De-Identified, Anonymized FHIR Profiles Library
0.1.0 - STU1 Release 1 - Standard for Trial-Use

De-Identified, Anonymized FHIR Profiles Library, published by HL7 International / Cross Group Projects. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-dapl/ and changes regularly. See the Directory of published versions

## Resource Profile: De-Identified UDS Plus MedicationStatement

Official URL: http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-medicationstatement | Version: 0.1.0
Standards status: Trial-use | Maturity Level: 1 | Computable Name: UDSPlusMedicationStatement

The UDS+ profile is based on the MedicationStatement resource and establishes the core elements, extensions, vocabularies and value sets for representing MedicationStatement for UDS+ program.

All canonical (Official) URLs will be changed in the future and are not available currently on the web.

### Introduction

This profile is used to represent de-identified MedicationStatement information. The de-identification process has to remove all data elements not explicitly identified as "SUPPORTED" in the profile.

The HHS De-identification Guidance is to be followed to ensure appropriate level of de-identification is performed.

According to the HHS guidance, dates should not have a precision of more than the year. This means month and day cannot be included. This includes MedicationStatement.authoredOn.

In FHIR Resources, text elements and reference.display elements which provide human readable information to the providers may be generated using programs and tools from the data present within the resource. For e.g a MedicationStatement resource text element may contain information such as the MedicationStatement date, patient information. This type of information will enable identification of the individuals. In order to avoid inadvertent revealing of PII/PHI, text elements cannot be included in the De-identified FHIR resource and the submission will be rejected when text elements are present by the validation process.

Ids and References

The original MedicationStatement resource id should not be included in the De-identified MedicationStatement instance. Instead a new id should be created and provided as part of the FHIR resource. The Data Submitter should be capable of using the generated id to relink the data to the original MedicationStatement. All resource references to the MedicationStatement submitted as part of the UDS+ report should refer to newly generated id.

Resource references cannot contain text element as it may contain PHI/PII. The text element for following references are not allowed

- subject
- encounter

Date Truncation

The Data Submitter has to truncate the following dates to only have a precision of year

- effective[x]
- dateAsserted

Usages:

- Examples for this Profile: MedicationStatement/de-identified-example

You can also check for usages in the FHIR IG Statistics

### 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
--- | --- | --- | --- | ---
MedicationStatement |  | 0..* | MedicationStatement | De-Identified UDS Plus MedicationStatement
id | S Σ | 0..1 | id | The de-identified MedicationStatement identifier created by the health center to send data to UDS+ Data Receiver
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken Binding: Medication Status Codes (required): A coded concept indicating the current status of a MedicationStatement.
medication[x] | S Σ | 1..1 |  | What medication was taken Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying the substance or product being taken.
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(Medication) |
subject | S Σ | 1..1 | Reference(De-Identified UDS Plus Patient) | Who is/was taking the medication
effective[x] | S Σ | 0..1 | dateTime | The date/time or interval when the medication is/was/will be taken
dateAsserted | S Σ | 0..1 | dateTime | When the statement was asserted?
dosage | S | 0..* | Dosage | Details of how medication is/was taken or should be taken
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationStatement.​status | Base | required | Medication status codes | 📍4.0.1 | FHIR Std.
MedicationStatement.​medication[x] | Base | example | SNOMED CT Medication Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | MedicationStatement | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | MedicationStatement | 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 | MedicationStatement | 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 | MedicationStatement | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | MedicationStatement | 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()`

This structure is derived from MedicationStatement

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationStatement |  | 0..* | MedicationStatement | De-Identified UDS Plus MedicationStatement
id | S | 0..1 | id | The de-identified MedicationStatement identifier created by the health center to send data to UDS+ Data Receiver
text |  | 0..0 |  | Cannot include any text in the resource as part of the de-identified data.
contained |  | 0..0 |  | Cannot include any contained resources in the resource as part of the de-identified data.
status | S | 1..1 | code | active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken
medication[x] | S | 1..1 | CodeableConcept, Reference(Medication) | What medication was taken
subject | S | 1..1 | Reference(De-Identified UDS Plus Patient) | Who is/was taking the medication
display |  | 0..0 |  | Text alternative for the resource
effective[x] | S | 0..1 | dateTime | The date/time or interval when the medication is/was/will be taken
dateAsserted | S | 0..1 | dateTime | When the statement was asserted?
dosage | S | 0..* | Dosage | Details of how medication is/was taken or should be taken
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationStatement |  | 0..* | MedicationStatement | De-Identified UDS Plus MedicationStatement
id | S Σ | 0..1 | id | The de-identified MedicationStatement identifier created by the health center to send data to UDS+ Data Receiver
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
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | External identifier
basedOn | Σ | 0..* | Reference(MedicationRequest | CarePlan | ServiceRequest) | Fulfils plan, proposal or order
partOf | Σ | 0..* | Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Observation) | Part of referenced event
status | ?!S Σ | 1..1 | code | active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken Binding: Medication Status Codes (required): A coded concept indicating the current status of a MedicationStatement.
statusReason |  | 0..* | CodeableConcept | Reason for current status Binding: SNOMEDCTDrugTherapyStatusCodes (example): A coded concept indicating the reason for the status of the statement.
category | Σ | 0..1 | CodeableConcept | Type of medication usage Binding: Medication usage category codes (preferred): A coded concept identifying where the medication included in the MedicationStatement is expected to be consumed or administered.
medication[x] | S Σ | 1..1 |  | What medication was taken Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying the substance or product being taken.
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(Medication) |
subject | S Σ | 1..1 | Reference(De-Identified UDS Plus Patient) | Who is/was taking the medication
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
context | Σ | 0..1 | Reference(Encounter | EpisodeOfCare) | Encounter / Episode associated with MedicationStatement
effective[x] | S Σ | 0..1 | dateTime | The date/time or interval when the medication is/was/will be taken
dateAsserted | S Σ | 0..1 | dateTime | When the statement was asserted?
informationSource |  | 0..1 | Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization) | Person or organization that provided the information about the taking of this medication
derivedFrom |  | 0..* | Reference(Resource) | Additional supporting information
reasonCode |  | 0..* | CodeableConcept | Reason for why the medication is being/was taken Binding: Condition/Problem/DiagnosisCodes (example): A coded concept identifying why the medication is being taken.
reasonReference |  | 0..* | Reference(Condition | Observation | DiagnosticReport) | Condition or observation that supports why the medication is being/was taken
note |  | 0..* | Annotation | Further information about the statement
dosage | S | 0..* | Dosage | Details of how medication is/was taken or should be taken
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationStatement.​language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
MedicationStatement.​status | Base | required | Medication status codes | 📍4.0.1 | FHIR Std.
MedicationStatement.​statusReason | Base | example | SNOMED CT Drug Therapy Status codes | 📍4.0.1 | FHIR Std.
MedicationStatement.​category | Base | preferred | Medication usage category codes | 📍4.0.1 | FHIR Std.
MedicationStatement.​medication[x] | Base | example | SNOMED CT Medication Codes | 📍4.0.1 | FHIR Std.
MedicationStatement.​subject.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
MedicationStatement.​reasonCode | Base | example | Condition/Problem/Diagnosis Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | MedicationStatement | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | MedicationStatement | 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 | MedicationStatement | 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 | MedicationStatement | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | MedicationStatement | 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()`

This structure is derived from MedicationStatement

Summary

Mandatory: 3 elements
Must-Support: 7 elements
Prohibited: 3 elements

Structures

This structure refers to these other structures:

- De-Identified UDS Plus Patient (http://hl7.org/fhir/us/uds-plus/StructureDefinition/de-identified-uds-plus-patient)

Maturity: 1

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationStatement |  | 0..* | MedicationStatement | De-Identified UDS Plus MedicationStatement
id | S Σ | 0..1 | id | The de-identified MedicationStatement identifier created by the health center to send data to UDS+ Data Receiver
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken Binding: Medication Status Codes (required): A coded concept indicating the current status of a MedicationStatement.
medication[x] | S Σ | 1..1 |  | What medication was taken Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying the substance or product being taken.
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(Medication) |
subject | S Σ | 1..1 | Reference(De-Identified UDS Plus Patient) | Who is/was taking the medication
effective[x] | S Σ | 0..1 | dateTime | The date/time or interval when the medication is/was/will be taken
dateAsserted | S Σ | 0..1 | dateTime | When the statement was asserted?
dosage | S | 0..* | Dosage | Details of how medication is/was taken or should be taken
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationStatement.​status | Base | required | Medication status codes | 📍4.0.1 | FHIR Std.
MedicationStatement.​medication[x] | Base | example | SNOMED CT Medication Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | MedicationStatement | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | MedicationStatement | 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 | MedicationStatement | 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 | MedicationStatement | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | MedicationStatement | 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()`

Differential View

This structure is derived from MedicationStatement

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationStatement |  | 0..* | MedicationStatement | De-Identified UDS Plus MedicationStatement
id | S | 0..1 | id | The de-identified MedicationStatement identifier created by the health center to send data to UDS+ Data Receiver
text |  | 0..0 |  | Cannot include any text in the resource as part of the de-identified data.
contained |  | 0..0 |  | Cannot include any contained resources in the resource as part of the de-identified data.
status | S | 1..1 | code | active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken
medication[x] | S | 1..1 | CodeableConcept, Reference(Medication) | What medication was taken
subject | S | 1..1 | Reference(De-Identified UDS Plus Patient) | Who is/was taking the medication
display |  | 0..0 |  | Text alternative for the resource
effective[x] | S | 0..1 | dateTime | The date/time or interval when the medication is/was/will be taken
dateAsserted | S | 0..1 | dateTime | When the statement was asserted?
dosage | S | 0..* | Dosage | Details of how medication is/was taken or should be taken
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationStatement |  | 0..* | MedicationStatement | De-Identified UDS Plus MedicationStatement
id | S Σ | 0..1 | id | The de-identified MedicationStatement identifier created by the health center to send data to UDS+ Data Receiver
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
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | External identifier
basedOn | Σ | 0..* | Reference(MedicationRequest | CarePlan | ServiceRequest) | Fulfils plan, proposal or order
partOf | Σ | 0..* | Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Observation) | Part of referenced event
status | ?!S Σ | 1..1 | code | active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken Binding: Medication Status Codes (required): A coded concept indicating the current status of a MedicationStatement.
statusReason |  | 0..* | CodeableConcept | Reason for current status Binding: SNOMEDCTDrugTherapyStatusCodes (example): A coded concept indicating the reason for the status of the statement.
category | Σ | 0..1 | CodeableConcept | Type of medication usage Binding: Medication usage category codes (preferred): A coded concept identifying where the medication included in the MedicationStatement is expected to be consumed or administered.
medication[x] | S Σ | 1..1 |  | What medication was taken Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying the substance or product being taken.
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(Medication) |
subject | S Σ | 1..1 | Reference(De-Identified UDS Plus Patient) | Who is/was taking the medication
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
context | Σ | 0..1 | Reference(Encounter | EpisodeOfCare) | Encounter / Episode associated with MedicationStatement
effective[x] | S Σ | 0..1 | dateTime | The date/time or interval when the medication is/was/will be taken
dateAsserted | S Σ | 0..1 | dateTime | When the statement was asserted?
informationSource |  | 0..1 | Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization) | Person or organization that provided the information about the taking of this medication
derivedFrom |  | 0..* | Reference(Resource) | Additional supporting information
reasonCode |  | 0..* | CodeableConcept | Reason for why the medication is being/was taken Binding: Condition/Problem/DiagnosisCodes (example): A coded concept identifying why the medication is being taken.
reasonReference |  | 0..* | Reference(Condition | Observation | DiagnosticReport) | Condition or observation that supports why the medication is being/was taken
note |  | 0..* | Annotation | Further information about the statement
dosage | S | 0..* | Dosage | Details of how medication is/was taken or should be taken
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationStatement.​language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
MedicationStatement.​status | Base | required | Medication status codes | 📍4.0.1 | FHIR Std.
MedicationStatement.​statusReason | Base | example | SNOMED CT Drug Therapy Status codes | 📍4.0.1 | FHIR Std.
MedicationStatement.​category | Base | preferred | Medication usage category codes | 📍4.0.1 | FHIR Std.
MedicationStatement.​medication[x] | Base | example | SNOMED CT Medication Codes | 📍4.0.1 | FHIR Std.
MedicationStatement.​subject.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
MedicationStatement.​reasonCode | Base | example | Condition/Problem/Diagnosis Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | MedicationStatement | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | MedicationStatement | 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 | MedicationStatement | 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 | MedicationStatement | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | MedicationStatement | 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()`

This structure is derived from MedicationStatement

Summary

Mandatory: 3 elements
Must-Support: 7 elements
Prohibited: 3 elements

Structures

This structure refers to these other structures:

- De-Identified UDS Plus Patient (http://hl7.org/fhir/us/uds-plus/StructureDefinition/de-identified-uds-plus-patient)

Maturity: 1

Other representations of profile: CSV, Excel, Schematron