# US Quality Core Medication Not Requested - US Quality Core Implementation Guide v0.1.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **US Quality Core Medication Not Requested**

## 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](patterns.md) 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](MedicationRequest-negation-example.md) | Medication not indicated; indicates that none of the medications in the given not done value set were requested. |
| [Negation Example using code](MedicationRequest-negation-example-code.md) | 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](index.md#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](MedicationRequest-negation-example-code.md) and [MedicationRequest/negation-example](MedicationRequest-negation-example.md)
* CapabilityStatements using this Profile: [US Quality Core Client CapabilityStatement](CapabilityStatement-us-quality-core-client.md) and [US Quality Core Server CapabilityStatement](CapabilityStatement-us-quality-core-server.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/fhir.astp.us-quality-core|current/StructureDefinition/us-quality-core-medicationnotrequested)

### Formal Views of Profile Content

 [Description of Profiles, Differentials, Snapshots and how the different presentations work](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](StructureDefinition-us-quality-core-medicationnotrequested.csv), [Excel](StructureDefinition-us-quality-core-medicationnotrequested.xlsx), [Schematron](StructureDefinition-us-quality-core-medicationnotrequested.sch) 



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "us-quality-core-medicationnotrequested",
  "url" : "http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-medicationnotrequested",
  "version" : "0.1.0",
  "name" : "USQualityCoreMedicationNotRequested",
  "title" : "US Quality Core Medication Not Requested",
  "status" : "active",
  "experimental" : false,
  "date" : "2026-03-31",
  "publisher" : "ASTP",
  "contact" : [{
    "telecom" : [{
      "system" : "url",
      "value" : "https://www.healthit.gov/"
    }]
  }],
  "description" : "Negation profile of MedicationRequest for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US",
      "display" : "United States of America"
    }],
    "text" : "USA"
  }],
  "fhirVersion" : "4.0.1",
  "mapping" : [{
    "identity" : "workflow",
    "uri" : "http://hl7.org/fhir/workflow",
    "name" : "Workflow Pattern"
  },
  {
    "identity" : "script10.6",
    "uri" : "http://ncpdp.org/SCRIPT10_6",
    "name" : "Mapping to NCPDP SCRIPT 10.6"
  },
  {
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  },
  {
    "identity" : "w5",
    "uri" : "http://hl7.org/fhir/fivews",
    "name" : "FiveWs Pattern Mapping"
  },
  {
    "identity" : "v2",
    "uri" : "http://hl7.org/v2",
    "name" : "HL7 v2 Mapping"
  }],
  "kind" : "resource",
  "abstract" : false,
  "type" : "MedicationRequest",
  "baseDefinition" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "MedicationRequest",
      "path" : "MedicationRequest",
      "constraint" : [{
        "key" : "mnr-1",
        "severity" : "error",
        "human" : "To indicate what medication was not requested, either at least one coding in the medication or a notDoneValueSet extension shall be provided",
        "expression" : "medication.extension('http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor medication.coding.exists()",
        "xpath" : "exists(f:extension)"
      }],
      "mustSupport" : false
    },
    {
      "id" : "MedicationRequest.status",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "MedicationRequest.status",
      "short" : "(USCDI) active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown"
    },
    {
      "id" : "MedicationRequest.doNotPerform",
      "extension" : [{
        "url" : "http://fhir.org/guides/astp/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "MedicationRequest.doNotPerform",
      "short" : "(USCDI+ Quality) True if medication was not requested",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "boolean"
      }],
      "fixedBoolean" : true
    },
    {
      "id" : "MedicationRequest.reported[x]",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "MedicationRequest.reported[x]",
      "short" : "(USCDI) Reported rather than primary record",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-practitioner",
        "http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-practitionerrole",
        "http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient",
        "http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-relatedperson"]
      }]
    },
    {
      "id" : "MedicationRequest.medication[x]",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "MedicationRequest.medication[x]",
      "short" : "(USCDI) Medication to be taken",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "binding" : {
        "strength" : "preferred",
        "valueSet" : "http://hl7.org/fhir/ValueSet/medication-codes"
      }
    },
    {
      "id" : "MedicationRequest.medication[x].extension:notDoneValueSet",
      "extension" : [{
        "url" : "http://fhir.org/guides/astp/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "MedicationRequest.medication[x].extension",
      "sliceName" : "notDoneValueSet",
      "short" : "(USCDI+ Quality) What was not requested",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "Extension",
        "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet"]
      }],
      "condition" : ["mnr-1"]
    },
    {
      "id" : "MedicationRequest.medication[x].coding",
      "path" : "MedicationRequest.medication[x].coding",
      "condition" : ["mnr-1"],
      "mustSupport" : false
    },
    {
      "id" : "MedicationRequest.subject",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "MedicationRequest.subject",
      "short" : "(USCDI) Who or group medication request is for",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient"]
      }]
    },
    {
      "id" : "MedicationRequest.encounter",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "MedicationRequest.encounter",
      "short" : "(USCDI) Encounter created as part of encounter/admission/stay",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter"]
      }]
    },
    {
      "id" : "MedicationRequest.authoredOn",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "MedicationRequest.authoredOn",
      "short" : "(USCDI) When request was initially authored",
      "min" : 1,
      "max" : "1"
    },
    {
      "id" : "MedicationRequest.requester",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "MedicationRequest.requester",
      "short" : "(USCDI) Who/What requested the Request",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-practitioner",
        "http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-practitionerrole",
        "http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient"]
      }]
    },
    {
      "id" : "MedicationRequest.reasonCode",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/astp/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "MedicationRequest.reasonCode",
      "short" : "(USCDI+ Quality) (USCDI) Reason or indication for ordering or not ordering the medication",
      "min" : 1,
      "max" : "1",
      "binding" : {
        "strength" : "extensible",
        "description" : "The reason the medication was not requested",
        "valueSet" : "http://fhir.org/guides/astp/us-quality-core/ValueSet/us-quality-core-negation-reason"
      }
    },
    {
      "id" : "MedicationRequest.reasonReference",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "MedicationRequest.reasonReference",
      "short" : "(USCDI) US Core Condition or Observation that supports the prescription",
      "definition" : "Condition or observation that supports why the medication was ordered.",
      "comment" : "This is a reference to a condition or observation that is the reason for the medication order.  If only a code exists, use reasonCode.",
      "min" : 0,
      "max" : "*",
      "base" : {
        "path" : "MedicationRequest.reasonReference",
        "min" : 0,
        "max" : "*"
      },
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis",
        "http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns",
        "http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-simple-observation"]
      }],
      "isModifier" : false,
      "isSummary" : false
    },
    {
      "id" : "MedicationRequest.dosageInstruction",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "MedicationRequest.dosageInstruction",
      "short" : "(USCDI) How the medication should be taken"
    },
    {
      "id" : "MedicationRequest.dosageInstruction.text",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "MedicationRequest.dosageInstruction.text",
      "short" : "(USCDI) Free text dosage instructions e.g. SIG"
    },
    {
      "id" : "MedicationRequest.dosageInstruction.timing",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "MedicationRequest.dosageInstruction.timing",
      "short" : "(USCDI) When medication should be administered"
    },
    {
      "id" : "MedicationRequest.dosageInstruction.asNeeded[x]",
      "path" : "MedicationRequest.dosageInstruction.asNeeded[x]",
      "short" : "Take \"as needed\" (for x)"
    },
    {
      "id" : "MedicationRequest.dosageInstruction.route",
      "path" : "MedicationRequest.dosageInstruction.route",
      "short" : "How drug should enter body"
    },
    {
      "id" : "MedicationRequest.dosageInstruction.doseAndRate",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "MedicationRequest.dosageInstruction.doseAndRate",
      "short" : "(USCDI) Amount of medication administered"
    },
    {
      "id" : "MedicationRequest.dosageInstruction.doseAndRate.dose[x]",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "MedicationRequest.dosageInstruction.doseAndRate.dose[x]",
      "short" : "(USCDI) Amount of medication per dose"
    },
    {
      "id" : "MedicationRequest.dispenseRequest.quantity",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "MedicationRequest.dispenseRequest.quantity",
      "short" : "(USCDI) Amount of medication to supply per dispense"
    },
    {
      "id" : "MedicationRequest.dispenseRequest.expectedSupplyDuration",
      "path" : "MedicationRequest.dispenseRequest.expectedSupplyDuration",
      "short" : "Number of days supply per dispense"
    }]
  }
}

```
