US Core Maturity: 5

Example Usage Scenarios:

The following are example usage scenarios for the US Core-MedicationRequest profile. See the Medication List section for guidance on accessing a patient's medications:

• Fetching all medications that have been prescribed to a patient
• Fetching all active medications that have been prescribed to a patient
• Fetching all medications that have been prescribed to a patient during a particular encounter
• Record or update medications that have been prescribed for a patient

Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each MedicationRequest Must Have:

1. a status
2. an intent code
3. a medication¹
4. a patient

Each MedicationRequest Must Support:

1. the category (e.g., Discharge Medication)
2. the reported flag or reference signaling that information is from a secondary source such as a patient²
3. the encounters
4. a prescriber³
5. a date for when written
6. free text dosage instructions (the SIG)
7. when medication should be administered
8. the route of administration
9. the dose and rate
10. the amount dispensed and number of refills

Additional USCDI Requirements:

These Additional USCDI Requirements elements are not Mandatory or Must Support but are required for ONC Health IT certification testing and are included in the formal definition of the profile and the MedicationRequest examples.

1. the reason or indication for the prescription⁴
2. reported adherence to prescribed medication instructions⁵

^1,2,3,4,5 see guidance below

Profile Specific Implementation Guidance

This section provides detailed implementation guidance for the US Core Profile to support implementation and certification.

• See the Medication List section for guidance on accessing a patient's medications, including over-the-counter (OTC) medications and other substances taken for medical and recreational use.
  • Servers SHALL return all active medications following the Get All Active Medications guidance.^§ It is always best practice to confirm this list with the patient or caregiver.
  • When recording "self-prescribed" medication, requester SHOULD be used to indicate the Patient or RelatedPerson as the prescriber.^§
• ¹ This Profile can represent a medication using a code or reference to a Medication resource.
  • The Server systems are not required to support both a code and a reference, but SHALL support at least one of these methods.^§
  • The Client application SHALL support all methods.^§,§
  • When using a code, RXNorm concepts are used. They are defined as an extensible binding to .medicationCodeableConcept. USCDI recommends the National Drug Codes (NDC) as an optional terminology. They MAY be supplied as an additional coding element.^§
    • Systems that primarily rely on NDC codes instead of RxNorm to represent medications can use the National Library of Medicine's (NLM) NDC to RxNorm mappings to aid in additional codings.
  • When referencing a Medication resource in .medicationReference, the resource may be contained or an external resource.^§,§ If an external reference to a Medication resource is used, the Server SHALL support the _include parameter for searching this element.^§

• ³The profile elements MedicationRequest.requester and MedicationRequest.reportedReference communicate the individual level provenance author data corresponding to the U.S. Core Data for Interoperability (USCDI) Provenance Author Data Elements.

• ²The MedicationRequest resource can represent that information is from a secondary source using either the flag MedicationRequest.reportedBoolean or a reference using MedicationRequest.reportedReference.
  • Although both are marked as Must Support, the Server system is not required to support both, but SHALL support at least one of these elements.^§
  • The Client application SHALL support both elements.^§,§
• ⁴The MedicationRequest resource can communicate the reason or indication for treatment using either a code in MedicationRequest.reasonCode or a reference using MedicationRequest.reasonReference.
  • Although both MedicationRequest.reasonCode and MedicationRequest.reasonReference are marked as Additional USCDI Requirements. The certifying Server system is not required to support both, but SHALL support at least one of these elements.^§ The certifying Client application SHALL support both elements.^§,§
    • when using MedicationRequest.reasonReference:
      • Servers SHALL support at least one target resource in MedicationRequest.reasonReference.^§ Clients SHALL support all target resources in MedicationRequest.reasonReference.^§
      • The referenced resources SHOULD be a US Core Profile as documented in Referencing US Core Profiles.^§
• Source EHR identifiers SHOULD be included to support deduplication across MedicationRequest resources.^§ Exposing the EHR identifiers helps Client applications identify duplicates.
• ⁵This profile uses the US Core Medication Adherence Extension to report medication adherence. This extension communicates whether a medication has been consumed according to instructions.^{[§][CONF-0406]}

Changes since version 9.0.0:

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
MedicationRequest	C	0..*	MedicationRequest	Ordering of medication for patient or group Constraints: us-core-21
MedicationRequest.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
MedicationRequest.Slices for extension				Content/Rules for all slices
MedicationRequest.Slices for extension.extension:medicationAdherence		0..*	(Complex)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Medication Adherence Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence
MedicationRequest.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
MedicationRequest.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	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.
MedicationRequest.intent	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries. C	1..1	code	proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order.
MedicationRequest.Slices for category	S This element must be supported.	0..*	CodeableConcept	Type of medication usage Slice: Unordered, Open by value:$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. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
MedicationRequest.Slices for category.category:us-core	S This element must be supported.	0..*	CodeableConcept	Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted in other slices, see Required Bindings When Slicing by Value Sets
MedicationRequest.doNotPerform	?! This element is a modifier element. Σ This element is included in summaries.	0..1	boolean	True if request is prohibiting action
MedicationRequest.reported[x]	S This element must be supported. Σ This element is included in summaries.	0..1		Reported rather than primary record
MedicationRequest.reported[x].reportedBoolean			boolean S This target must be supported.
MedicationRequest.reported[x].reportedReference			Reference S This type must be supported. (US Core Practitioner Profile S This target must be supported. | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile)
MedicationRequest.medication[x]	S This element must be supported. Σ This element is included in summaries.	1..1		Medication to be taken Binding: Medication Clinical Drug (extensible)
MedicationRequest.medication[x].medicationCodeableConcept			CodeableConcept
MedicationRequest.medication[x].medicationReference			Reference(US Core Medication Profile)
MedicationRequest.subject	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(US Core Patient Profile S This type must be supported. | Group)	Who or group medication request is for
MedicationRequest.encounter	S This element must be supported.	0..1	Reference(US Core Encounter Profile)	Encounter created as part of encounter/admission/stay
MedicationRequest.authoredOn	S This element must be supported. Σ This element is included in summaries.	0..1	dateTime	When request was initially authored
MedicationRequest.requester	S This element must be supported. Σ This element is included in summaries. C	0..1	Reference(US Core Practitioner Profile S This type must be supported. | US Core Patient Profile | US Core Organization Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | US Core Device Profile)	Who/What requested the Request
MedicationRequest.reasonCode		0..*	CodeableConcept	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Reason or indication for ordering or not ordering the medication Binding: US Core Condition Codes (extensible)
MedicationRequest.reasonReference		0..*	Reference(Condition | Observation)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Condition or Observation that supports the prescription
MedicationRequest.dosageInstruction	S This element must be supported.	0..*	Dosage	How the medication should be taken
MedicationRequest.dosageInstruction.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
MedicationRequest.dosageInstruction.text	S This element must be supported. Σ This element is included in summaries.	0..1	string	Free text dosage instructions e.g. SIG
MedicationRequest.dosageInstruction.timing	S This element must be supported. Σ This element is included in summaries.	0..1	Timing	When medication should be administered
MedicationRequest.dosageInstruction.route	S This element must be supported. Σ This element is included in summaries.	0..1	CodeableConcept	How drug should enter body Binding: Route of Administration of Therapeutic Agents (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes
MedicationRequest.dosageInstruction.doseAndRate	S This element must be supported. Σ This element is included in summaries.	0..*	Element	Amount of medication administered
MedicationRequest.dosageInstruction.doseAndRate.dose[x]	S This element must be supported. Σ This element is included in summaries.	0..1		Amount of medication per dose Binding: Common UCUM units (preferred) Additional Bindings Purpose UCUMCodes Max Binding
MedicationRequest.dosageInstruction.doseAndRate.dose[x].doseQuantity			Quantity S This type must be supported. (SimpleQuantity)
MedicationRequest.dosageInstruction.doseAndRate.dose[x].doseRange			Range
MedicationRequest.dispenseRequest	S This element must be supported.	0..1	BackboneElement	Medication supply authorization
MedicationRequest.dispenseRequest.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
MedicationRequest.dispenseRequest.numberOfRepeatsAllowed	S This element must be supported.	0..1	unsignedInt	Number of refills authorized
MedicationRequest.dispenseRequest.quantity	S This element must be supported. C	0..1	SimpleQuantity(4.0.1)	Amount of medication to supply per dispense Constraints: sqty-1
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	extensible	Medication Clinical Drug	⏿20240606	tx.fhir.org
MedicationRequest.reasonCode	Base	extensible	US Core Condition Codes	📦10.0.0-ballot	This IG
MedicationRequest.dosageInstruction.​route	Base	extensible	Route of Administration of Therapeutic Agents	⏿20241015	tx.fhir.org
MedicationRequest.dosageInstruction.​doseAndRate.dose[x]	Base	preferred	Common UCUM units	📦4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
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 MedicationRequest

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
MedicationRequest	C	0..*	MedicationRequest	Ordering of medication for patient or group Constraints: us-core-21
MedicationRequest.Slices for extension				Content/Rules for all slices
MedicationRequest.Slices for extension.extension:medicationAdherence		0..*	(Complex)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Medication Adherence Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence
MedicationRequest.status	S This element must be supported.	1..1	code	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.
MedicationRequest.intent	S This element must be supported. C	1..1	code	proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order.
MedicationRequest.Slices for category	S This element must be supported.	0..*	CodeableConcept	Type of medication usage Slice: Unordered, Open by value:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
MedicationRequest.Slices for category.category:us-core	S This element must be supported.	0..*	CodeableConcept	Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted in other slices, see Required Bindings When Slicing by Value Sets
MedicationRequest.reported[x]	S This element must be supported.	0..1		Reported rather than primary record
MedicationRequest.reported[x].reportedBoolean			boolean S This target must be supported.
MedicationRequest.reported[x].reportedReference			Reference S This type must be supported. (US Core Practitioner Profile S This target must be supported. | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile)
MedicationRequest.medication[x]	S This element must be supported.	1..1		Medication to be taken Binding: Medication Clinical Drug (extensible)
MedicationRequest.medication[x].medicationCodeableConcept			CodeableConcept
MedicationRequest.medication[x].medicationReference			Reference(US Core Medication Profile)
MedicationRequest.subject	S This element must be supported.	1..1	Reference(US Core Patient Profile S This type must be supported. | Group)	Who or group medication request is for
MedicationRequest.encounter	S This element must be supported.	0..1	Reference(US Core Encounter Profile)	Encounter created as part of encounter/admission/stay
MedicationRequest.authoredOn	S This element must be supported.	0..1	dateTime	When request was initially authored
MedicationRequest.requester	S This element must be supported. C	0..1	Reference(US Core Practitioner Profile S This type must be supported. | US Core Patient Profile | US Core Organization Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | US Core Device Profile)	Who/What requested the Request
MedicationRequest.reasonCode		0..*	CodeableConcept	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Reason or indication for ordering or not ordering the medication Binding: US Core Condition Codes (extensible)
MedicationRequest.reasonReference		0..*	Reference(Condition | Observation)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Condition or Observation that supports the prescription
MedicationRequest.dosageInstruction	S This element must be supported.	0..*	Dosage	How the medication should be taken
MedicationRequest.dosageInstruction.text	S This element must be supported.	0..1	string	Free text dosage instructions e.g. SIG
MedicationRequest.dosageInstruction.timing	S This element must be supported.	0..1	Timing	When medication should be administered
MedicationRequest.dosageInstruction.route	S This element must be supported.	0..1	CodeableConcept	How drug should enter body Binding: Route of Administration of Therapeutic Agents (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes
MedicationRequest.dosageInstruction.doseAndRate	S This element must be supported.	0..*	Element	Amount of medication administered
MedicationRequest.dosageInstruction.doseAndRate.dose[x]	S This element must be supported.	0..1		Amount of medication per dose Binding: Common UCUM units (preferred) Additional Bindings Purpose UCUMCodes Max Binding
MedicationRequest.dosageInstruction.doseAndRate.dose[x].doseQuantity			Quantity S This type must be supported. (SimpleQuantity)
MedicationRequest.dosageInstruction.doseAndRate.dose[x].doseRange			Range
MedicationRequest.dispenseRequest	S This element must be supported.	0..1	BackboneElement	Medication supply authorization
MedicationRequest.dispenseRequest.numberOfRepeatsAllowed	S This element must be supported.	0..1	unsignedInt	Number of refills authorized
MedicationRequest.dispenseRequest.quantity	S This element must be supported.	0..1	SimpleQuantity(4.0.1)	Amount of medication to supply per dispense
Documentation for this format

Terminology Bindings (Differential)

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:us-core	Base	required	Medication request category codes	📦4.0.1	FHIR Std.
MedicationRequest.medication[x]	Base	extensible	Medication Clinical Drug	⏿20240606	tx.fhir.org
MedicationRequest.reasonCode	Base	extensible	US Core Condition Codes	📦10.0.0-ballot	This IG
MedicationRequest.dosageInstruction.​route	Base	extensible	Route of Administration of Therapeutic Agents	⏿20241015	tx.fhir.org
MedicationRequest.dosageInstruction.​doseAndRate.dose[x]	Base	preferred	Common UCUM units	📦4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
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()

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
MedicationRequest	C	0..*	MedicationRequest	Ordering of medication for patient or group Constraints: us-core-21
MedicationRequest.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
MedicationRequest.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
MedicationRequest.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
MedicationRequest.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
MedicationRequest.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
MedicationRequest.contained		0..*	Resource	Contained, inline Resources
MedicationRequest.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
MedicationRequest.Slices for extension.extension:medicationAdherence		0..*	(Complex)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Medication Adherence Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence
MedicationRequest.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
MedicationRequest.identifier		0..*	Identifier	External ids for this request
MedicationRequest.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	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.
MedicationRequest.statusReason		0..1	CodeableConcept	Reason for current status Binding: medicationRequest Status Reason Codes (example): Identifies the reasons for a given status.
MedicationRequest.intent	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries. C	1..1	code	proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order.
MedicationRequest.Slices for category	S This element must be supported.	0..*	CodeableConcept	Type of medication usage Slice: Unordered, Open by value:$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. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
MedicationRequest.Slices for category.category:us-core	S This element must be supported.	0..*	CodeableConcept	Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted in other slices, see Required Bindings When Slicing by Value Sets
MedicationRequest.priority	Σ This element is included in summaries.	0..1	code	routine | urgent | asap | stat Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.
MedicationRequest.doNotPerform	?! This element is a modifier element. Σ This element is included in summaries.	0..1	boolean	True if request is prohibiting action
MedicationRequest.reported[x]	S This element must be supported. Σ This element is included in summaries.	0..1		Reported rather than primary record
MedicationRequest.reported[x].reportedBoolean			boolean S This target must be supported.
MedicationRequest.reported[x].reportedReference			Reference S This type must be supported. (US Core Practitioner Profile S This target must be supported. | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile)
MedicationRequest.medication[x]	S This element must be supported. Σ This element is included in summaries.	1..1		Medication to be taken Binding: Medication Clinical Drug (extensible)
MedicationRequest.medication[x].medicationCodeableConcept			CodeableConcept
MedicationRequest.medication[x].medicationReference			Reference(US Core Medication Profile)
MedicationRequest.subject	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(US Core Patient Profile S This type must be supported. | Group)	Who or group medication request is for
MedicationRequest.encounter	S This element must be supported.	0..1	Reference(US Core Encounter Profile)	Encounter created as part of encounter/admission/stay
MedicationRequest.supportingInformation		0..*	Reference(Resource)	Information to support ordering of the medication
MedicationRequest.authoredOn	S This element must be supported. Σ This element is included in summaries.	0..1	dateTime	When request was initially authored
MedicationRequest.requester	S This element must be supported. Σ This element is included in summaries. C	0..1	Reference(US Core Practitioner Profile S This type must be supported. | US Core Patient Profile | US Core Organization Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | US Core Device Profile)	Who/What requested the Request
MedicationRequest.performer		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam)	Intended performer of administration
MedicationRequest.performerType	Σ This element is included in summaries.	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.
MedicationRequest.recorder		0..1	Reference(Practitioner | PractitionerRole)	Person who entered the request
MedicationRequest.reasonCode		0..*	CodeableConcept	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Reason or indication for ordering or not ordering the medication Binding: US Core Condition Codes (extensible)
MedicationRequest.reasonReference		0..*	Reference(Condition | Observation)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Condition or Observation that supports the prescription
MedicationRequest.instantiatesCanonical	Σ This element is included in summaries.	0..*	canonical()	Instantiates FHIR protocol or definition
MedicationRequest.instantiatesUri	Σ This element is included in summaries.	0..*	uri	Instantiates external protocol or definition
MedicationRequest.basedOn	Σ This element is included in summaries.	0..*	Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation)	What request fulfills
MedicationRequest.groupIdentifier	Σ This element is included in summaries.	0..1	Identifier	Composite request this is part of
MedicationRequest.courseOfTherapyType		0..1	CodeableConcept	Overall pattern of medication administration Binding: medicationRequest Course of Therapy Codes (example): Identifies the overall pattern of medication administratio.
MedicationRequest.insurance		0..*	Reference(Coverage | ClaimResponse)	Associated insurance coverage
MedicationRequest.note		0..*	Annotation	Information about the prescription
MedicationRequest.dosageInstruction	S This element must be supported.	0..*	Dosage	How the medication should be taken
MedicationRequest.dosageInstruction.id		0..1	string	Unique id for inter-element referencing
MedicationRequest.dosageInstruction.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
MedicationRequest.dosageInstruction.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
MedicationRequest.dosageInstruction.sequence	Σ This element is included in summaries.	0..1	integer	The order of the dosage instructions
MedicationRequest.dosageInstruction.text	S This element must be supported. Σ This element is included in summaries.	0..1	string	Free text dosage instructions e.g. SIG
MedicationRequest.dosageInstruction.additionalInstruction	Σ This element is included in summaries.	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".
MedicationRequest.dosageInstruction.patientInstruction	Σ This element is included in summaries.	0..1	string	Patient or consumer oriented instructions
MedicationRequest.dosageInstruction.timing	S This element must be supported. Σ This element is included in summaries.	0..1	Timing	When medication should be administered
MedicationRequest.dosageInstruction.asNeeded[x]	Σ This element is included in summaries.	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.
MedicationRequest.dosageInstruction.asNeeded[x].asNeededBoolean			boolean
MedicationRequest.dosageInstruction.asNeeded[x].asNeededCodeableConcept			CodeableConcept
MedicationRequest.dosageInstruction.site	Σ This element is included in summaries.	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.
MedicationRequest.dosageInstruction.route	S This element must be supported. Σ This element is included in summaries.	0..1	CodeableConcept	How drug should enter body Binding: Route of Administration of Therapeutic Agents (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes
MedicationRequest.dosageInstruction.method	Σ This element is included in summaries.	0..1	CodeableConcept	Technique for administering medication Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
MedicationRequest.dosageInstruction.doseAndRate	S This element must be supported. Σ This element is included in summaries.	0..*	Element	Amount of medication administered
MedicationRequest.dosageInstruction.doseAndRate.id		0..1	string	Unique id for inter-element referencing
MedicationRequest.dosageInstruction.doseAndRate.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
MedicationRequest.dosageInstruction.doseAndRate.type	Σ This element is included in summaries.	0..1	CodeableConcept	The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
MedicationRequest.dosageInstruction.doseAndRate.dose[x]	S This element must be supported. Σ This element is included in summaries.	0..1		Amount of medication per dose Binding: Common UCUM units (preferred) Additional Bindings Purpose UCUMCodes Max Binding
MedicationRequest.dosageInstruction.doseAndRate.dose[x].doseQuantity			Quantity S This type must be supported. (SimpleQuantity)
MedicationRequest.dosageInstruction.doseAndRate.dose[x].doseRange			Range
MedicationRequest.dosageInstruction.doseAndRate.rate[x]	Σ This element is included in summaries.	0..1		Amount of medication per unit of time
MedicationRequest.dosageInstruction.doseAndRate.rate[x].rateRatio			Ratio
MedicationRequest.dosageInstruction.doseAndRate.rate[x].rateRange			Range
MedicationRequest.dosageInstruction.doseAndRate.rate[x].rateQuantity			Quantity(SimpleQuantity)
MedicationRequest.dosageInstruction.maxDosePerPeriod	Σ This element is included in summaries.	0..1	Ratio	Upper limit on medication per unit of time
MedicationRequest.dosageInstruction.maxDosePerAdministration	Σ This element is included in summaries. C	0..1	SimpleQuantity(4.0.1)	Upper limit on medication per administration Constraints: sqty-1
MedicationRequest.dosageInstruction.maxDosePerLifetime	Σ This element is included in summaries. C	0..1	SimpleQuantity(4.0.1)	Upper limit on medication per lifetime of the patient Constraints: sqty-1
MedicationRequest.dispenseRequest	S This element must be supported.	0..1	BackboneElement	Medication supply authorization
MedicationRequest.dispenseRequest.id		0..1	string	Unique id for inter-element referencing
MedicationRequest.dispenseRequest.extension		0..*	Extension	Additional content defined by implementations
MedicationRequest.dispenseRequest.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
MedicationRequest.dispenseRequest.initialFill		0..1	BackboneElement	First fill details
MedicationRequest.dispenseRequest.initialFill.id		0..1	string	Unique id for inter-element referencing
MedicationRequest.dispenseRequest.initialFill.extension		0..*	Extension	Additional content defined by implementations
MedicationRequest.dispenseRequest.initialFill.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
MedicationRequest.dispenseRequest.initialFill.quantity	C	0..1	SimpleQuantity(4.0.1)	First fill quantity Constraints: sqty-1
MedicationRequest.dispenseRequest.initialFill.duration		0..1	Duration	First fill duration
MedicationRequest.dispenseRequest.dispenseInterval		0..1	Duration	Minimum period of time between dispenses
MedicationRequest.dispenseRequest.validityPeriod		0..1	Period	Time period supply is authorized for
MedicationRequest.dispenseRequest.numberOfRepeatsAllowed	S This element must be supported.	0..1	unsignedInt	Number of refills authorized
MedicationRequest.dispenseRequest.quantity	S This element must be supported. C	0..1	SimpleQuantity(4.0.1)	Amount of medication to supply per dispense Constraints: sqty-1
MedicationRequest.dispenseRequest.expectedSupplyDuration		0..1	Duration	Number of days supply per dispense
MedicationRequest.dispenseRequest.performer		0..1	Reference(Organization)	Intended dispenser
MedicationRequest.substitution		0..1	BackboneElement	Any restrictions on medication substitution
MedicationRequest.substitution.id		0..1	string	Unique id for inter-element referencing
MedicationRequest.substitution.extension		0..*	Extension	Additional content defined by implementations
MedicationRequest.substitution.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
MedicationRequest.substitution.allowed[x]		1..1		Whether substitution is allowed or not Binding: ActSubstanceAdminSubstitutionCode (example): Identifies the type of substitution allowed.
MedicationRequest.substitution.allowed[x].allowedBoolean			boolean
MedicationRequest.substitution.allowed[x].allowedCodeableConcept			CodeableConcept
MedicationRequest.substitution.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.
MedicationRequest.priorPrescription		0..1	Reference(MedicationRequest)	An order/prescription that is being replaced
MedicationRequest.detectedIssue		0..*	Reference(DetectedIssue)	Clinical Issue with action
MedicationRequest.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	extensible	Medication Clinical Drug	⏿20240606	tx.fhir.org
MedicationRequest.performerType	Base	example	Procedure Performer Role Codes	📍4.0.1	FHIR Std.
MedicationRequest.reasonCode	Base	extensible	US Core Condition Codes	📦10.0.0-ballot	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	extensible	Route of Administration of Therapeutic Agents	⏿20241015	tx.fhir.org
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 v7.4
MedicationRequest.substitution.​reason	Base	example	SubstanceAdminSubstitutionReason	📦3.0.0	THO v7.4

Constraints

Id	Grade	Path(s)	Description	Expression
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()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
MedicationRequest	C	0..*	MedicationRequest	Ordering of medication for patient or group Constraints: us-core-21
MedicationRequest.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
MedicationRequest.Slices for extension				Content/Rules for all slices
MedicationRequest.Slices for extension.extension:medicationAdherence		0..*	(Complex)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Medication Adherence Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence
MedicationRequest.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
MedicationRequest.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	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.
MedicationRequest.intent	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries. C	1..1	code	proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order.
MedicationRequest.Slices for category	S This element must be supported.	0..*	CodeableConcept	Type of medication usage Slice: Unordered, Open by value:$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. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
MedicationRequest.Slices for category.category:us-core	S This element must be supported.	0..*	CodeableConcept	Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted in other slices, see Required Bindings When Slicing by Value Sets
MedicationRequest.doNotPerform	?! This element is a modifier element. Σ This element is included in summaries.	0..1	boolean	True if request is prohibiting action
MedicationRequest.reported[x]	S This element must be supported. Σ This element is included in summaries.	0..1		Reported rather than primary record
MedicationRequest.reported[x].reportedBoolean			boolean S This target must be supported.
MedicationRequest.reported[x].reportedReference			Reference S This type must be supported. (US Core Practitioner Profile S This target must be supported. | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile)
MedicationRequest.medication[x]	S This element must be supported. Σ This element is included in summaries.	1..1		Medication to be taken Binding: Medication Clinical Drug (extensible)
MedicationRequest.medication[x].medicationCodeableConcept			CodeableConcept
MedicationRequest.medication[x].medicationReference			Reference(US Core Medication Profile)
MedicationRequest.subject	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(US Core Patient Profile S This type must be supported. | Group)	Who or group medication request is for
MedicationRequest.encounter	S This element must be supported.	0..1	Reference(US Core Encounter Profile)	Encounter created as part of encounter/admission/stay
MedicationRequest.authoredOn	S This element must be supported. Σ This element is included in summaries.	0..1	dateTime	When request was initially authored
MedicationRequest.requester	S This element must be supported. Σ This element is included in summaries. C	0..1	Reference(US Core Practitioner Profile S This type must be supported. | US Core Patient Profile | US Core Organization Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | US Core Device Profile)	Who/What requested the Request
MedicationRequest.reasonCode		0..*	CodeableConcept	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Reason or indication for ordering or not ordering the medication Binding: US Core Condition Codes (extensible)
MedicationRequest.reasonReference		0..*	Reference(Condition | Observation)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Condition or Observation that supports the prescription
MedicationRequest.dosageInstruction	S This element must be supported.	0..*	Dosage	How the medication should be taken
MedicationRequest.dosageInstruction.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
MedicationRequest.dosageInstruction.text	S This element must be supported. Σ This element is included in summaries.	0..1	string	Free text dosage instructions e.g. SIG
MedicationRequest.dosageInstruction.timing	S This element must be supported. Σ This element is included in summaries.	0..1	Timing	When medication should be administered
MedicationRequest.dosageInstruction.route	S This element must be supported. Σ This element is included in summaries.	0..1	CodeableConcept	How drug should enter body Binding: Route of Administration of Therapeutic Agents (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes
MedicationRequest.dosageInstruction.doseAndRate	S This element must be supported. Σ This element is included in summaries.	0..*	Element	Amount of medication administered
MedicationRequest.dosageInstruction.doseAndRate.dose[x]	S This element must be supported. Σ This element is included in summaries.	0..1		Amount of medication per dose Binding: Common UCUM units (preferred) Additional Bindings Purpose UCUMCodes Max Binding
MedicationRequest.dosageInstruction.doseAndRate.dose[x].doseQuantity			Quantity S This type must be supported. (SimpleQuantity)
MedicationRequest.dosageInstruction.doseAndRate.dose[x].doseRange			Range
MedicationRequest.dispenseRequest	S This element must be supported.	0..1	BackboneElement	Medication supply authorization
MedicationRequest.dispenseRequest.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
MedicationRequest.dispenseRequest.numberOfRepeatsAllowed	S This element must be supported.	0..1	unsignedInt	Number of refills authorized
MedicationRequest.dispenseRequest.quantity	S This element must be supported. C	0..1	SimpleQuantity(4.0.1)	Amount of medication to supply per dispense Constraints: sqty-1
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	extensible	Medication Clinical Drug	⏿20240606	tx.fhir.org
MedicationRequest.reasonCode	Base	extensible	US Core Condition Codes	📦10.0.0-ballot	This IG
MedicationRequest.dosageInstruction.​route	Base	extensible	Route of Administration of Therapeutic Agents	⏿20241015	tx.fhir.org
MedicationRequest.dosageInstruction.​doseAndRate.dose[x]	Base	preferred	Common UCUM units	📦4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
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 MedicationRequest

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
MedicationRequest	C	0..*	MedicationRequest	Ordering of medication for patient or group Constraints: us-core-21
MedicationRequest.Slices for extension				Content/Rules for all slices
MedicationRequest.Slices for extension.extension:medicationAdherence		0..*	(Complex)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Medication Adherence Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence
MedicationRequest.status	S This element must be supported.	1..1	code	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.
MedicationRequest.intent	S This element must be supported. C	1..1	code	proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order.
MedicationRequest.Slices for category	S This element must be supported.	0..*	CodeableConcept	Type of medication usage Slice: Unordered, Open by value:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
MedicationRequest.Slices for category.category:us-core	S This element must be supported.	0..*	CodeableConcept	Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted in other slices, see Required Bindings When Slicing by Value Sets
MedicationRequest.reported[x]	S This element must be supported.	0..1		Reported rather than primary record
MedicationRequest.reported[x].reportedBoolean			boolean S This target must be supported.
MedicationRequest.reported[x].reportedReference			Reference S This type must be supported. (US Core Practitioner Profile S This target must be supported. | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile)
MedicationRequest.medication[x]	S This element must be supported.	1..1		Medication to be taken Binding: Medication Clinical Drug (extensible)
MedicationRequest.medication[x].medicationCodeableConcept			CodeableConcept
MedicationRequest.medication[x].medicationReference			Reference(US Core Medication Profile)
MedicationRequest.subject	S This element must be supported.	1..1	Reference(US Core Patient Profile S This type must be supported. | Group)	Who or group medication request is for
MedicationRequest.encounter	S This element must be supported.	0..1	Reference(US Core Encounter Profile)	Encounter created as part of encounter/admission/stay
MedicationRequest.authoredOn	S This element must be supported.	0..1	dateTime	When request was initially authored
MedicationRequest.requester	S This element must be supported. C	0..1	Reference(US Core Practitioner Profile S This type must be supported. | US Core Patient Profile | US Core Organization Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | US Core Device Profile)	Who/What requested the Request
MedicationRequest.reasonCode		0..*	CodeableConcept	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Reason or indication for ordering or not ordering the medication Binding: US Core Condition Codes (extensible)
MedicationRequest.reasonReference		0..*	Reference(Condition | Observation)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Condition or Observation that supports the prescription
MedicationRequest.dosageInstruction	S This element must be supported.	0..*	Dosage	How the medication should be taken
MedicationRequest.dosageInstruction.text	S This element must be supported.	0..1	string	Free text dosage instructions e.g. SIG
MedicationRequest.dosageInstruction.timing	S This element must be supported.	0..1	Timing	When medication should be administered
MedicationRequest.dosageInstruction.route	S This element must be supported.	0..1	CodeableConcept	How drug should enter body Binding: Route of Administration of Therapeutic Agents (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes
MedicationRequest.dosageInstruction.doseAndRate	S This element must be supported.	0..*	Element	Amount of medication administered
MedicationRequest.dosageInstruction.doseAndRate.dose[x]	S This element must be supported.	0..1		Amount of medication per dose Binding: Common UCUM units (preferred) Additional Bindings Purpose UCUMCodes Max Binding
MedicationRequest.dosageInstruction.doseAndRate.dose[x].doseQuantity			Quantity S This type must be supported. (SimpleQuantity)
MedicationRequest.dosageInstruction.doseAndRate.dose[x].doseRange			Range
MedicationRequest.dispenseRequest	S This element must be supported.	0..1	BackboneElement	Medication supply authorization
MedicationRequest.dispenseRequest.numberOfRepeatsAllowed	S This element must be supported.	0..1	unsignedInt	Number of refills authorized
MedicationRequest.dispenseRequest.quantity	S This element must be supported.	0..1	SimpleQuantity(4.0.1)	Amount of medication to supply per dispense
Documentation for this format

Terminology Bindings (Differential)

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:us-core	Base	required	Medication request category codes	📦4.0.1	FHIR Std.
MedicationRequest.medication[x]	Base	extensible	Medication Clinical Drug	⏿20240606	tx.fhir.org
MedicationRequest.reasonCode	Base	extensible	US Core Condition Codes	📦10.0.0-ballot	This IG
MedicationRequest.dosageInstruction.​route	Base	extensible	Route of Administration of Therapeutic Agents	⏿20241015	tx.fhir.org
MedicationRequest.dosageInstruction.​doseAndRate.dose[x]	Base	preferred	Common UCUM units	📦4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
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()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
MedicationRequest	C	0..*	MedicationRequest	Ordering of medication for patient or group Constraints: us-core-21
MedicationRequest.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
MedicationRequest.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
MedicationRequest.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
MedicationRequest.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
MedicationRequest.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
MedicationRequest.contained		0..*	Resource	Contained, inline Resources
MedicationRequest.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
MedicationRequest.Slices for extension.extension:medicationAdherence		0..*	(Complex)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Medication Adherence Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence
MedicationRequest.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
MedicationRequest.identifier		0..*	Identifier	External ids for this request
MedicationRequest.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	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.
MedicationRequest.statusReason		0..1	CodeableConcept	Reason for current status Binding: medicationRequest Status Reason Codes (example): Identifies the reasons for a given status.
MedicationRequest.intent	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries. C	1..1	code	proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order.
MedicationRequest.Slices for category	S This element must be supported.	0..*	CodeableConcept	Type of medication usage Slice: Unordered, Open by value:$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. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
MedicationRequest.Slices for category.category:us-core	S This element must be supported.	0..*	CodeableConcept	Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted in other slices, see Required Bindings When Slicing by Value Sets
MedicationRequest.priority	Σ This element is included in summaries.	0..1	code	routine | urgent | asap | stat Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.
MedicationRequest.doNotPerform	?! This element is a modifier element. Σ This element is included in summaries.	0..1	boolean	True if request is prohibiting action
MedicationRequest.reported[x]	S This element must be supported. Σ This element is included in summaries.	0..1		Reported rather than primary record
MedicationRequest.reported[x].reportedBoolean			boolean S This target must be supported.
MedicationRequest.reported[x].reportedReference			Reference S This type must be supported. (US Core Practitioner Profile S This target must be supported. | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile)
MedicationRequest.medication[x]	S This element must be supported. Σ This element is included in summaries.	1..1		Medication to be taken Binding: Medication Clinical Drug (extensible)
MedicationRequest.medication[x].medicationCodeableConcept			CodeableConcept
MedicationRequest.medication[x].medicationReference			Reference(US Core Medication Profile)
MedicationRequest.subject	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(US Core Patient Profile S This type must be supported. | Group)	Who or group medication request is for
MedicationRequest.encounter	S This element must be supported.	0..1	Reference(US Core Encounter Profile)	Encounter created as part of encounter/admission/stay
MedicationRequest.supportingInformation		0..*	Reference(Resource)	Information to support ordering of the medication
MedicationRequest.authoredOn	S This element must be supported. Σ This element is included in summaries.	0..1	dateTime	When request was initially authored
MedicationRequest.requester	S This element must be supported. Σ This element is included in summaries. C	0..1	Reference(US Core Practitioner Profile S This type must be supported. | US Core Patient Profile | US Core Organization Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | US Core Device Profile)	Who/What requested the Request
MedicationRequest.performer		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam)	Intended performer of administration
MedicationRequest.performerType	Σ This element is included in summaries.	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.
MedicationRequest.recorder		0..1	Reference(Practitioner | PractitionerRole)	Person who entered the request
MedicationRequest.reasonCode		0..*	CodeableConcept	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Reason or indication for ordering or not ordering the medication Binding: US Core Condition Codes (extensible)
MedicationRequest.reasonReference		0..*	Reference(Condition | Observation)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Condition or Observation that supports the prescription
MedicationRequest.instantiatesCanonical	Σ This element is included in summaries.	0..*	canonical()	Instantiates FHIR protocol or definition
MedicationRequest.instantiatesUri	Σ This element is included in summaries.	0..*	uri	Instantiates external protocol or definition
MedicationRequest.basedOn	Σ This element is included in summaries.	0..*	Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation)	What request fulfills
MedicationRequest.groupIdentifier	Σ This element is included in summaries.	0..1	Identifier	Composite request this is part of
MedicationRequest.courseOfTherapyType		0..1	CodeableConcept	Overall pattern of medication administration Binding: medicationRequest Course of Therapy Codes (example): Identifies the overall pattern of medication administratio.
MedicationRequest.insurance		0..*	Reference(Coverage | ClaimResponse)	Associated insurance coverage
MedicationRequest.note		0..*	Annotation	Information about the prescription
MedicationRequest.dosageInstruction	S This element must be supported.	0..*	Dosage	How the medication should be taken
MedicationRequest.dosageInstruction.id		0..1	string	Unique id for inter-element referencing
MedicationRequest.dosageInstruction.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
MedicationRequest.dosageInstruction.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
MedicationRequest.dosageInstruction.sequence	Σ This element is included in summaries.	0..1	integer	The order of the dosage instructions
MedicationRequest.dosageInstruction.text	S This element must be supported. Σ This element is included in summaries.	0..1	string	Free text dosage instructions e.g. SIG
MedicationRequest.dosageInstruction.additionalInstruction	Σ This element is included in summaries.	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".
MedicationRequest.dosageInstruction.patientInstruction	Σ This element is included in summaries.	0..1	string	Patient or consumer oriented instructions
MedicationRequest.dosageInstruction.timing	S This element must be supported. Σ This element is included in summaries.	0..1	Timing	When medication should be administered
MedicationRequest.dosageInstruction.asNeeded[x]	Σ This element is included in summaries.	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.
MedicationRequest.dosageInstruction.asNeeded[x].asNeededBoolean			boolean
MedicationRequest.dosageInstruction.asNeeded[x].asNeededCodeableConcept			CodeableConcept
MedicationRequest.dosageInstruction.site	Σ This element is included in summaries.	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.
MedicationRequest.dosageInstruction.route	S This element must be supported. Σ This element is included in summaries.	0..1	CodeableConcept	How drug should enter body Binding: Route of Administration of Therapeutic Agents (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes
MedicationRequest.dosageInstruction.method	Σ This element is included in summaries.	0..1	CodeableConcept	Technique for administering medication Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
MedicationRequest.dosageInstruction.doseAndRate	S This element must be supported. Σ This element is included in summaries.	0..*	Element	Amount of medication administered
MedicationRequest.dosageInstruction.doseAndRate.id		0..1	string	Unique id for inter-element referencing
MedicationRequest.dosageInstruction.doseAndRate.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
MedicationRequest.dosageInstruction.doseAndRate.type	Σ This element is included in summaries.	0..1	CodeableConcept	The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
MedicationRequest.dosageInstruction.doseAndRate.dose[x]	S This element must be supported. Σ This element is included in summaries.	0..1		Amount of medication per dose Binding: Common UCUM units (preferred) Additional Bindings Purpose UCUMCodes Max Binding
MedicationRequest.dosageInstruction.doseAndRate.dose[x].doseQuantity			Quantity S This type must be supported. (SimpleQuantity)
MedicationRequest.dosageInstruction.doseAndRate.dose[x].doseRange			Range
MedicationRequest.dosageInstruction.doseAndRate.rate[x]	Σ This element is included in summaries.	0..1		Amount of medication per unit of time
MedicationRequest.dosageInstruction.doseAndRate.rate[x].rateRatio			Ratio
MedicationRequest.dosageInstruction.doseAndRate.rate[x].rateRange			Range
MedicationRequest.dosageInstruction.doseAndRate.rate[x].rateQuantity			Quantity(SimpleQuantity)
MedicationRequest.dosageInstruction.maxDosePerPeriod	Σ This element is included in summaries.	0..1	Ratio	Upper limit on medication per unit of time
MedicationRequest.dosageInstruction.maxDosePerAdministration	Σ This element is included in summaries. C	0..1	SimpleQuantity(4.0.1)	Upper limit on medication per administration Constraints: sqty-1
MedicationRequest.dosageInstruction.maxDosePerLifetime	Σ This element is included in summaries. C	0..1	SimpleQuantity(4.0.1)	Upper limit on medication per lifetime of the patient Constraints: sqty-1
MedicationRequest.dispenseRequest	S This element must be supported.	0..1	BackboneElement	Medication supply authorization
MedicationRequest.dispenseRequest.id		0..1	string	Unique id for inter-element referencing
MedicationRequest.dispenseRequest.extension		0..*	Extension	Additional content defined by implementations
MedicationRequest.dispenseRequest.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
MedicationRequest.dispenseRequest.initialFill		0..1	BackboneElement	First fill details
MedicationRequest.dispenseRequest.initialFill.id		0..1	string	Unique id for inter-element referencing
MedicationRequest.dispenseRequest.initialFill.extension		0..*	Extension	Additional content defined by implementations
MedicationRequest.dispenseRequest.initialFill.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
MedicationRequest.dispenseRequest.initialFill.quantity	C	0..1	SimpleQuantity(4.0.1)	First fill quantity Constraints: sqty-1
MedicationRequest.dispenseRequest.initialFill.duration		0..1	Duration	First fill duration
MedicationRequest.dispenseRequest.dispenseInterval		0..1	Duration	Minimum period of time between dispenses
MedicationRequest.dispenseRequest.validityPeriod		0..1	Period	Time period supply is authorized for
MedicationRequest.dispenseRequest.numberOfRepeatsAllowed	S This element must be supported.	0..1	unsignedInt	Number of refills authorized
MedicationRequest.dispenseRequest.quantity	S This element must be supported. C	0..1	SimpleQuantity(4.0.1)	Amount of medication to supply per dispense Constraints: sqty-1
MedicationRequest.dispenseRequest.expectedSupplyDuration		0..1	Duration	Number of days supply per dispense
MedicationRequest.dispenseRequest.performer		0..1	Reference(Organization)	Intended dispenser
MedicationRequest.substitution		0..1	BackboneElement	Any restrictions on medication substitution
MedicationRequest.substitution.id		0..1	string	Unique id for inter-element referencing
MedicationRequest.substitution.extension		0..*	Extension	Additional content defined by implementations
MedicationRequest.substitution.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
MedicationRequest.substitution.allowed[x]		1..1		Whether substitution is allowed or not Binding: ActSubstanceAdminSubstitutionCode (example): Identifies the type of substitution allowed.
MedicationRequest.substitution.allowed[x].allowedBoolean			boolean
MedicationRequest.substitution.allowed[x].allowedCodeableConcept			CodeableConcept
MedicationRequest.substitution.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.
MedicationRequest.priorPrescription		0..1	Reference(MedicationRequest)	An order/prescription that is being replaced
MedicationRequest.detectedIssue		0..*	Reference(DetectedIssue)	Clinical Issue with action
MedicationRequest.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	extensible	Medication Clinical Drug	⏿20240606	tx.fhir.org
MedicationRequest.performerType	Base	example	Procedure Performer Role Codes	📍4.0.1	FHIR Std.
MedicationRequest.reasonCode	Base	extensible	US Core Condition Codes	📦10.0.0-ballot	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	extensible	Route of Administration of Therapeutic Agents	⏿20241015	tx.fhir.org
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 v7.4
MedicationRequest.substitution.​reason	Base	example	SubstanceAdminSubstitutionReason	📦3.0.0	THO v7.4

Constraints

Id	Grade	Path(s)	Description	Expression
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 MedicationRequest

Summary

Must-Support: 19 elements

Structures

This structure refers to these other structures:

• US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
• US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
• US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
• US Core PractitionerRole Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole)
• US Core RelatedPerson Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson)
• US Core Medication Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication)
• US Core Encounter Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter)
• US Core Device Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-device)
• SimpleQuantity (http://hl7.org/fhir/StructureDefinition/SimpleQuantity)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of MedicationRequest.category

Maturity: 5

Quick Start

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

• See the Scopes Format section for a description of the SMART scopes syntax.
• See the Search Syntax section for a description of the US Core search syntax.
• See the General Requirements section for additional rules and expectations when a Server requires status parameters.
• See the General Guidance section for additional guidance on searching for multiple patients.

US Core Scopes

Servers providing access to prescription data SHALL support these US Core SMART Scopes:

• resource level scopes: <patient|user|system>/MedicationRequest.rs ^§

Mandatory Search Parameters:

The following search parameters and search parameter combinations SHALL be supported:

1. SHALL support searching for all medications that have been prescribed to a patient. See the [Medication List Guidance] section for guidance on accessing a patient medications. The server application represents the medication using either an inline code or a contained or external reference to the Medication resource. using the combination of the patient and intent search parameters

   • Including optional support for these _include parameters: MedicationRequest:medication
   • Including support OR search on intent (e.g.intent={system|}[code],{system|}[code],...)

   GET [base]/MedicationRequest?patient={Patient/}[id]&intent={system|}[search_code]{,{system|}[code],...}

   Examples:

   1. GET [base]/MedicationRequest?patient=Patient/1137192&intent=order,plan

   2. GET [base]/MedicationRequest?patient=Patient/1137192&intent=order,plan&_include=MedicationRequest:medication

   Implementation Notes: Fetches a bundle of all US Core MedicationRequest Profile resources for the specified patient and intent code = "order,plan" ( see how to search by reference and how to search by token).

2. SHALL support searching for all prescriptions for a patient for a given status (for example all active prescriptions) using the combination of the patient and intent and status search parameters

   • Including optional support for these _include parameters: MedicationRequest:medication

   • Including support OR search on intent (e.g.intent={system|}[code],{system|}[code],...)

   • Including support OR search on status (e.g.status={system|}[code],{system|}[code],...)

   GET [base]/MedicationRequest?patient={Patient/}[id]&intent={system|}[search_code]{,{system|}[code],...}&status={system|}[search_code]{,{system|}[code],...}

   Examples:

   1. GET [base]/MedicationRequest?patient=Patient/1137192&intent=order,plan&status=active

   2. GET [base]/MedicationRequest?patient=Patient/1137192&intent=order,plan&status=active&_include=MedicationRequest:medication

   Implementation Notes: Fetches a bundle of all US Core MedicationRequest Profile resources for the specified patient and intent code = "order,plan" and status ( see how to search by reference and how to search by token).

Optional Search Parameters:

The following search parameters and search parameter combinations SHOULD be supported

1. SHOULD support searching for all prescriptions for a patient for a given status (for example all active prescriptions) using the combination of the patient and intent and encounter search parameters

   • Including optional support for these _include parameters: MedicationRequest:medication
   • Including support OR search on intent (e.g.intent={system|}[code],{system|}[code],...)

   GET [base]/MedicationRequest?patient={Patient/}[id]&intent={system|}[search_code]{,{system|}[code],...}&encounter={Type/}[id]

   Examples:

   1. GET [base]/MedicationRequest?patient=Patient/1137192&intent=order,plan&status=active&encounter=Encounter/123

   2. GET [base]/MedicationRequest?patient=Patient/1137192&intent=order,plan&status=active&&encounter=Encounter/123&_include=MedicationRequest:medication

   Implementation Notes: Fetches a bundle of all US Core MedicationRequest Profile resources for the specified patient and intent code = "order,plan" and encounter ( see how to search by reference and how to search by token).

2. SHOULD support searching for all prescriptions for a patient by date using the combination of the patient and intent and authoredon search parameters

   • Including optional support for these _include parameters: MedicationRequest:medication

   • Including support OR search on intent (e.g.intent={system|}[code],{system|}[code],...)

   • Including optional support for AND search on authoredon (e.g.authoredon=[date]&authoredon=[date]&...)

   • Including support for these authoredon comparators: "gt", "lt", "ge", "le"

   GET [base]/MedicationRequest?patient={Patient/}[id]&intent={system|}[search_code]{,{system|}[code],...}&authoredon={gt|lt|ge|le}[dateTime]{&date={gt|lt|ge|le}[dateTime]&...}

   Examples:

   1. GET [base]/MedicationRequest?patient=Patient/1137192&intent=order,plan&authoredon=ge2019-01-01T00:00:00Z

   2. GET [base]/MedicationRequest?patient=Patient/1137192&intent=order,plan&authoredon=ge2019-01-01T00:00:00Z&_include=MedicationRequest:medication

   Implementation Notes: Fetches a bundle of all US Core MedicationRequest Profile resources for the specified patient and intent code = "order,plan" and authoredon date ( see how to search by reference and how to search by token and how to search by date).