US Core Implementation Guide
8.0.1 - STU 8

US Core Implementation Guide, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 8.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/US-Core/ and changes regularly. See the Directory of published versions

## Extension: US Core Medication Adherence Extension

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence | Version: 8.0.1
Standards status: Trial-use | Maturity Level: 2 | Computable Name: USCoreMedicationAdherenceExtension
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.42.37
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

The Medication Adherence Extension is used to report whether a medication has been consumed according to instructions as reported by a patient or on behalf of the patient.

Context of Use

This extension may be used on the following element(s)

- Element ID: `MedicationRequest`

Profile Specific Implementation Guidance:

This Complex Extension is made up of three sub-extensions:

1. A required Medication Adherence Code, which is bound to the Medication Adherence ValueSet - a "starter" set of medication compliance SNOMED CT and NullValue codes. Its binding is extensible, and other concepts from SNOMED CT or another code system, including local codes, can be used. The table below illustrates basic scenarios of how an implementer can use them:

   Example Scenario | Medication Adherence Code (SCT ID)|Preferred Term
   --- | ---
   The medication is being taken as directed. | 1156699004|Complies with drug therapy (finding)
   The medication is being taken, but not as directed. For example, the patient occasionally forgets or takes two pills instead of three. | 702565001|Non-compliance of drug therapy (finding)
   The medication is not being taken. For example, the patient did not pick up a prescription. | 715036001|Does not take medication (finding)

2. A required date asserting when the information was provided
3. A Must Support information source code with an example binding to the Medication Adherence ValueSet - a "starter" set of informant role codes.

Usage info

Usages:

- Use this Extension: US Core MedicationRequest Profile
- Examples for this Extension: MedicationRequest/medicationrequest-coded-oral-axid and MedicationRequest/self-tylenol

You can also check for usages in the FHIR IG Statistics

Changes since version 7.0.0:

- No changes

### Formal Views of Extension Content

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

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

This structure is derived from Extension

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Extension
Slices for extension |  | 2..* | Extension | Extension Slice: Unordered, Open by value:url
extension:medicationAdherence | S | 1..1 | Extension | Medication adherence code
url |  | 1..1 | uri | "medicationAdherence"
value[x] |  | 1..1 | CodeableConcept | Value of extension Binding: Medication Adherence (extensible): This set of values contains terms representing whether a medication has been consumed according to instructions.
extension:dateAsserted | S | 1..1 | Extension | When the medication adherence was asserted
url |  | 1..1 | uri | "dateAsserted"
value[x] |  | 1..1 | dateTime | Value of extension
extension:informationSource | S | 0..* | Extension | Who provided the information about the medication adherence
url |  | 1..1 | uri | "informationSource"
value[x] |  | 1..1 | CodeableConcept | Value of extension Binding: Information Source for Medication Adherence (example): The person or organization that provided the information about the medication adherence
url |  | 1..1 | uri | "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence"
value[x] |  | 0..0 |  | Value of extension
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 2..* | Extension | Extension Slice: Unordered, Open by value:url
extension:medicationAdherence | S | 1..1 | Extension | Medication adherence code
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "medicationAdherence"
value[x] |  | 1..1 | CodeableConcept | Value of extension Binding: Medication Adherence (extensible): This set of values contains terms representing whether a medication has been consumed according to instructions.
extension:dateAsserted | S | 1..1 | Extension | When the medication adherence was asserted
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "dateAsserted"
value[x] |  | 1..1 | dateTime | Value of extension
extension:informationSource | S | 0..* | Extension | Who provided the information about the medication adherence
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "informationSource"
value[x] |  | 1..1 | CodeableConcept | Value of extension Binding: Information Source for Medication Adherence (example): The person or organization that provided the information about the medication adherence
url |  | 1..1 | uri | "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence"
Documentation for this format

This structure is derived from Extension

Summary

Complex Extension: The Medication Adherence Extension is used to report whether a medication has been consumed according to instructions as reported by a patient or on behalf of the patient.

- medicationAdherence: CodeableConcept: Code stating whether the patient is consuming medications according to instructions.
- dateAsserted: dateTime: When the medication adherence was asserted by the information source
- informationSource: CodeableConcept: The person or organization that provided the information about the medication adherence

Maturity: 2

Differential View

This structure is derived from Extension

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Extension
Slices for extension |  | 2..* | Extension | Extension Slice: Unordered, Open by value:url
extension:medicationAdherence | S | 1..1 | Extension | Medication adherence code
url |  | 1..1 | uri | "medicationAdherence"
value[x] |  | 1..1 | CodeableConcept | Value of extension Binding: Medication Adherence (extensible): This set of values contains terms representing whether a medication has been consumed according to instructions.
extension:dateAsserted | S | 1..1 | Extension | When the medication adherence was asserted
url |  | 1..1 | uri | "dateAsserted"
value[x] |  | 1..1 | dateTime | Value of extension
extension:informationSource | S | 0..* | Extension | Who provided the information about the medication adherence
url |  | 1..1 | uri | "informationSource"
value[x] |  | 1..1 | CodeableConcept | Value of extension Binding: Information Source for Medication Adherence (example): The person or organization that provided the information about the medication adherence
url |  | 1..1 | uri | "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence"
value[x] |  | 0..0 |  | Value of extension
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 2..* | Extension | Extension Slice: Unordered, Open by value:url
extension:medicationAdherence | S | 1..1 | Extension | Medication adherence code
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "medicationAdherence"
value[x] |  | 1..1 | CodeableConcept | Value of extension Binding: Medication Adherence (extensible): This set of values contains terms representing whether a medication has been consumed according to instructions.
extension:dateAsserted | S | 1..1 | Extension | When the medication adherence was asserted
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "dateAsserted"
value[x] |  | 1..1 | dateTime | Value of extension
extension:informationSource | S | 0..* | Extension | Who provided the information about the medication adherence
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "informationSource"
value[x] |  | 1..1 | CodeableConcept | Value of extension Binding: Information Source for Medication Adherence (example): The person or organization that provided the information about the medication adherence
url |  | 1..1 | uri | "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence"
Documentation for this format

This structure is derived from Extension

Summary

Complex Extension: The Medication Adherence Extension is used to report whether a medication has been consumed according to instructions as reported by a patient or on behalf of the patient.

- medicationAdherence: CodeableConcept: Code stating whether the patient is consuming medications according to instructions.
- dateAsserted: dateTime: When the medication adherence was asserted by the information source
- informationSource: CodeableConcept: The person or organization that provided the information about the medication adherence

Maturity: 2

Other representations of profile: CSV, Excel, Schematron

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Extension.extension:medicationAdherence.​value[x] | Base | extensible | Medication Adherence | 📦20231025 | VSAC v0.24
Extension.extension:informationSource.​value[x] | Base | example | Information Source for Medication Adherence | 📦20240329 | VSAC v0.24

#### Constraints

Id | Grade | Path(s) | Description | Expression
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()`