be created that could be grouped together. The decision on which dose and route of administration to use is based on the patient's condition at the time the dose is needed.

MedicationRequest.dispenseRequest
Element IdMedicationRequest.dispenseRequest
Definition

Indicates the specific details for the dispense or medication supply part of a medication request (also known as a Medication Prescription or Medication Order). Note that this information is not always sent with the order. There may be in some settings (e.g. hospitals) institutional or system support for completing the dispense details in the pharmacy department.

Cardinality0..1
MedicationRequest.dispenseRequest.initialFill
Element IdMedicationRequest.dispenseRequest.initialFill
Definition

Indicates the quantity or duration for the first dispense of the medication.

Cardinality0..1
Comments

If populating this element, either the quantity or the duration must be included.

MedicationRequest.dispenseRequest.initialFill.quantity
Element IdMedicationRequest.dispenseRequest.initialFill.quantity
Definition

The amount or quantity to provide as part of the first dispense.

Cardinality0..1
TypeSimpleQuantity
MedicationRequest.dispenseRequest.initialFill.duration
Element IdMedicationRequest.dispenseRequest.initialFill.duration
Definition

The length of time that the first dispense is expected to last.

Cardinality0..1
TypeDuration
MedicationRequest.dispenseRequest.dispenseInterval
Element IdMedicationRequest.dispenseRequest.dispenseInterval
Definition

The minimum period of time that must occur between dispenses of the medication.

Cardinality0..1
TypeDuration
MedicationRequest.dispenseRequest.validityPeriod
Element IdMedicationRequest.dispenseRequest.validityPeriod
Definition

This indicates the validity period of a prescription (stale dating the Prescription).

Cardinality0..1
TypePeriod
Requirements

Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.

Comments

It reflects the prescribers' perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations.

MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
Element IdMedicationRequest.dispenseRequest.numberOfRepeatsAllowed
Definition

An integer indicating the number of times, in addition to the original dispense, (aka refills or repeats) that the patient can receive the prescribed medication. Usage Notes: This integer does not include the original order dispense. This means that if an order indicates dispense 30 tablets plus "3 repeats", then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets. A prescriber may explicitly say that zero refills are permitted after the initial dispense.

Cardinality0..1
TypeunsignedInt
Comments

If displaying "number of authorized fills", add 1 to this number.

MedicationRequest.dispenseRequest.quantity
Element IdMedicationRequest.dispenseRequest.quantity
Definition

The amount that is to be dispensed for one fill.

Cardinality0..1
TypeSimpleQuantity
MedicationRequest.dispenseRequest.expectedSupplyDuration
Element IdMedicationRequest.dispenseRequest.expectedSupplyDuration
Definition

Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last.

Cardinality0..1
TypeDuration
Comments

In some situations, this attribute may be used instead of quantity to identify the amount supplied by how long it is expected to last, rather than the physical quantity issued, e.g. 90 days supply of medication (based on an ordered dosage). When possible, it is always better to specify quantity, as this tends to be more precise. expectedSupplyDuration will always be an estimate that can be influenced by external factors.

MedicationRequest.dispenseRequest.performer
Element IdMedicationRequest.dispenseRequest.performer
Definition

Indicates the intended dispensing Organization specified by the prescriber.

Cardinality0..1
TypeReference(Organization)
MedicationRequest.substitution
Element IdMedicationRequest.substitution
Definition

Indicates whether or not substitution can or should be part of the dispense. In some cases, substitution must happen, in other cases substitution must not happen. This block explains the prescriber's intent. If nothing is specified substitution may be done.

Cardinality0..1
MedicationRequest.substitution.allowed[x]
Element IdMedicationRequest.substitution.allowed[x]
Definition

True if the prescriber allows a different drug to be dispensed from what was prescribed.

Cardinality1..1
Terminology BindingV3 Value SetActSubstanceAdminSubstitutionCode (Example)
Typeboolean|CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

This element is labeled as a modifier because whether substitution is allow or not, it cannot be ignored.

MedicationRequest.substitution.reason
Element IdMedicationRequest.substitution.reason
Definition

Indicates the reason for the substitution, or why substitution must or must not be performed.

Cardinality0..1
Terminology BindingV3 Value SetSubstanceAdminSubstitutionReason (Example)
TypeCodeableConcept
MedicationRequest.priorPrescription
Element IdMedicationRequest.priorPrescription
Definition

A link to a resource representing an earlier order related order or prescription.

Cardinality0..1
TypeReference(MedicationRequest)
MedicationRequest.detectedIssue
Element IdMedicationRequest.detectedIssue
Definition

Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etc.

Cardinality0..*
TypeReference(DetectedIssue)
Alternate NamesContraindication; Drug Utilization Review (DUR); Alert
Comments

This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.

MedicationRequest.eventHistory
Element IdMedicationRequest.eventHistory
Definition

Links to Provenance records for past versions of this resource or fulfilling request or event resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resource.

Cardinality0..*
TypeReference(Provenance)
Comments

This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).