Patient Cost Transparency Implementation Guide
2.0.1 - STU 2

Patient Cost Transparency Implementation Guide, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pct/ and changes regularly. See the Directory of published versions

## Resource Profile: PCT GFE MedicationRequest

Official URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-medicationrequest | Version: 2.0.1
Standards status: Draft | Maturity Level: 0 | Computable Name: PCTMedicationRequest
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.42.49

The PCT MedicationRequest including details about a medication for which a GFE is being requested.

The following profile relates to the Good Faith Estimate (GFE) Coordination workflow and is marked as DRAFT. This content has not yet met the requisite level of testing to be balloted as trial-use. However, this part of the specification has been reviewed by the Da Vinci Patient Cost Transparency (PCT) open community of providers, payers, and health information technology (IT) vendors and was determined to be at a sufficient level of development to be included in this publication for the purposes of soliciting feedback from, and enabling testing by, the larger implementation community with the intention of bringing the content related to the GFE Coordination workflow to full standard for trial use (STU) status in a future version. Feedback is welcome and may be submitted through the FHIR change tracker indicating "US Da Vinci Patient Cost Transparency (PCT)(FHIR)" as the specification.

Usages:

- Use this Profile: PCT GFE Information Bundle and PCT GFE Missing Bundle
- Examples for this Profile: MedicationRequest/PCT-MedicationRequest-1

You can also check for usages in the FHIR IG Statistics

Changes since version 1.1.0:

- New Content

### Formal Views of Profile Content

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

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationRequest | C | 0..* | USCoreMedicationRequestProfile(7.0.0) | Ordering of medication for patient or group Constraints: us-core-21
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  |  |  | Content/Rules for all slices
extension:medicationAdherence |  | 0..* | (Complex) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Medication Adherence Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 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. Required Pattern: active
intent | ?!S Σ 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. Required Pattern: proposal
Slices for category | S | 0..* | CodeableConcept | Type of medication usage Slice: Unordered, Open by pattern:$this Binding: medicationRequest Category Codes (example): A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.
category:us-core | S | 0..* | CodeableConcept | Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
reported[x] | S Σ | 0..1 |  | Reported rather than primary record
reportedBoolean |  |  | boolean S |
reportedReference |  |  | Reference S(US Core Practitioner Profile(7.0.0) S | US Core Organization Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0)) |
medication[x] | S Σ | 1..1 |  | Medication to be taken Binding: MedicationClinicalDrug (20240606) (extensible)
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Core Medication Profile(7.0.0)) |
subject | S Σ | 1..1 | Reference(US Core Patient Profile(7.0.0)) | Who or group medication request is for
encounter | S | 0..1 | Reference(US Core Encounter Profile(7.0.0)) | Encounter created as part of encounter/admission/stay
authoredOn | S Σ | 0..1 | dateTime | When request was initially authored
requester | S Σ C | 0..1 | Reference(US Core Practitioner Profile(7.0.0) S | US Core Patient Profile(7.0.0) | US Core Organization Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | Device) | Who/What requested the Request
dosageInstruction | S | 0..* | Dosage | How the medication should be taken
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
text | S Σ | 0..1 | string | Free text dosage instructions e.g. SIG
timing | S Σ | 0..1 | Timing | When medication should be administered
doseAndRate | S Σ | 0..* | Element | Amount of medication administered
dose[x] | S Σ | 0..1 |  | Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S(SimpleQuantity) |
doseRange |  |  | Range |
dispenseRequest | S | 0..1 | BackboneElement | Medication supply authorization
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
numberOfRepeatsAllowed | S | 0..1 | unsignedInt | Number of refills authorized
quantity | S | 0..1 | SimpleQuantity | Amount of medication to supply per dispense
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationRequest.status | Base | required | Medicationrequest status | 📦4.0.1 | FHIR Std.
MedicationRequest.intent | Base | required | Medication request intent | 📦4.0.1 | FHIR Std.
MedicationRequest.category | Base | example | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.category:us-core | Base | required | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.medication[x] | Base | extensible | Medication Clinical Drug | 📍20240606 | VSAC v0.19
MedicationRequest.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.

#### Constraints

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

This structure is derived from USCoreMedicationRequestProfile

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationRequest |  |  | USCoreMedicationRequestProfile(7.0.0) |
status |  | 1..1 | code | active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown Required Pattern: active
intent |  | 1..1 | code | proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Required Pattern: proposal
doNotPerform |  | 0..0 |  | True if request is prohibiting action
subject |  | 1..1 | Reference(US Core Patient Profile(7.0.0)) | Who or group medication request is for
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationRequest | C | 0..* | USCoreMedicationRequestProfile(7.0.0) | Ordering of medication for patient or group Constraints: us-core-21
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:medicationAdherence |  | 0..* | (Complex) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Medication Adherence Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | External ids for this request
status | ?!S Σ | 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. Required Pattern: active
statusReason |  | 0..1 | CodeableConcept | Reason for current status Binding: medicationRequest Status Reason Codes (example): Identifies the reasons for a given status.
intent | ?!S Σ C | 1..1 | code | proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order. Required Pattern: proposal
Slices for category | S | 0..* | CodeableConcept | Type of medication usage Slice: Unordered, Open by pattern:$this Binding: medicationRequest Category Codes (example): A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.
category:us-core | S | 0..* | CodeableConcept | Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
priority | Σ | 0..1 | code | routine | urgent | asap | stat Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.
reported[x] | S Σ | 0..1 |  | Reported rather than primary record
reportedBoolean |  |  | boolean S |
reportedReference |  |  | Reference S(US Core Practitioner Profile(7.0.0) S | US Core Organization Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0)) |
medication[x] | S Σ | 1..1 |  | Medication to be taken Binding: MedicationClinicalDrug (20240606) (extensible)
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Core Medication Profile(7.0.0)) |
subject | S Σ | 1..1 | Reference(US Core Patient Profile(7.0.0)) | Who or group medication request is for
encounter | S | 0..1 | Reference(US Core Encounter Profile(7.0.0)) | Encounter created as part of encounter/admission/stay
supportingInformation |  | 0..* | Reference(Resource) | Information to support ordering of the medication
authoredOn | S Σ | 0..1 | dateTime | When request was initially authored
requester | S Σ C | 0..1 | Reference(US Core Practitioner Profile(7.0.0) S | US Core Patient Profile(7.0.0) | US Core Organization Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | Device) | Who/What requested the Request
performer |  | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam) | Intended performer of administration
performerType | Σ | 0..1 | CodeableConcept | Desired kind of performer of the medication administration Binding: ProcedurePerformerRoleCodes (example): Identifies the type of individual that is desired to administer the medication.
recorder |  | 0..1 | Reference(Practitioner | PractitionerRole) | Person who entered the request
reasonCode |  | 0..* | CodeableConcept | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Reason or indication for ordering or not ordering the medication Binding: USCoreConditionCodes (7.0.0) (extensible)
reasonReference |  | 0..* | Reference(Condition | Observation) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Condition or Observation that supports the prescription
instantiatesCanonical | Σ | 0..* | canonical() | Instantiates FHIR protocol or definition
instantiatesUri | Σ | 0..* | uri | Instantiates external protocol or definition
basedOn | Σ | 0..* | Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation) | What request fulfills
groupIdentifier | Σ | 0..1 | Identifier | Composite request this is part of
courseOfTherapyType |  | 0..1 | CodeableConcept | Overall pattern of medication administration Binding: medicationRequest Course of Therapy Codes (example): Identifies the overall pattern of medication administratio.
insurance |  | 0..* | Reference(Coverage | ClaimResponse) | Associated insurance coverage
note |  | 0..* | Annotation | Information about the prescription
dosageInstruction | S | 0..* | Dosage | How the medication should be taken
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 0..1 | integer | The order of the dosage instructions
text | S Σ | 0..1 | string | Free text dosage instructions e.g. SIG
additionalInstruction | Σ | 0..* | CodeableConcept | Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
patientInstruction | Σ | 0..1 | string | Patient or consumer oriented instructions
timing | S Σ | 0..1 | Timing | When medication should be administered
asNeeded[x] | Σ | 0..1 |  | Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
asNeededBoolean |  |  | boolean |
asNeededCodeableConcept |  |  | CodeableConcept |
site | Σ | 0..1 | CodeableConcept | Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route | Σ | 0..1 | CodeableConcept | How drug should enter body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
method | Σ | 0..1 | CodeableConcept | Technique for administering medication Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
doseAndRate | S Σ | 0..* | Element | Amount of medication administered
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
type | Σ | 0..1 | CodeableConcept | The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
dose[x] | S Σ | 0..1 |  | Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S(SimpleQuantity) |
doseRange |  |  | Range |
rate[x] | Σ | 0..1 |  | Amount of medication per unit of time
rateRatio |  |  | Ratio |
rateRange |  |  | Range |
rateQuantity |  |  | Quantity(SimpleQuantity) |
maxDosePerPeriod | Σ | 0..1 | Ratio | Upper limit on medication per unit of time
maxDosePerAdministration | Σ | 0..1 | SimpleQuantity | Upper limit on medication per administration
maxDosePerLifetime | Σ | 0..1 | SimpleQuantity | Upper limit on medication per lifetime of the patient
dispenseRequest | S | 0..1 | BackboneElement | Medication supply authorization
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
initialFill |  | 0..1 | BackboneElement | First fill details
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
quantity |  | 0..1 | SimpleQuantity | First fill quantity
duration |  | 0..1 | Duration | First fill duration
dispenseInterval |  | 0..1 | Duration | Minimum period of time between dispenses
validityPeriod |  | 0..1 | Period | Time period supply is authorized for
numberOfRepeatsAllowed | S | 0..1 | unsignedInt | Number of refills authorized
quantity | S | 0..1 | SimpleQuantity | Amount of medication to supply per dispense
expectedSupplyDuration |  | 0..1 | Duration | Number of days supply per dispense
performer |  | 0..1 | Reference(Organization) | Intended dispenser
substitution |  | 0..1 | BackboneElement | Any restrictions on medication substitution
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
allowed[x] |  | 1..1 |  | Whether substitution is allowed or not Binding: ActSubstanceAdminSubstitutionCode (3.0.0) (example): Identifies the type of substitution allowed.
allowedBoolean |  |  | boolean |
allowedCodeableConcept |  |  | CodeableConcept |
reason |  | 0..1 | CodeableConcept | Why should (not) substitution be made Binding: SubstanceAdminSubstitutionReason (3.0.0) (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
priorPrescription |  | 0..1 | Reference(MedicationRequest) | An order/prescription that is being replaced
detectedIssue |  | 0..* | Reference(DetectedIssue) | Clinical Issue with action
eventHistory |  | 0..* | Reference(Provenance) | A list of events of interest in the lifecycle
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationRequest.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
MedicationRequest.status | Base | required | Medicationrequest status | 📦4.0.1 | FHIR Std.
MedicationRequest.statusReason | Base | example | Medication request status reason codes | 📦4.0.1 | FHIR Std.
MedicationRequest.intent | Base | required | Medication request intent | 📦4.0.1 | FHIR Std.
MedicationRequest.category | Base | example | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.category:us-core | Base | required | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.priority | Base | required | Request priority | 📍4.0.1 | FHIR Std.
MedicationRequest.medication[x] | Base | extensible | Medication Clinical Drug | 📍20240606 | VSAC v0.19
MedicationRequest.performerType | Base | example | Procedure Performer Role Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.reasonCode | Base | extensible | US Core Condition Codes | 📍7.0.0 | US Core v7.0
MedicationRequest.courseOfTherapyType | Base | example | Medication request course of therapy codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​additionalInstruction | Base | example | SNOMED CT Additional Dosage Instructions | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​asNeeded[x] | Base | example | SNOMED CT Medication As Needed Reason Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​site | Base | example | SNOMED CT Anatomical Structure for Administration Site Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​route | Base | example | SNOMED CT Route Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​method | Base | example | SNOMED CT Administration Method Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​doseAndRate.type | Base | example | DoseAndRateType | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationRequest.substitution.​allowed[x] | Base | example | ActSubstanceAdminSubstitutionCode | 📍3.0.0 | THO v6.5
MedicationRequest.substitution.​reason | Base | example | SubstanceAdminSubstitutionReason | 📍3.0.0 | THO v6.5

#### Constraints

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

This structure is derived from USCoreMedicationRequestProfile

Summary

Prohibited: 1 element

Structures

This structure refers to these other structures:

- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0)

Maturity: 0

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationRequest | C | 0..* | USCoreMedicationRequestProfile(7.0.0) | Ordering of medication for patient or group Constraints: us-core-21
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  |  |  | Content/Rules for all slices
extension:medicationAdherence |  | 0..* | (Complex) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Medication Adherence Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 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. Required Pattern: active
intent | ?!S Σ 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. Required Pattern: proposal
Slices for category | S | 0..* | CodeableConcept | Type of medication usage Slice: Unordered, Open by pattern:$this Binding: medicationRequest Category Codes (example): A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.
category:us-core | S | 0..* | CodeableConcept | Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
reported[x] | S Σ | 0..1 |  | Reported rather than primary record
reportedBoolean |  |  | boolean S |
reportedReference |  |  | Reference S(US Core Practitioner Profile(7.0.0) S | US Core Organization Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0)) |
medication[x] | S Σ | 1..1 |  | Medication to be taken Binding: MedicationClinicalDrug (20240606) (extensible)
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Core Medication Profile(7.0.0)) |
subject | S Σ | 1..1 | Reference(US Core Patient Profile(7.0.0)) | Who or group medication request is for
encounter | S | 0..1 | Reference(US Core Encounter Profile(7.0.0)) | Encounter created as part of encounter/admission/stay
authoredOn | S Σ | 0..1 | dateTime | When request was initially authored
requester | S Σ C | 0..1 | Reference(US Core Practitioner Profile(7.0.0) S | US Core Patient Profile(7.0.0) | US Core Organization Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | Device) | Who/What requested the Request
dosageInstruction | S | 0..* | Dosage | How the medication should be taken
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
text | S Σ | 0..1 | string | Free text dosage instructions e.g. SIG
timing | S Σ | 0..1 | Timing | When medication should be administered
doseAndRate | S Σ | 0..* | Element | Amount of medication administered
dose[x] | S Σ | 0..1 |  | Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S(SimpleQuantity) |
doseRange |  |  | Range |
dispenseRequest | S | 0..1 | BackboneElement | Medication supply authorization
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
numberOfRepeatsAllowed | S | 0..1 | unsignedInt | Number of refills authorized
quantity | S | 0..1 | SimpleQuantity | Amount of medication to supply per dispense
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationRequest.status | Base | required | Medicationrequest status | 📦4.0.1 | FHIR Std.
MedicationRequest.intent | Base | required | Medication request intent | 📦4.0.1 | FHIR Std.
MedicationRequest.category | Base | example | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.category:us-core | Base | required | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.medication[x] | Base | extensible | Medication Clinical Drug | 📍20240606 | VSAC v0.19
MedicationRequest.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.

#### Constraints

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

Differential View

This structure is derived from USCoreMedicationRequestProfile

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationRequest |  |  | USCoreMedicationRequestProfile(7.0.0) |
status |  | 1..1 | code | active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown Required Pattern: active
intent |  | 1..1 | code | proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Required Pattern: proposal
doNotPerform |  | 0..0 |  | True if request is prohibiting action
subject |  | 1..1 | Reference(US Core Patient Profile(7.0.0)) | Who or group medication request is for
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationRequest | C | 0..* | USCoreMedicationRequestProfile(7.0.0) | Ordering of medication for patient or group Constraints: us-core-21
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:medicationAdherence |  | 0..* | (Complex) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Medication Adherence Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | External ids for this request
status | ?!S Σ | 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. Required Pattern: active
statusReason |  | 0..1 | CodeableConcept | Reason for current status Binding: medicationRequest Status Reason Codes (example): Identifies the reasons for a given status.
intent | ?!S Σ C | 1..1 | code | proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order. Required Pattern: proposal
Slices for category | S | 0..* | CodeableConcept | Type of medication usage Slice: Unordered, Open by pattern:$this Binding: medicationRequest Category Codes (example): A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.
category:us-core | S | 0..* | CodeableConcept | Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
priority | Σ | 0..1 | code | routine | urgent | asap | stat Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.
reported[x] | S Σ | 0..1 |  | Reported rather than primary record
reportedBoolean |  |  | boolean S |
reportedReference |  |  | Reference S(US Core Practitioner Profile(7.0.0) S | US Core Organization Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0)) |
medication[x] | S Σ | 1..1 |  | Medication to be taken Binding: MedicationClinicalDrug (20240606) (extensible)
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Core Medication Profile(7.0.0)) |
subject | S Σ | 1..1 | Reference(US Core Patient Profile(7.0.0)) | Who or group medication request is for
encounter | S | 0..1 | Reference(US Core Encounter Profile(7.0.0)) | Encounter created as part of encounter/admission/stay
supportingInformation |  | 0..* | Reference(Resource) | Information to support ordering of the medication
authoredOn | S Σ | 0..1 | dateTime | When request was initially authored
requester | S Σ C | 0..1 | Reference(US Core Practitioner Profile(7.0.0) S | US Core Patient Profile(7.0.0) | US Core Organization Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | Device) | Who/What requested the Request
performer |  | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam) | Intended performer of administration
performerType | Σ | 0..1 | CodeableConcept | Desired kind of performer of the medication administration Binding: ProcedurePerformerRoleCodes (example): Identifies the type of individual that is desired to administer the medication.
recorder |  | 0..1 | Reference(Practitioner | PractitionerRole) | Person who entered the request
reasonCode |  | 0..* | CodeableConcept | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Reason or indication for ordering or not ordering the medication Binding: USCoreConditionCodes (7.0.0) (extensible)
reasonReference |  | 0..* | Reference(Condition | Observation) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Condition or Observation that supports the prescription
instantiatesCanonical | Σ | 0..* | canonical() | Instantiates FHIR protocol or definition
instantiatesUri | Σ | 0..* | uri | Instantiates external protocol or definition
basedOn | Σ | 0..* | Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation) | What request fulfills
groupIdentifier | Σ | 0..1 | Identifier | Composite request this is part of
courseOfTherapyType |  | 0..1 | CodeableConcept | Overall pattern of medication administration Binding: medicationRequest Course of Therapy Codes (example): Identifies the overall pattern of medication administratio.
insurance |  | 0..* | Reference(Coverage | ClaimResponse) | Associated insurance coverage
note |  | 0..* | Annotation | Information about the prescription
dosageInstruction | S | 0..* | Dosage | How the medication should be taken
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 0..1 | integer | The order of the dosage instructions
text | S Σ | 0..1 | string | Free text dosage instructions e.g. SIG
additionalInstruction | Σ | 0..* | CodeableConcept | Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
patientInstruction | Σ | 0..1 | string | Patient or consumer oriented instructions
timing | S Σ | 0..1 | Timing | When medication should be administered
asNeeded[x] | Σ | 0..1 |  | Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
asNeededBoolean |  |  | boolean |
asNeededCodeableConcept |  |  | CodeableConcept |
site | Σ | 0..1 | CodeableConcept | Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route | Σ | 0..1 | CodeableConcept | How drug should enter body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
method | Σ | 0..1 | CodeableConcept | Technique for administering medication Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
doseAndRate | S Σ | 0..* | Element | Amount of medication administered
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
type | Σ | 0..1 | CodeableConcept | The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
dose[x] | S Σ | 0..1 |  | Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S(SimpleQuantity) |
doseRange |  |  | Range |
rate[x] | Σ | 0..1 |  | Amount of medication per unit of time
rateRatio |  |  | Ratio |
rateRange |  |  | Range |
rateQuantity |  |  | Quantity(SimpleQuantity) |
maxDosePerPeriod | Σ | 0..1 | Ratio | Upper limit on medication per unit of time
maxDosePerAdministration | Σ | 0..1 | SimpleQuantity | Upper limit on medication per administration
maxDosePerLifetime | Σ | 0..1 | SimpleQuantity | Upper limit on medication per lifetime of the patient
dispenseRequest | S | 0..1 | BackboneElement | Medication supply authorization
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
initialFill |  | 0..1 | BackboneElement | First fill details
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
quantity |  | 0..1 | SimpleQuantity | First fill quantity
duration |  | 0..1 | Duration | First fill duration
dispenseInterval |  | 0..1 | Duration | Minimum period of time between dispenses
validityPeriod |  | 0..1 | Period | Time period supply is authorized for
numberOfRepeatsAllowed | S | 0..1 | unsignedInt | Number of refills authorized
quantity | S | 0..1 | SimpleQuantity | Amount of medication to supply per dispense
expectedSupplyDuration |  | 0..1 | Duration | Number of days supply per dispense
performer |  | 0..1 | Reference(Organization) | Intended dispenser
substitution |  | 0..1 | BackboneElement | Any restrictions on medication substitution
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
allowed[x] |  | 1..1 |  | Whether substitution is allowed or not Binding: ActSubstanceAdminSubstitutionCode (3.0.0) (example): Identifies the type of substitution allowed.
allowedBoolean |  |  | boolean |
allowedCodeableConcept |  |  | CodeableConcept |
reason |  | 0..1 | CodeableConcept | Why should (not) substitution be made Binding: SubstanceAdminSubstitutionReason (3.0.0) (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
priorPrescription |  | 0..1 | Reference(MedicationRequest) | An order/prescription that is being replaced
detectedIssue |  | 0..* | Reference(DetectedIssue) | Clinical Issue with action
eventHistory |  | 0..* | Reference(Provenance) | A list of events of interest in the lifecycle
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationRequest.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
MedicationRequest.status | Base | required | Medicationrequest status | 📦4.0.1 | FHIR Std.
MedicationRequest.statusReason | Base | example | Medication request status reason codes | 📦4.0.1 | FHIR Std.
MedicationRequest.intent | Base | required | Medication request intent | 📦4.0.1 | FHIR Std.
MedicationRequest.category | Base | example | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.category:us-core | Base | required | Medication request category codes | 📦4.0.1 | FHIR Std.
MedicationRequest.priority | Base | required | Request priority | 📍4.0.1 | FHIR Std.
MedicationRequest.medication[x] | Base | extensible | Medication Clinical Drug | 📍20240606 | VSAC v0.19
MedicationRequest.performerType | Base | example | Procedure Performer Role Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.reasonCode | Base | extensible | US Core Condition Codes | 📍7.0.0 | US Core v7.0
MedicationRequest.courseOfTherapyType | Base | example | Medication request course of therapy codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​additionalInstruction | Base | example | SNOMED CT Additional Dosage Instructions | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​asNeeded[x] | Base | example | SNOMED CT Medication As Needed Reason Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​site | Base | example | SNOMED CT Anatomical Structure for Administration Site Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​route | Base | example | SNOMED CT Route Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​method | Base | example | SNOMED CT Administration Method Codes | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​doseAndRate.type | Base | example | DoseAndRateType | 📦4.0.1 | FHIR Std.
MedicationRequest.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationRequest.substitution.​allowed[x] | Base | example | ActSubstanceAdminSubstitutionCode | 📍3.0.0 | THO v6.5
MedicationRequest.substitution.​reason | Base | example | SubstanceAdminSubstitutionReason | 📍3.0.0 | THO v6.5

#### Constraints

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

This structure is derived from USCoreMedicationRequestProfile

Summary

Prohibited: 1 element

Structures

This structure refers to these other structures:

- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0)

Maturity: 0

Other representations of profile: CSV, Excel, Schematron