International Patient Access
1.1.0 - STU1

International Patient Access, published by HL7 International / Patient Care. This guide is not an authorized publication; it is the continuous build for version 1.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-ipa/ and changes regularly. See the Directory of published versions

## Resource Profile: IPA-MedicationRequest

Official URL: http://hl7.org/fhir/uv/ipa/StructureDefinition/ipa-medicationrequest | Version: 1.1.0
Standards status: Trial-use | Computable Name: IPAMedicationRequest
Copyright/Legal: Used by permission of HL7 International all rights reserved Creative Commons License

Minimum expectations for a MedicationRequest resource when accessed via a International Patient Access API. The MedicationRequest resource represents an order or request for both supply of the medication and the instructions for administration of the medication to a patient.

### Mandatory and Must Support Data Elements

The following data elements must always be present (in other words, mandatory resource properties where the minimum cardinality is 1) or must be supported (Must Support definition). Servers cannot restrict access to mandatory elements when authorizing an application. However, servers may choose to provide additional information or may be required to do so by national or other profiles that apply to the server's context.

Each MedicationRequest SHALL have:

- a status
- a code to indicate wether the request is a proposal, plan, or an original order
- a medication*
- a patient

* see guidance below

Applications must also support:

- the reported flag or reference signaling that information is from a secondary source such as a patient
- the encounter
- a date for when written
- the prescriber/requester
- the prescription Sig

### Profile Specific Implementation Rules and Guidance

#### Medication Statement and Medication Request

While the relationship between Medication Statement and Medication Request is clear in principle, in practice, when patients report medications, these may also be implicitly treated as statements of intent about what the patient should be taking. As such, information systems may record these statements as either Medication Requests or Medication Statements, or as both. The choice between these options may be influenced by many factors including wording in legislation and regulations.

For this reason, clients implementing the International Patient Access specification SHALL query for both MedicationStatement and MedicationRequest when fetching patient Medication information.

As noted there is currently no consensus how a patient can access their active, historical and future (planned) medications list. Feedback is welcome on what additional guidance can be given to promote more international alignment.

#### Fetching Medications

The MedicationRequest and MedicationStatement resources can represent a medication using either a code or refer to the Medication resource. When referencing Medication, the resource may be contained or an external resource. The server application MAY choose any one way or more than one method, but if an external reference to Medication is used, the server SHALL support the `_include` parameter for searching this element. The client application SHALL support all methods. For example, A server SHALL be capable of returning all medications for a patient using one of or both:

`GET /MedicationStatement?patient=[id]`

`GET/MedicationStatement?patient=[id]&_include=MedicationStatement:medication`

#### Medication specificity

When representing a prescribed medication, servers SHOULD use codings at the level of a clinical drug rather than ingredient or dose form (e.g. “loratadine 10mg oral tablet”, rather than a bare ingredient like “loratadine” or a dose form like “loratadine oral tablet”).

Usage:

- Examples for this Resource Profile: MedicationRequest/MedRecExample1
- CapabilityStatements using this Resource Profile: International Patient Access Client CapabilityStatement and International Patient Access Server CapabilityStatement

### 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
--- | --- | --- | --- | ---
MedicationRequest |  | 0..* | MedicationRequest | Ordering of medication for patient or group dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
status | ?!SO Σ | 1..1 | code | active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown Binding: medicationrequest Status (required): A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription. ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
intent | ?!SO Σ | 1..1 | code | proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order. ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHALL:populate-if-known | Server
doNotPerform | ?!O Σ | 0..1 | boolean | True if request is prohibiting action ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHOULD:populate | Server
SHALL:handle | Client
reported[x] | SO Σ | 0..1 |  | Reported rather than primary record ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHALL:populate-if-known | Server
SHOULD:handle | Client
reportedBoolean |  |  | boolean |
reportedReference |  |  | Reference(IPA-Patient | IPA-Practitioner | IPA-PractitionerRole) |
medication[x] | SO Σ | 1..1 |  | Medication to be taken Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying substance or product that can be ordered. ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(IPA-Medication) |
subject | SO Σ | 1..1 | Reference(IPA-Patient) | Who or group medication request is for ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
encounter | SO | 0..1 | Reference(Encounter) | Encounter created as part of encounter/admission/stay ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHALL:populate-if-known | Server
authoredOn | SO Σ | 0..1 | dateTime | When request was initially authored ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHALL:populate-if-known | Server
requester | SO Σ | 0..1 | Reference(IPA-Practitioner | IPA-PractitionerRole | Organization | IPA-Patient | RelatedPerson | Device) | Who/What requested the Request ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
dosageInstruction | SO | 0..* | Dosage | How the medication should be taken ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
text | SO Σ | 0..1 | string | Free text dosage instructions e.g. SIG ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
MedicationRequest.status | required | medicationrequest Status `http://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1` from the FHIR Standard
MedicationRequest.intent | required | medicationRequest Intent `http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1` from the FHIR Standard
MedicationRequest.medication[x] | example | SNOMEDCTMedicationCodes `http://hl7.org/fhir/ValueSet/medication-codes` from the FHIR Standard

This structure is derived from MedicationRequest

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
MedicationRequest |  | 0..* | MedicationRequest | Ordering of medication for patient or group
status | SO | 1..1 | code | active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
intent | SO | 1..1 | code | proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
Obligations | Actor
SHALL:populate-if-known | Server
doNotPerform | O | 0..1 | boolean | True if request is prohibiting action
Obligations | Actor
SHOULD:populate | Server
SHALL:handle | Client
reported[x] | SO | 0..1 |  | Reported rather than primary record
Obligations | Actor
SHALL:populate-if-known | Server
SHOULD:handle | Client
reportedBoolean |  |  | boolean |
reportedReference |  |  | Reference(IPA-Patient | IPA-Practitioner | IPA-PractitionerRole) |
medication[x] | SO | 1..1 |  | Medication to be taken
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(IPA-Medication) |
subject | SO | 1..1 | Reference(IPA-Patient) | Who or group medication request is for
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
encounter | SO | 0..1 | Reference(Encounter) | Encounter created as part of encounter/admission/stay
Obligations | Actor
SHALL:populate-if-known | Server
authoredOn | SO | 0..1 | dateTime | When request was initially authored
Obligations | Actor
SHALL:populate-if-known | Server
requester | SO | 0..1 | Reference(IPA-Practitioner | IPA-PractitionerRole | Organization | IPA-Patient | RelatedPerson | Device) | Who/What requested the Request
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
dosageInstruction | SO | 0..* | Dosage | How the medication should be taken
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
text | SO | 0..1 | string | Free text dosage instructions e.g. SIG
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
MedicationRequest |  | 0..* | MedicationRequest | Ordering of medication for patient or group
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
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | External ids for this request
status | ?!SO Σ | 1..1 | code | active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown Binding: medicationrequest Status (required): A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
statusReason |  | 0..1 | CodeableConcept | Reason for current status Binding: medicationRequest Status Reason Codes (example): Identifies the reasons for a given status.
intent | ?!SO Σ | 1..1 | code | proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order.
Obligations | Actor
SHALL:populate-if-known | Server
category |  | 0..* | CodeableConcept | Type of medication usage 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.
priority | Σ | 0..1 | code | routine | urgent | asap | stat Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.
doNotPerform | ?!O Σ | 0..1 | boolean | True if request is prohibiting action
Obligations | Actor
SHOULD:populate | Server
SHALL:handle | Client
reported[x] | SO Σ | 0..1 |  | Reported rather than primary record
Obligations | Actor
SHALL:populate-if-known | Server
SHOULD:handle | Client
reportedBoolean |  |  | boolean |
reportedReference |  |  | Reference(IPA-Patient | IPA-Practitioner | IPA-PractitionerRole) |
medication[x] | SO Σ | 1..1 |  | Medication to be taken Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying substance or product that can be ordered.
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(IPA-Medication) |
subject | SO Σ | 1..1 | Reference(IPA-Patient) | Who or group medication request is for
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
encounter | SO | 0..1 | Reference(Encounter) | Encounter created as part of encounter/admission/stay
Obligations | Actor
SHALL:populate-if-known | Server
supportingInformation |  | 0..* | Reference(Resource) | Information to support ordering of the medication
authoredOn | SO Σ | 0..1 | dateTime | When request was initially authored
Obligations | Actor
SHALL:populate-if-known | Server
requester | SO Σ | 0..1 | Reference(IPA-Practitioner | IPA-PractitionerRole | Organization | IPA-Patient | RelatedPerson | Device) | Who/What requested the Request
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
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 | Reason or indication for ordering or not ordering the medication Binding: Condition/Problem/DiagnosisCodes (example): A coded concept indicating why the medication was ordered.
reasonReference |  | 0..* | Reference(Condition | Observation) | Condition or observation that supports why the prescription is being written
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 | SO | 0..* | Dosage | How the medication should be taken
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
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 | SO Σ | 0..1 | string | Free text dosage instructions e.g. SIG
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
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 | 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 | 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] | Σ | 0..1 |  | Amount of medication per dose
doseRange |  |  | Range |
doseQuantity |  |  | Quantity(SimpleQuantity) |
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 |  | 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 |  | 0..1 | unsignedInt | Number of refills authorized
quantity |  | 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 (example): Identifies the type of substitution allowed.
allowedBoolean |  |  | boolean |
allowedCodeableConcept |  |  | CodeableConcept |
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.
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 | Conformance | ValueSet | URI
MedicationRequest.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages` from the FHIR Standard
Additional Bindings | Purpose
AllLanguages | Max Binding
MedicationRequest.status | required | medicationrequest Status `http://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1` from the FHIR Standard
MedicationRequest.statusReason | example | medicationRequest Status Reason Codes `http://hl7.org/fhir/ValueSet/medicationrequest-status-reason` from the FHIR Standard
MedicationRequest.intent | required | medicationRequest Intent `http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1` from the FHIR Standard
MedicationRequest.category | example | medicationRequest Category Codes `http://hl7.org/fhir/ValueSet/medicationrequest-category` from the FHIR Standard
MedicationRequest.priority | required | RequestPriority `http://hl7.org/fhir/ValueSet/request-priority|4.0.1` from the FHIR Standard
MedicationRequest.medication[x] | example | SNOMEDCTMedicationCodes `http://hl7.org/fhir/ValueSet/medication-codes` from the FHIR Standard
MedicationRequest.performerType | example | ProcedurePerformerRoleCodes `http://hl7.org/fhir/ValueSet/performer-role` from the FHIR Standard
MedicationRequest.reasonCode | example | Condition/Problem/DiagnosisCodes `http://hl7.org/fhir/ValueSet/condition-code` from the FHIR Standard
MedicationRequest.courseOfTherapyType | example | medicationRequest Course of Therapy Codes `http://hl7.org/fhir/ValueSet/medicationrequest-course-of-therapy` from the FHIR Standard
MedicationRequest.dosageInstruction.additionalInstruction | example | SNOMEDCTAdditionalDosageInstructions `http://hl7.org/fhir/ValueSet/additional-instruction-codes` from the FHIR Standard
MedicationRequest.dosageInstruction.asNeeded[x] | example | SNOMEDCTMedicationAsNeededReasonCodes `http://hl7.org/fhir/ValueSet/medication-as-needed-reason` from the FHIR Standard
MedicationRequest.dosageInstruction.site | example | SNOMEDCTAnatomicalStructureForAdministrationSiteCodes `http://hl7.org/fhir/ValueSet/approach-site-codes` from the FHIR Standard
MedicationRequest.dosageInstruction.route | example | SNOMEDCTRouteCodes `http://hl7.org/fhir/ValueSet/route-codes` from the FHIR Standard
MedicationRequest.dosageInstruction.method | example | SNOMEDCTAdministrationMethodCodes `http://hl7.org/fhir/ValueSet/administration-method-codes` from the FHIR Standard
MedicationRequest.dosageInstruction.doseAndRate.type | example | DoseAndRateType `http://hl7.org/fhir/ValueSet/dose-rate-type` from the FHIR Standard
MedicationRequest.substitution.allowed[x] | example | ActSubstanceAdminSubstitutionCode `http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode`
MedicationRequest.substitution.reason | example | SubstanceAdminSubstitutionReason `http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason`

This structure is derived from MedicationRequest

Summary

Must-Support: 10 elements

Structures

This structure refers to these other structures:

- IPA-Patient (http://hl7.org/fhir/uv/ipa/StructureDefinition/ipa-patient)
- IPA-Practitioner (http://hl7.org/fhir/uv/ipa/StructureDefinition/ipa-practitioner)
- IPA-PractitionerRole (http://hl7.org/fhir/uv/ipa/StructureDefinition/ipa-practitionerrole)
- IPA-Medication (http://hl7.org/fhir/uv/ipa/StructureDefinition/ipa-medication)

Key Elements View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
MedicationRequest |  | 0..* | MedicationRequest | Ordering of medication for patient or group dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
status | ?!SO Σ | 1..1 | code | active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown Binding: medicationrequest Status (required): A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription. ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
intent | ?!SO Σ | 1..1 | code | proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order. ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHALL:populate-if-known | Server
doNotPerform | ?!O Σ | 0..1 | boolean | True if request is prohibiting action ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHOULD:populate | Server
SHALL:handle | Client
reported[x] | SO Σ | 0..1 |  | Reported rather than primary record ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHALL:populate-if-known | Server
SHOULD:handle | Client
reportedBoolean |  |  | boolean |
reportedReference |  |  | Reference(IPA-Patient | IPA-Practitioner | IPA-PractitionerRole) |
medication[x] | SO Σ | 1..1 |  | Medication to be taken Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying substance or product that can be ordered. ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(IPA-Medication) |
subject | SO Σ | 1..1 | Reference(IPA-Patient) | Who or group medication request is for ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
encounter | SO | 0..1 | Reference(Encounter) | Encounter created as part of encounter/admission/stay ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHALL:populate-if-known | Server
authoredOn | SO Σ | 0..1 | dateTime | When request was initially authored ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHALL:populate-if-known | Server
requester | SO Σ | 0..1 | Reference(IPA-Practitioner | IPA-PractitionerRole | Organization | IPA-Patient | RelatedPerson | Device) | Who/What requested the Request ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
dosageInstruction | SO | 0..* | Dosage | How the medication should be taken ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
text | SO Σ | 0..1 | string | Free text dosage instructions e.g. SIG ele-1: All FHIR elements must have a @value or children
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
MedicationRequest.status | required | medicationrequest Status `http://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1` from the FHIR Standard
MedicationRequest.intent | required | medicationRequest Intent `http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1` from the FHIR Standard
MedicationRequest.medication[x] | example | SNOMEDCTMedicationCodes `http://hl7.org/fhir/ValueSet/medication-codes` from the FHIR Standard

Differential View

This structure is derived from MedicationRequest

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
MedicationRequest |  | 0..* | MedicationRequest | Ordering of medication for patient or group
status | SO | 1..1 | code | active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
intent | SO | 1..1 | code | proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
Obligations | Actor
SHALL:populate-if-known | Server
doNotPerform | O | 0..1 | boolean | True if request is prohibiting action
Obligations | Actor
SHOULD:populate | Server
SHALL:handle | Client
reported[x] | SO | 0..1 |  | Reported rather than primary record
Obligations | Actor
SHALL:populate-if-known | Server
SHOULD:handle | Client
reportedBoolean |  |  | boolean |
reportedReference |  |  | Reference(IPA-Patient | IPA-Practitioner | IPA-PractitionerRole) |
medication[x] | SO | 1..1 |  | Medication to be taken
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(IPA-Medication) |
subject | SO | 1..1 | Reference(IPA-Patient) | Who or group medication request is for
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
encounter | SO | 0..1 | Reference(Encounter) | Encounter created as part of encounter/admission/stay
Obligations | Actor
SHALL:populate-if-known | Server
authoredOn | SO | 0..1 | dateTime | When request was initially authored
Obligations | Actor
SHALL:populate-if-known | Server
requester | SO | 0..1 | Reference(IPA-Practitioner | IPA-PractitionerRole | Organization | IPA-Patient | RelatedPerson | Device) | Who/What requested the Request
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
dosageInstruction | SO | 0..* | Dosage | How the medication should be taken
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
text | SO | 0..1 | string | Free text dosage instructions e.g. SIG
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
MedicationRequest |  | 0..* | MedicationRequest | Ordering of medication for patient or group
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
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | External ids for this request
status | ?!SO Σ | 1..1 | code | active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown Binding: medicationrequest Status (required): A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
statusReason |  | 0..1 | CodeableConcept | Reason for current status Binding: medicationRequest Status Reason Codes (example): Identifies the reasons for a given status.
intent | ?!SO Σ | 1..1 | code | proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order.
Obligations | Actor
SHALL:populate-if-known | Server
category |  | 0..* | CodeableConcept | Type of medication usage 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.
priority | Σ | 0..1 | code | routine | urgent | asap | stat Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.
doNotPerform | ?!O Σ | 0..1 | boolean | True if request is prohibiting action
Obligations | Actor
SHOULD:populate | Server
SHALL:handle | Client
reported[x] | SO Σ | 0..1 |  | Reported rather than primary record
Obligations | Actor
SHALL:populate-if-known | Server
SHOULD:handle | Client
reportedBoolean |  |  | boolean |
reportedReference |  |  | Reference(IPA-Patient | IPA-Practitioner | IPA-PractitionerRole) |
medication[x] | SO Σ | 1..1 |  | Medication to be taken Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying substance or product that can be ordered.
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(IPA-Medication) |
subject | SO Σ | 1..1 | Reference(IPA-Patient) | Who or group medication request is for
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
encounter | SO | 0..1 | Reference(Encounter) | Encounter created as part of encounter/admission/stay
Obligations | Actor
SHALL:populate-if-known | Server
supportingInformation |  | 0..* | Reference(Resource) | Information to support ordering of the medication
authoredOn | SO Σ | 0..1 | dateTime | When request was initially authored
Obligations | Actor
SHALL:populate-if-known | Server
requester | SO Σ | 0..1 | Reference(IPA-Practitioner | IPA-PractitionerRole | Organization | IPA-Patient | RelatedPerson | Device) | Who/What requested the Request
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
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 | Reason or indication for ordering or not ordering the medication Binding: Condition/Problem/DiagnosisCodes (example): A coded concept indicating why the medication was ordered.
reasonReference |  | 0..* | Reference(Condition | Observation) | Condition or observation that supports why the prescription is being written
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 | SO | 0..* | Dosage | How the medication should be taken
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
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 | SO Σ | 0..1 | string | Free text dosage instructions e.g. SIG
Obligations | Actor
SHALL:populate-if-known | Server
SHALL:handle | Client
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 | 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 | 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] | Σ | 0..1 |  | Amount of medication per dose
doseRange |  |  | Range |
doseQuantity |  |  | Quantity(SimpleQuantity) |
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 |  | 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 |  | 0..1 | unsignedInt | Number of refills authorized
quantity |  | 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 (example): Identifies the type of substitution allowed.
allowedBoolean |  |  | boolean |
allowedCodeableConcept |  |  | CodeableConcept |
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.
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 | Conformance | ValueSet | URI
MedicationRequest.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages` from the FHIR Standard
Additional Bindings | Purpose
AllLanguages | Max Binding
MedicationRequest.status | required | medicationrequest Status `http://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1` from the FHIR Standard
MedicationRequest.statusReason | example | medicationRequest Status Reason Codes `http://hl7.org/fhir/ValueSet/medicationrequest-status-reason` from the FHIR Standard
MedicationRequest.intent | required | medicationRequest Intent `http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1` from the FHIR Standard
MedicationRequest.category | example | medicationRequest Category Codes `http://hl7.org/fhir/ValueSet/medicationrequest-category` from the FHIR Standard
MedicationRequest.priority | required | RequestPriority `http://hl7.org/fhir/ValueSet/request-priority|4.0.1` from the FHIR Standard
MedicationRequest.medication[x] | example | SNOMEDCTMedicationCodes `http://hl7.org/fhir/ValueSet/medication-codes` from the FHIR Standard
MedicationRequest.performerType | example | ProcedurePerformerRoleCodes `http://hl7.org/fhir/ValueSet/performer-role` from the FHIR Standard
MedicationRequest.reasonCode | example | Condition/Problem/DiagnosisCodes `http://hl7.org/fhir/ValueSet/condition-code` from the FHIR Standard
MedicationRequest.courseOfTherapyType | example | medicationRequest Course of Therapy Codes `http://hl7.org/fhir/ValueSet/medicationrequest-course-of-therapy` from the FHIR Standard
MedicationRequest.dosageInstruction.additionalInstruction | example | SNOMEDCTAdditionalDosageInstructions `http://hl7.org/fhir/ValueSet/additional-instruction-codes` from the FHIR Standard
MedicationRequest.dosageInstruction.asNeeded[x] | example | SNOMEDCTMedicationAsNeededReasonCodes `http://hl7.org/fhir/ValueSet/medication-as-needed-reason` from the FHIR Standard
MedicationRequest.dosageInstruction.site | example | SNOMEDCTAnatomicalStructureForAdministrationSiteCodes `http://hl7.org/fhir/ValueSet/approach-site-codes` from the FHIR Standard
MedicationRequest.dosageInstruction.route | example | SNOMEDCTRouteCodes `http://hl7.org/fhir/ValueSet/route-codes` from the FHIR Standard
MedicationRequest.dosageInstruction.method | example | SNOMEDCTAdministrationMethodCodes `http://hl7.org/fhir/ValueSet/administration-method-codes` from the FHIR Standard
MedicationRequest.dosageInstruction.doseAndRate.type | example | DoseAndRateType `http://hl7.org/fhir/ValueSet/dose-rate-type` from the FHIR Standard
MedicationRequest.substitution.allowed[x] | example | ActSubstanceAdminSubstitutionCode `http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode`
MedicationRequest.substitution.reason | example | SubstanceAdminSubstitutionReason `http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason`

This structure is derived from MedicationRequest

Summary

Must-Support: 10 elements

Structures

This structure refers to these other structures:

- IPA-Patient (http://hl7.org/fhir/uv/ipa/StructureDefinition/ipa-patient)
- IPA-Practitioner (http://hl7.org/fhir/uv/ipa/StructureDefinition/ipa-practitioner)
- IPA-PractitionerRole (http://hl7.org/fhir/uv/ipa/StructureDefinition/ipa-practitionerrole)
- IPA-Medication (http://hl7.org/fhir/uv/ipa/StructureDefinition/ipa-medication)

Other representations of profile: CSV, Excel, Schematron