US Quality Core Implementation Guide
0.1.0 - cibuild

US Quality Core Implementation Guide, published by ASTP. 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/FHIR/us-quality-core/ and changes regularly. See the Directory of published versions

## Resource Profile: US Quality Core Medication Not Requested

Official URL: http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-medicationnotrequested | Version: 0.1.0
Active as of 2026-03-31 | Computable Name: USQualityCoreMedicationNotRequested

Negation profile of MedicationRequest for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

Usage

See the patterns page for implementation and usage patterns.

The MedicationRequest and MedicationNotRequested profiles represent the positive and negative statements for a medication order.

### Examples

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

Both of these example instances meet measure intent for exclusion as defined in the following example CQL:

    define "Reason for Not Ordering Antithrombotic":
      ["MedicationNotRequested": "Antithrombotic Therapy"] NoAntithromboticDischarge
        where (NoAntithromboticDischarge.reasonCode in "Medical Reason"
          or NoAntithromboticDischarge.reasonCode in "Patient Refusal")
          and (NoAntithromboticDischarge.isCommunity() or NoAntithromboticDischarge.isDischarge())
          and NoAntithromboticDischarge.status in { 'active', 'completed' }
          and NoAntithromboticDischarge.intent = 'order'

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

USCDI+ Quality Elements:

- doNotPerform: (USCDI+ Quality) True if medication was not requested
- medication[x].extension:notDoneValueSet: (USCDI+ Quality) What was not requested
- reasonCode: (USCDI+ Quality) (USCDI) Reason or indication for ordering or not ordering the medication

Usages:

- Examples for this Profile: MedicationRequest/negation-example-code and MedicationRequest/negation-example
- CapabilityStatements using this Profile: US Quality Core Client CapabilityStatement and US Quality Core Server CapabilityStatement

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

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

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationRequest | C | 0..* | USCoreMedicationRequestProfile | Ordering of medication for patient or group Constraints: us-core-21, mnr-1
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | (USCDI) active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.
intent | ?!S Σ C | 1..1 | code | (USCDI) proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order.
Slices for category | S | 0..* | CodeableConcept | (USCDI) Type of medication usage Slice: Unordered, Open by pattern:$this Binding: medicationRequest Category Codes (example): A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.
category:us-core | S | 0..* | CodeableConcept | (USCDI) Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
doNotPerform | ?!Σ | 1..1 | boolean | (USCDI+ Quality) True if medication was not requested Fixed Value: true
reported[x] | S Σ | 0..1 | Reference S(US Quality Core Practitioner | US Quality Core PractitionerRole | US Quality Core Patient | US Quality Core RelatedPerson) | (USCDI) Reported rather than primary record
medication[x] | S Σ | 1..1 | CodeableConcept | (USCDI) Medication to be taken Binding: SNOMEDCTMedicationCodes (preferred)
Slices for extension |  |  |  | Content/Rules for all slices
extension:notDoneValueSet | C | 0..1 | canonical(ValueSet) | (USCDI+ Quality) What was not requested URL: http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet
coding | Σ C | 0..* | Coding | Code defined by a terminology system
subject | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who or group medication request is for
encounter | S | 0..1 | Reference(US Quality Core Encounter) | (USCDI) Encounter created as part of encounter/admission/stay
authoredOn | S Σ | 1..1 | dateTime | (USCDI) When request was initially authored
requester | S Σ C | 0..1 | Reference(US Quality Core Practitioner | US Quality Core PractitionerRole | US Quality Core Patient) | (USCDI) Who/What requested the Request
reasonCode |  | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Reason or indication for ordering or not ordering the medication Binding: USQualityCore Negation Reason Codes (extensible): The reason the medication was not requested
reasonReference |  | 0..* | Reference(US Quality Core Condition Encounter Diagnosis | US Quality Core Condition Problems Health Concerns | US Quality Core Simple Observation) | (USCDI) US Core Condition or Observation that supports the prescription
dosageInstruction | S | 0..* | Dosage | (USCDI) How the medication should be taken
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
text | S Σ | 0..1 | string | (USCDI) Free text dosage instructions e.g. SIG
timing | S Σ | 0..1 | Timing | (USCDI) When medication should be administered
asNeeded[x] | Σ | 0..1 |  | Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
asNeededBoolean |  |  | boolean |
asNeededCodeableConcept |  |  | CodeableConcept |
route | Σ | 0..1 | CodeableConcept | How drug should enter body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
doseAndRate | S Σ | 0..* | Element | (USCDI) Amount of medication administered
dose[x] | S Σ | 0..1 |  | (USCDI) Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S |
doseRange |  |  | Range |
dispenseRequest | S | 0..1 | BackboneElement | (USCDI) Medication supply authorization
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
numberOfRepeatsAllowed | S | 0..1 | unsignedInt | (USCDI) Number of refills authorized
quantity | S | 0..1 | SimpleQuantity | (USCDI) Amount of medication to supply per dispense
expectedSupplyDuration |  | 0..1 | Duration | Number of days supply per dispense
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationRequest.status | Base | required | Medicationrequest status | 📦4.0.1 | FHIR Std.
MedicationRequest.intent | Base | required | Medication request intent | 📦4.0.1 | FHIR Std.
MedicationRequest.category | Base | example | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.category:us-core | Base | required | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.medication[x] | Base | preferred | SNOMED CT Medication Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.reasonCode | Base | extensible | USQualityCore Negation Reason Codes | 📦0.1.0 | This IG
MedicationRequest.dosageInstruction.​asNeeded[x] | Base | example | SNOMED CT Medication As Needed Reason Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​route | Base | example | SNOMED CT Route Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | MedicationRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | MedicationRequest | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | MedicationRequest | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | MedicationRequest | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | MedicationRequest | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
mnr-1 | error | MedicationRequest | To indicate what medication was not requested, either at least one coding in the medication or a notDoneValueSet extension shall be provided | `medication.extension('http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor medication.coding.exists()`
us-core-21 | error | MedicationRequest | requester SHALL be present if intent is "order" | `(intent='order' or intent='original-order' or intent='reflex-order'or intent='filler-order' or intent='instance-order') implies requester.exists()`

This structure is derived from USCoreMedicationRequestProfile

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationRequest | C | 0..* | USCoreMedicationRequestProfile | Ordering of medication for patient or group Constraints: mnr-1
status |  | 1..1 | code | (USCDI) active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
doNotPerform |  | 1..1 | boolean | (USCDI+ Quality) True if medication was not requested Fixed Value: true
reported[x] |  | 0..1 | Reference(US Quality Core Practitioner | US Quality Core PractitionerRole | US Quality Core Patient | US Quality Core RelatedPerson) | (USCDI) Reported rather than primary record
medication[x] |  | 1..1 | CodeableConcept | (USCDI) Medication to be taken Binding: SNOMEDCTMedicationCodes (preferred)
Slices for extension |  |  |  | Content/Rules for all slices
extension:notDoneValueSet | C | 0..1 | canonical(ValueSet) | (USCDI+ Quality) What was not requested URL: http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet
coding | C | 0..* | Coding | Code defined by a terminology system
subject |  | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who or group medication request is for
encounter |  | 0..1 | Reference(US Quality Core Encounter) | (USCDI) Encounter created as part of encounter/admission/stay
authoredOn |  | 1..1 | dateTime | (USCDI) When request was initially authored
requester |  | 0..1 | Reference(US Quality Core Practitioner | US Quality Core PractitionerRole | US Quality Core Patient) | (USCDI) Who/What requested the Request
reasonCode |  | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Reason or indication for ordering or not ordering the medication Binding: USQualityCore Negation Reason Codes (extensible): The reason the medication was not requested
reasonReference |  | 0..* | Reference(US Quality Core Condition Encounter Diagnosis | US Quality Core Condition Problems Health Concerns | US Quality Core Simple Observation) | (USCDI) US Core Condition or Observation that supports the prescription
dosageInstruction |  | 0..* | Dosage | (USCDI) How the medication should be taken
text |  | 0..1 | string | (USCDI) Free text dosage instructions e.g. SIG
timing |  | 0..1 | Timing | (USCDI) When medication should be administered
asNeeded[x] |  | 0..1 | boolean, CodeableConcept | Take "as needed" (for x)
route |  | 0..1 | CodeableConcept | How drug should enter body
doseAndRate |  | 0..* | Element | (USCDI) Amount of medication administered
dose[x] |  | 0..1 | Quantity, Range | (USCDI) Amount of medication per dose
dispenseRequest |  |  |  |
quantity |  | 0..1 | SimpleQuantity | (USCDI) Amount of medication to supply per dispense
expectedSupplyDuration |  | 0..1 | Duration | Number of days supply per dispense
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
MedicationRequest.medication[x] | Base | preferred | SNOMED CT Medication Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.reasonCode | Base | extensible | USQualityCore Negation Reason Codes | 📦0.1.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
mnr-1 | error | MedicationRequest | To indicate what medication was not requested, either at least one coding in the medication or a notDoneValueSet extension shall be provided | `medication.extension('http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor medication.coding.exists()`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationRequest | C | 0..* | USCoreMedicationRequestProfile | Ordering of medication for patient or group Constraints: us-core-21, mnr-1
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | External ids for this request
status | ?!S Σ | 1..1 | code | (USCDI) active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.
statusReason |  | 0..1 | CodeableConcept | Reason for current status Binding: medicationRequest Status Reason Codes (example): Identifies the reasons for a given status.
intent | ?!S Σ C | 1..1 | code | (USCDI) proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order.
Slices for category | S | 0..* | CodeableConcept | (USCDI) Type of medication usage Slice: Unordered, Open by pattern:$this Binding: medicationRequest Category Codes (example): A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.
category:us-core | S | 0..* | CodeableConcept | (USCDI) Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
priority | Σ | 0..1 | code | routine | urgent | asap | stat Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.
doNotPerform | ?!Σ | 1..1 | boolean | (USCDI+ Quality) True if medication was not requested Fixed Value: true
reported[x] | S Σ | 0..1 | Reference S(US Quality Core Practitioner | US Quality Core PractitionerRole | US Quality Core Patient | US Quality Core RelatedPerson) | (USCDI) Reported rather than primary record
medication[x] | S Σ | 1..1 | CodeableConcept | (USCDI) Medication to be taken Binding: SNOMEDCTMedicationCodes (preferred)
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:notDoneValueSet | C | 0..1 | canonical(ValueSet) | (USCDI+ Quality) What was not requested URL: http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet
coding | Σ C | 0..* | Coding | Code defined by a terminology system
text | Σ | 0..1 | string | Plain text representation of the concept
subject | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who or group medication request is for
encounter | S | 0..1 | Reference(US Quality Core Encounter) | (USCDI) Encounter created as part of encounter/admission/stay
supportingInformation |  | 0..* | Reference(Resource) | Information to support ordering of the medication
authoredOn | S Σ | 1..1 | dateTime | (USCDI) When request was initially authored
requester | S Σ C | 0..1 | Reference(US Quality Core Practitioner | US Quality Core PractitionerRole | US Quality Core Patient) | (USCDI) Who/What requested the Request
performer |  | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam) | Intended performer of administration
performerType | Σ | 0..1 | CodeableConcept | Desired kind of performer of the medication administration Binding: ProcedurePerformerRoleCodes (example): Identifies the type of individual that is desired to administer the medication.
recorder |  | 0..1 | Reference(Practitioner | PractitionerRole) | Person who entered the request
reasonCode |  | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Reason or indication for ordering or not ordering the medication Binding: USQualityCore Negation Reason Codes (extensible): The reason the medication was not requested
reasonReference |  | 0..* | Reference(US Quality Core Condition Encounter Diagnosis | US Quality Core Condition Problems Health Concerns | US Quality Core Simple Observation) | (USCDI) US Core Condition or Observation that supports the prescription
instantiatesCanonical | Σ | 0..* | canonical() | Instantiates FHIR protocol or definition
instantiatesUri | Σ | 0..* | uri | Instantiates external protocol or definition
basedOn | Σ | 0..* | Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation) | What request fulfills
groupIdentifier | Σ | 0..1 | Identifier | Composite request this is part of
courseOfTherapyType |  | 0..1 | CodeableConcept | Overall pattern of medication administration Binding: medicationRequest Course of Therapy Codes (example): Identifies the overall pattern of medication administratio.
insurance |  | 0..* | Reference(Coverage | ClaimResponse) | Associated insurance coverage
note |  | 0..* | Annotation | Information about the prescription
dosageInstruction | S | 0..* | Dosage | (USCDI) How the medication should be taken
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 0..1 | integer | The order of the dosage instructions
text | S Σ | 0..1 | string | (USCDI) Free text dosage instructions e.g. SIG
additionalInstruction | Σ | 0..* | CodeableConcept | Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
patientInstruction | Σ | 0..1 | string | Patient or consumer oriented instructions
timing | S Σ | 0..1 | Timing | (USCDI) When medication should be administered
asNeeded[x] | Σ | 0..1 |  | Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
asNeededBoolean |  |  | boolean |
asNeededCodeableConcept |  |  | CodeableConcept |
site | Σ | 0..1 | CodeableConcept | Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route | Σ | 0..1 | CodeableConcept | How drug should enter body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
method | Σ | 0..1 | CodeableConcept | Technique for administering medication Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
doseAndRate | S Σ | 0..* | Element | (USCDI) Amount of medication administered
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
type | Σ | 0..1 | CodeableConcept | The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
dose[x] | S Σ | 0..1 |  | (USCDI) Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S |
doseRange |  |  | Range |
rate[x] | Σ | 0..1 |  | Amount of medication per unit of time
rateRatio |  |  | Ratio |
rateRange |  |  | Range |
rateQuantity |  |  | Quantity(SimpleQuantity) |
maxDosePerPeriod | Σ | 0..1 | Ratio | Upper limit on medication per unit of time
maxDosePerAdministration | Σ | 0..1 | SimpleQuantity | Upper limit on medication per administration
maxDosePerLifetime | Σ | 0..1 | SimpleQuantity | Upper limit on medication per lifetime of the patient
dispenseRequest | S | 0..1 | BackboneElement | (USCDI) Medication supply authorization
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
initialFill |  | 0..1 | BackboneElement | First fill details
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
quantity |  | 0..1 | SimpleQuantity | First fill quantity
duration |  | 0..1 | Duration | First fill duration
dispenseInterval |  | 0..1 | Duration | Minimum period of time between dispenses
validityPeriod |  | 0..1 | Period | Time period supply is authorized for
numberOfRepeatsAllowed | S | 0..1 | unsignedInt | (USCDI) Number of refills authorized
quantity | S | 0..1 | SimpleQuantity | (USCDI) Amount of medication to supply per dispense
expectedSupplyDuration |  | 0..1 | Duration | Number of days supply per dispense
performer |  | 0..1 | Reference(Organization) | Intended dispenser
substitution |  | 0..1 | BackboneElement | Any restrictions on medication substitution
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
allowed[x] |  | 1..1 |  | Whether substitution is allowed or not Binding: ActSubstanceAdminSubstitutionCode (example): Identifies the type of substitution allowed.
allowedBoolean |  |  | boolean |
allowedCodeableConcept |  |  | CodeableConcept |
reason |  | 0..1 | CodeableConcept | Why should (not) substitution be made Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
priorPrescription |  | 0..1 | Reference(MedicationRequest) | An order/prescription that is being replaced
detectedIssue |  | 0..* | Reference(DetectedIssue) | Clinical Issue with action
eventHistory |  | 0..* | Reference(Provenance) | A list of events of interest in the lifecycle
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationRequest.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
MedicationRequest.status | Base | required | Medicationrequest status | 📦4.0.1 | FHIR Std.
MedicationRequest.statusReason | Base | example | Medication request status reason codes | 📦4.0.1 | FHIR Std.
MedicationRequest.intent | Base | required | Medication request intent | 📦4.0.1 | FHIR Std.
MedicationRequest.category | Base | example | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.category:us-core | Base | required | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.priority | Base | required | Request priority | 📍4.0.1 | FHIR Std.
MedicationRequest.medication[x] | Base | preferred | SNOMED CT Medication Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.performerType | Base | example | Procedure Performer Role Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.reasonCode | Base | extensible | USQualityCore Negation Reason Codes | 📦0.1.0 | This IG
MedicationRequest.courseOfTherapyType | Base | example | Medication request course of therapy codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​additionalInstruction | Base | example | SNOMED CT Additional Dosage Instructions | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​asNeeded[x] | Base | example | SNOMED CT Medication As Needed Reason Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​site | Base | example | SNOMED CT Anatomical Structure for Administration Site Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​route | Base | example | SNOMED CT Route Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​method | Base | example | SNOMED CT Administration Method Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​doseAndRate.type | Base | example | DoseAndRateType | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationRequest.substitution.​allowed[x] | Base | example | ActSubstanceAdminSubstitutionCode | 📦3.0.0 | THO v5.4
MedicationRequest.substitution.​reason | Base | example | SubstanceAdminSubstitutionReason | 📦3.0.0 | THO v5.4

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | MedicationRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | MedicationRequest | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | MedicationRequest | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | MedicationRequest | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | MedicationRequest | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
mnr-1 | error | MedicationRequest | To indicate what medication was not requested, either at least one coding in the medication or a notDoneValueSet extension shall be provided | `medication.extension('http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor medication.coding.exists()`
us-core-21 | error | MedicationRequest | requester SHALL be present if intent is "order" | `(intent='order' or intent='original-order' or intent='reflex-order'or intent='filler-order' or intent='instance-order') implies requester.exists()`

This structure is derived from USCoreMedicationRequestProfile

Summary

Mandatory: 3 elements
Fixed: 1 element

Structures

This structure refers to these other structures:

- US Quality Core Practitioner (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-practitioner)
- US Quality Core PractitionerRole (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-practitionerrole)
- US Quality Core Patient (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient)
- US Quality Core RelatedPerson (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-relatedperson)
- US Quality Core Encounter (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter)
- US Quality Core Condition Encounter Diagnosis (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis)
- US Quality Core Condition Problems Health Concerns (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns)
- US Quality Core Simple Observation (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-simple-observation)

Extensions

This structure refers to these extensions:

- http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationRequest | C | 0..* | USCoreMedicationRequestProfile | Ordering of medication for patient or group Constraints: us-core-21, mnr-1
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | (USCDI) active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.
intent | ?!S Σ C | 1..1 | code | (USCDI) proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order.
Slices for category | S | 0..* | CodeableConcept | (USCDI) Type of medication usage Slice: Unordered, Open by pattern:$this Binding: medicationRequest Category Codes (example): A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.
category:us-core | S | 0..* | CodeableConcept | (USCDI) Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
doNotPerform | ?!Σ | 1..1 | boolean | (USCDI+ Quality) True if medication was not requested Fixed Value: true
reported[x] | S Σ | 0..1 | Reference S(US Quality Core Practitioner | US Quality Core PractitionerRole | US Quality Core Patient | US Quality Core RelatedPerson) | (USCDI) Reported rather than primary record
medication[x] | S Σ | 1..1 | CodeableConcept | (USCDI) Medication to be taken Binding: SNOMEDCTMedicationCodes (preferred)
Slices for extension |  |  |  | Content/Rules for all slices
extension:notDoneValueSet | C | 0..1 | canonical(ValueSet) | (USCDI+ Quality) What was not requested URL: http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet
coding | Σ C | 0..* | Coding | Code defined by a terminology system
subject | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who or group medication request is for
encounter | S | 0..1 | Reference(US Quality Core Encounter) | (USCDI) Encounter created as part of encounter/admission/stay
authoredOn | S Σ | 1..1 | dateTime | (USCDI) When request was initially authored
requester | S Σ C | 0..1 | Reference(US Quality Core Practitioner | US Quality Core PractitionerRole | US Quality Core Patient) | (USCDI) Who/What requested the Request
reasonCode |  | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Reason or indication for ordering or not ordering the medication Binding: USQualityCore Negation Reason Codes (extensible): The reason the medication was not requested
reasonReference |  | 0..* | Reference(US Quality Core Condition Encounter Diagnosis | US Quality Core Condition Problems Health Concerns | US Quality Core Simple Observation) | (USCDI) US Core Condition or Observation that supports the prescription
dosageInstruction | S | 0..* | Dosage | (USCDI) How the medication should be taken
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
text | S Σ | 0..1 | string | (USCDI) Free text dosage instructions e.g. SIG
timing | S Σ | 0..1 | Timing | (USCDI) When medication should be administered
asNeeded[x] | Σ | 0..1 |  | Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
asNeededBoolean |  |  | boolean |
asNeededCodeableConcept |  |  | CodeableConcept |
route | Σ | 0..1 | CodeableConcept | How drug should enter body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
doseAndRate | S Σ | 0..* | Element | (USCDI) Amount of medication administered
dose[x] | S Σ | 0..1 |  | (USCDI) Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S |
doseRange |  |  | Range |
dispenseRequest | S | 0..1 | BackboneElement | (USCDI) Medication supply authorization
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
numberOfRepeatsAllowed | S | 0..1 | unsignedInt | (USCDI) Number of refills authorized
quantity | S | 0..1 | SimpleQuantity | (USCDI) Amount of medication to supply per dispense
expectedSupplyDuration |  | 0..1 | Duration | Number of days supply per dispense
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationRequest.status | Base | required | Medicationrequest status | 📦4.0.1 | FHIR Std.
MedicationRequest.intent | Base | required | Medication request intent | 📦4.0.1 | FHIR Std.
MedicationRequest.category | Base | example | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.category:us-core | Base | required | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.medication[x] | Base | preferred | SNOMED CT Medication Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.reasonCode | Base | extensible | USQualityCore Negation Reason Codes | 📦0.1.0 | This IG
MedicationRequest.dosageInstruction.​asNeeded[x] | Base | example | SNOMED CT Medication As Needed Reason Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​route | Base | example | SNOMED CT Route Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | MedicationRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | MedicationRequest | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | MedicationRequest | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | MedicationRequest | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | MedicationRequest | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
mnr-1 | error | MedicationRequest | To indicate what medication was not requested, either at least one coding in the medication or a notDoneValueSet extension shall be provided | `medication.extension('http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor medication.coding.exists()`
us-core-21 | error | MedicationRequest | requester SHALL be present if intent is "order" | `(intent='order' or intent='original-order' or intent='reflex-order'or intent='filler-order' or intent='instance-order') implies requester.exists()`

Differential View

This structure is derived from USCoreMedicationRequestProfile

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationRequest | C | 0..* | USCoreMedicationRequestProfile | Ordering of medication for patient or group Constraints: mnr-1
status |  | 1..1 | code | (USCDI) active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
doNotPerform |  | 1..1 | boolean | (USCDI+ Quality) True if medication was not requested Fixed Value: true
reported[x] |  | 0..1 | Reference(US Quality Core Practitioner | US Quality Core PractitionerRole | US Quality Core Patient | US Quality Core RelatedPerson) | (USCDI) Reported rather than primary record
medication[x] |  | 1..1 | CodeableConcept | (USCDI) Medication to be taken Binding: SNOMEDCTMedicationCodes (preferred)
Slices for extension |  |  |  | Content/Rules for all slices
extension:notDoneValueSet | C | 0..1 | canonical(ValueSet) | (USCDI+ Quality) What was not requested URL: http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet
coding | C | 0..* | Coding | Code defined by a terminology system
subject |  | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who or group medication request is for
encounter |  | 0..1 | Reference(US Quality Core Encounter) | (USCDI) Encounter created as part of encounter/admission/stay
authoredOn |  | 1..1 | dateTime | (USCDI) When request was initially authored
requester |  | 0..1 | Reference(US Quality Core Practitioner | US Quality Core PractitionerRole | US Quality Core Patient) | (USCDI) Who/What requested the Request
reasonCode |  | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Reason or indication for ordering or not ordering the medication Binding: USQualityCore Negation Reason Codes (extensible): The reason the medication was not requested
reasonReference |  | 0..* | Reference(US Quality Core Condition Encounter Diagnosis | US Quality Core Condition Problems Health Concerns | US Quality Core Simple Observation) | (USCDI) US Core Condition or Observation that supports the prescription
dosageInstruction |  | 0..* | Dosage | (USCDI) How the medication should be taken
text |  | 0..1 | string | (USCDI) Free text dosage instructions e.g. SIG
timing |  | 0..1 | Timing | (USCDI) When medication should be administered
asNeeded[x] |  | 0..1 | boolean, CodeableConcept | Take "as needed" (for x)
route |  | 0..1 | CodeableConcept | How drug should enter body
doseAndRate |  | 0..* | Element | (USCDI) Amount of medication administered
dose[x] |  | 0..1 | Quantity, Range | (USCDI) Amount of medication per dose
dispenseRequest |  |  |  |
quantity |  | 0..1 | SimpleQuantity | (USCDI) Amount of medication to supply per dispense
expectedSupplyDuration |  | 0..1 | Duration | Number of days supply per dispense
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
MedicationRequest.medication[x] | Base | preferred | SNOMED CT Medication Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.reasonCode | Base | extensible | USQualityCore Negation Reason Codes | 📦0.1.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
mnr-1 | error | MedicationRequest | To indicate what medication was not requested, either at least one coding in the medication or a notDoneValueSet extension shall be provided | `medication.extension('http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor medication.coding.exists()`

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationRequest | C | 0..* | USCoreMedicationRequestProfile | Ordering of medication for patient or group Constraints: us-core-21, mnr-1
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | External ids for this request
status | ?!S Σ | 1..1 | code | (USCDI) active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.
statusReason |  | 0..1 | CodeableConcept | Reason for current status Binding: medicationRequest Status Reason Codes (example): Identifies the reasons for a given status.
intent | ?!S Σ C | 1..1 | code | (USCDI) proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order.
Slices for category | S | 0..* | CodeableConcept | (USCDI) Type of medication usage Slice: Unordered, Open by pattern:$this Binding: medicationRequest Category Codes (example): A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.
category:us-core | S | 0..* | CodeableConcept | (USCDI) Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
priority | Σ | 0..1 | code | routine | urgent | asap | stat Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.
doNotPerform | ?!Σ | 1..1 | boolean | (USCDI+ Quality) True if medication was not requested Fixed Value: true
reported[x] | S Σ | 0..1 | Reference S(US Quality Core Practitioner | US Quality Core PractitionerRole | US Quality Core Patient | US Quality Core RelatedPerson) | (USCDI) Reported rather than primary record
medication[x] | S Σ | 1..1 | CodeableConcept | (USCDI) Medication to be taken Binding: SNOMEDCTMedicationCodes (preferred)
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:notDoneValueSet | C | 0..1 | canonical(ValueSet) | (USCDI+ Quality) What was not requested URL: http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet
coding | Σ C | 0..* | Coding | Code defined by a terminology system
text | Σ | 0..1 | string | Plain text representation of the concept
subject | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who or group medication request is for
encounter | S | 0..1 | Reference(US Quality Core Encounter) | (USCDI) Encounter created as part of encounter/admission/stay
supportingInformation |  | 0..* | Reference(Resource) | Information to support ordering of the medication
authoredOn | S Σ | 1..1 | dateTime | (USCDI) When request was initially authored
requester | S Σ C | 0..1 | Reference(US Quality Core Practitioner | US Quality Core PractitionerRole | US Quality Core Patient) | (USCDI) Who/What requested the Request
performer |  | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam) | Intended performer of administration
performerType | Σ | 0..1 | CodeableConcept | Desired kind of performer of the medication administration Binding: ProcedurePerformerRoleCodes (example): Identifies the type of individual that is desired to administer the medication.
recorder |  | 0..1 | Reference(Practitioner | PractitionerRole) | Person who entered the request
reasonCode |  | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Reason or indication for ordering or not ordering the medication Binding: USQualityCore Negation Reason Codes (extensible): The reason the medication was not requested
reasonReference |  | 0..* | Reference(US Quality Core Condition Encounter Diagnosis | US Quality Core Condition Problems Health Concerns | US Quality Core Simple Observation) | (USCDI) US Core Condition or Observation that supports the prescription
instantiatesCanonical | Σ | 0..* | canonical() | Instantiates FHIR protocol or definition
instantiatesUri | Σ | 0..* | uri | Instantiates external protocol or definition
basedOn | Σ | 0..* | Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation) | What request fulfills
groupIdentifier | Σ | 0..1 | Identifier | Composite request this is part of
courseOfTherapyType |  | 0..1 | CodeableConcept | Overall pattern of medication administration Binding: medicationRequest Course of Therapy Codes (example): Identifies the overall pattern of medication administratio.
insurance |  | 0..* | Reference(Coverage | ClaimResponse) | Associated insurance coverage
note |  | 0..* | Annotation | Information about the prescription
dosageInstruction | S | 0..* | Dosage | (USCDI) How the medication should be taken
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 0..1 | integer | The order of the dosage instructions
text | S Σ | 0..1 | string | (USCDI) Free text dosage instructions e.g. SIG
additionalInstruction | Σ | 0..* | CodeableConcept | Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
patientInstruction | Σ | 0..1 | string | Patient or consumer oriented instructions
timing | S Σ | 0..1 | Timing | (USCDI) When medication should be administered
asNeeded[x] | Σ | 0..1 |  | Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
asNeededBoolean |  |  | boolean |
asNeededCodeableConcept |  |  | CodeableConcept |
site | Σ | 0..1 | CodeableConcept | Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route | Σ | 0..1 | CodeableConcept | How drug should enter body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
method | Σ | 0..1 | CodeableConcept | Technique for administering medication Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
doseAndRate | S Σ | 0..* | Element | (USCDI) Amount of medication administered
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
type | Σ | 0..1 | CodeableConcept | The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
dose[x] | S Σ | 0..1 |  | (USCDI) Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S |
doseRange |  |  | Range |
rate[x] | Σ | 0..1 |  | Amount of medication per unit of time
rateRatio |  |  | Ratio |
rateRange |  |  | Range |
rateQuantity |  |  | Quantity(SimpleQuantity) |
maxDosePerPeriod | Σ | 0..1 | Ratio | Upper limit on medication per unit of time
maxDosePerAdministration | Σ | 0..1 | SimpleQuantity | Upper limit on medication per administration
maxDosePerLifetime | Σ | 0..1 | SimpleQuantity | Upper limit on medication per lifetime of the patient
dispenseRequest | S | 0..1 | BackboneElement | (USCDI) Medication supply authorization
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
initialFill |  | 0..1 | BackboneElement | First fill details
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
quantity |  | 0..1 | SimpleQuantity | First fill quantity
duration |  | 0..1 | Duration | First fill duration
dispenseInterval |  | 0..1 | Duration | Minimum period of time between dispenses
validityPeriod |  | 0..1 | Period | Time period supply is authorized for
numberOfRepeatsAllowed | S | 0..1 | unsignedInt | (USCDI) Number of refills authorized
quantity | S | 0..1 | SimpleQuantity | (USCDI) Amount of medication to supply per dispense
expectedSupplyDuration |  | 0..1 | Duration | Number of days supply per dispense
performer |  | 0..1 | Reference(Organization) | Intended dispenser
substitution |  | 0..1 | BackboneElement | Any restrictions on medication substitution
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
allowed[x] |  | 1..1 |  | Whether substitution is allowed or not Binding: ActSubstanceAdminSubstitutionCode (example): Identifies the type of substitution allowed.
allowedBoolean |  |  | boolean |
allowedCodeableConcept |  |  | CodeableConcept |
reason |  | 0..1 | CodeableConcept | Why should (not) substitution be made Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
priorPrescription |  | 0..1 | Reference(MedicationRequest) | An order/prescription that is being replaced
detectedIssue |  | 0..* | Reference(DetectedIssue) | Clinical Issue with action
eventHistory |  | 0..* | Reference(Provenance) | A list of events of interest in the lifecycle
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationRequest.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
MedicationRequest.status | Base | required | Medicationrequest status | 📦4.0.1 | FHIR Std.
MedicationRequest.statusReason | Base | example | Medication request status reason codes | 📦4.0.1 | FHIR Std.
MedicationRequest.intent | Base | required | Medication request intent | 📦4.0.1 | FHIR Std.
MedicationRequest.category | Base | example | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.category:us-core | Base | required | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.priority | Base | required | Request priority | 📍4.0.1 | FHIR Std.
MedicationRequest.medication[x] | Base | preferred | SNOMED CT Medication Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.performerType | Base | example | Procedure Performer Role Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.reasonCode | Base | extensible | USQualityCore Negation Reason Codes | 📦0.1.0 | This IG
MedicationRequest.courseOfTherapyType | Base | example | Medication request course of therapy codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​additionalInstruction | Base | example | SNOMED CT Additional Dosage Instructions | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​asNeeded[x] | Base | example | SNOMED CT Medication As Needed Reason Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​site | Base | example | SNOMED CT Anatomical Structure for Administration Site Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​route | Base | example | SNOMED CT Route Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​method | Base | example | SNOMED CT Administration Method Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​doseAndRate.type | Base | example | DoseAndRateType | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationRequest.substitution.​allowed[x] | Base | example | ActSubstanceAdminSubstitutionCode | 📦3.0.0 | THO v5.4
MedicationRequest.substitution.​reason | Base | example | SubstanceAdminSubstitutionReason | 📦3.0.0 | THO v5.4

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | MedicationRequest | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | MedicationRequest | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | MedicationRequest | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | MedicationRequest | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | MedicationRequest | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
mnr-1 | error | MedicationRequest | To indicate what medication was not requested, either at least one coding in the medication or a notDoneValueSet extension shall be provided | `medication.extension('http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor medication.coding.exists()`
us-core-21 | error | MedicationRequest | requester SHALL be present if intent is "order" | `(intent='order' or intent='original-order' or intent='reflex-order'or intent='filler-order' or intent='instance-order') implies requester.exists()`

This structure is derived from USCoreMedicationRequestProfile

Summary

Mandatory: 3 elements
Fixed: 1 element

Structures

This structure refers to these other structures:

- US Quality Core Practitioner (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-practitioner)
- US Quality Core PractitionerRole (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-practitionerrole)
- US Quality Core Patient (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient)
- US Quality Core RelatedPerson (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-relatedperson)
- US Quality Core Encounter (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter)
- US Quality Core Condition Encounter Diagnosis (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis)
- US Quality Core Condition Problems Health Concerns (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns)
- US Quality Core Simple Observation (http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-simple-observation)

Extensions

This structure refers to these extensions:

- http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet

Other representations of profile: CSV, Excel, Schematron