# Medication Request Example - Da Vinci Prior Authorization Support (PAS) FHIR IG v2.2.0-ballot

## Example MedicationRequest: Medication Request Example

Language: en

Profile: [PAS Medication Request](StructureDefinition-profile-medicationrequest.md)

**status**: Active

**intent**: Order

**medication**: Prozac, 100 CAPSULE in 1 BOTTLE (0777-3105-02) (package)

**subject**: [JESSE SMITH Female, DoB: 1947-01-18 ( Member Number)](Patient-BeneficiaryExample.md)

**authoredOn**: 2005-06-02

**requester**: [Practitioner SUSAN WATSON ](Practitioner-ReferralPractitionerExample.md)

### DosageInstructions

| | |
| :--- | :--- |
| - | **Timing** |
| * |  |

### DispenseRequests

| | |
| :--- | :--- |
| - | **Quantity** |
| * | 300 mg (Details: UCUM codemg = 'mg') |



## Resource Content

```json
{
  "resourceType" : "MedicationRequest",
  "id" : "MedicationRequestExample",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-medicationrequest"
    ]
  },
  "language" : "en",
  "status" : "active",
  "intent" : "order",
  "medicationCodeableConcept" : {
    "coding" : [
      {
        "system" : "http://hl7.org/fhir/sid/ndc",
        "code" : "0777-3105-02"
      }
    ]
  },
  "subject" : {
    "reference" : "Patient/BeneficiaryExample"
  },
  "authoredOn" : "2005-06-02",
  "requester" : {
    "reference" : "Practitioner/ReferralPractitionerExample"
  },
  "dosageInstruction" : [
    {
      "timing" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-timingcalendarpattern",
            "valueCodeableConcept" : {
              "coding" : [
                {
                  "system" : "https://codesystem.x12.org/005010/678",
                  "code" : "L",
                  "display" : "Monday through Thursday"
                }
              ]
            }
          },
          {
            "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-timingdeliverypattern",
            "valueCodeableConcept" : {
              "coding" : [
                {
                  "system" : "https://codesystem.x12.org/005010/679",
                  "code" : "D",
                  "display" : "A.M."
                }
              ]
            }
          }
        ]
      }
    }
  ],
  "dispenseRequest" : {
    "quantity" : {
      "value" : 300,
      "unit" : "mg",
      "system" : "http://unitsofmeasure.org",
      "code" : "mg"
    }
  }
}

```
