RIVO-Noord Zorgviewer Implementation Guide
1.21.0 - CI build Netherlands flag

RIVO-Noord Zorgviewer Implementation Guide, published by RIVO-NN HL7NL. This guide is not an authorized publication; it is the continuous build for version 1.21.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/RIVO-Noord/zorgviewer-ig/ and changes regularly. See the Directory of published versions

Resource Profile: MedicationAgreement - Detailed Descriptions

Active as of 2025-10-04

Definitions for the MedicationRequest resource profile.

Guidance on how to interpret the contents of this table can be foundhere

0. MedicationRequest
Definition

A medication agreement is a prescriber’s proposal for a patient to use medication. An agreement to discontinue the use of medication is also a medication agreement.


This is the base resource type for everything.

ShortMedicationAgreementBase Resource
Control0..*
Alternate NamesPrescription, Order, Medicatieafspraak
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.empty())
dom-4: 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-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
2. MedicationRequest.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

Control0..1
Typeuri
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
4. MedicationRequest.extension:periodOfUse
Slice NameperiodOfUse
Definition

An Extension

ShortUsagePeriod
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(HCIM Medication Period Of Use) (Extension Type: Period)
Must Supporttrue
Alternate NamesGebruiksperiode
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
6. MedicationRequest.extension:usageDuration
Slice NameusageDuration
Definition

Duration: The intended duration of use. E.g. 5 days or 8 weeks. It is not allowed to indicate the duration in months, because different months have a variable duration in days.

ShortDuration
Comments

According to the HCIM TimeInterval, a time interval is defined by either a start and end time, a start time and duration, or a duration and end time. As this HCIM is expressed by the periodOfUse and usageDuration extensions in this profile, this means that precisely two elements out of .valuePeriod.start, .valuePeriod.end (both in the periodOfUse extension) and .valueDuration (in the usageDuration extension) should be present in order to correctly represent the time interval in which the agreement is used (and in particular not all three elements).

Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(HCIM MedicationUse Duration) (Extension Type: Duration)
Alternate Namesextensions, user content, Duur
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
8. MedicationRequest.extension:additionalInformation
Slice NameadditionalInformation
Definition

Additional information includes details on the structure of the agreement made that are relevant for pharmacovigilance and fulfillment by the pharmacist. This can be used e.g. to indicate that there was a conscious decision to deviate from the norm or that the agreement is to be structured in a certain way.

ShortMedicationAgreementAdditionalInformation
Comments

When choosing a medicine, you can deviate from what is expected or from what the standard is. For example, when the hospital uses a different formulary than the community pharmacy. For reasons of efficiency, for example, one gastric acid inhibitor has been chosen in the hospital: pantoprazole. Upon admission, a patient with omeprazole is converted to pantoprazole for the duration of the stay. When discharged, the patient goes back to omeprazole. It is clear that something can go wrong here and that the patient takes both omeprazole and pantoprazole when there is no intervention. In the hospital's medication agreement for pantoprazole a remark can be made about the deviation so that it is clear that pantoprazole is the substitute for omeprazole or that it should be used in addition to omeprazole. Another example are the half strengths. The hospital sometimes stocks tablets with half the strength of the normal trade preparation (own production). Where the patient enters the hospital on 25 mg chlortalidone, half a tablet once a day, he receives 12.5 mg intramural chlortalidone, one tablet once a day. Then the nursing does not have to break tablets in this case. Here there is a risk that the patient will use the 25 mg again at home, but then a whole tablet at a time in stead of half a tablet. By means of an explanation in the medication agreement (Additional information) of the last chlortalidone 25 mg, it can be indicated whether this has been a intended increase.

Control0..*
This element is affected by the following invariants: ele-1
TypeExtension(HCIM AdditionalInformation) (Extension Type: CodeableConcept)
Alternate Namesextensions, user content, MedicatieafspraakAanvullendeInformatie
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
10. MedicationRequest.extension:additionalInformation.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional Content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..0*
TypeExtension
Alternate Namesextensions, user content
SlicingThis element introduces a set of slices on MedicationRequest.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 12. MedicationRequest.extension:additionalInformation.url
    Definition

    Source of the definition for the extension code - a logical name or a URL.

    Shortidentifies the meaning of the extension
    Comments

    The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

    Control1..1
    Typeuri
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/zib-Medication-AdditionalInformation
    14. MedicationRequest.extension:additionalInformation.value[x]:valueCodeableConcept
    Slice NamevalueCodeableConcept
    Definition

    Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

    ShortValue of extension
    Control0..1
    BindingUnless not suitable, these codes SHALL be taken from For codes, see MedicatieafspraakAanvullendeInformatieCodelijst
    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.6.3--20171231000000)

    MedicatieafspraakAanvullendeInformatieCodelijst

    TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    ExampleExample of MedicationAgreementAdditionalInformation: { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.20.77.5.2.3.2050", "code" : "1", "display" : "Bewust hoge dosering" }] }
    16. MedicationRequest.extension:medicationTreatment
    Slice NamemedicationTreatment
    Definition

    This extension is to describe which overarching medication treatment this information is part of. This is done by the use of an identifier of that medication treatment.

    ShortMedication Treatment
    Comments

    No HCIM concept is available for this element. Therefore a mapping to the relevant Medication Process data element is provided.

    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(HCIM MedicationTreatment) (Extension Type: Identifier)
    Alternate Namesextensions, user content, Medicamenteuze behandeling
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    18. MedicationRequest.extension:nl-core-episodeofcare
    Slice Namenl-core-episodeofcare
    Definition

    Optional Extension Element - found in all resources.

    ShortOptional Extensions Element
    Comments

    It is recommended to use the nl-core-episodeofcare extension to reference nl-core-episodeofcare (EpisodeOfCare) instances rather than the context element, as this approach will be enforced in FHIR R4.

    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension(http://nictiz.nl/fhir/StructureDefinition/extension-context-nl-core-episodeofcare)
    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    20. MedicationRequest.modifierExtension
    Definition

    May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    ShortExtensions that cannot be ignored
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
    Alternate Namesextensions, user content
    SlicingThis element introduces a set of slices on MedicationRequest.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 22. MedicationRequest.modifierExtension:stopType
      Slice NamestopType
      Definition

      The manner in which (and indicator that) this medication is discontinued (temporarily or permanently).

      ShortStopType
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(HCIM Medication StopType) (Extension Type: CodeableConcept)
      Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
      Must Supporttrue
      LabelMedicatieafspraakStopType
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      24. MedicationRequest.modifierExtension:stopType.extension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

      ShortAdditional Content defined by implementations
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..0*
      TypeExtension
      Alternate Namesextensions, user content
      SlicingThis element introduces a set of slices on MedicationRequest.modifierExtension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 26. MedicationRequest.modifierExtension:stopType.url
        Definition

        Source of the definition for the extension code - a logical name or a URL.

        Shortidentifies the meaning of the extension
        Comments

        The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

        Control1..1
        Typeuri
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/zib-Medication-StopType
        28. MedicationRequest.modifierExtension:stopType.value[x]:valueCodeableConcept
        Slice NamevalueCodeableConcept
        Definition

        Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

        ShortValue of extension
        Control0..1
        BindingThe codes SHALL be taken from For codes, see Stoptype
        (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.19--20160617101300)

        StopType

        TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        30. MedicationRequest.modifierExtension:repeatPeriodCyclicalSchedule
        Slice NamerepeatPeriodCyclicalSchedule
        Definition

        The repeated period in a cyclical schedule (of one or more dosing instructions). A cyclic schedule is noted in days, the corresponding dosing duration is also in days.

        Examples of a cyclical schedule: contraceptive pill (21 days, 1 pill 1x a day, then skip for 7 days, repeat), repeat period here is 28 days. RepeatPeriodCyclicalSchedule

        ShortRepeatPeriodCyclicalSchedule
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(HCIM Medication RepeatPeriodCyclicalSchedule) (Extension Type: Duration)
        Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
        LabelHerhaalperiodeCyclischSchema
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        32. MedicationRequest.status
        Definition

        A code specifying the current state of the order. Generally this will be active or completed state.

        Shortactive | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
        Comments

        This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

        Control0..1
        BindingThe codes SHALL be taken from MedicationRequestStatushttp://hl7.org/fhir/ValueSet/medication-request-status|3.0.2
        (required to http://hl7.org/fhir/ValueSet/medication-request-status)

        A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription

        Typecode
        Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        34. MedicationRequest.intent
        Definition

        Whether the request is a proposal, plan, or an original order.

        Shortproposal | plan | order | instance-order
        Comments

        It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only.

        An instance-order is an instantiation of a request or order and may be used to populate Medication Administration Record.

        This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.

        Control1..1
        BindingThe codes SHALL be taken from MedicationRequestIntenthttp://hl7.org/fhir/ValueSet/medication-request-intent|3.0.2
        (required to http://hl7.org/fhir/ValueSet/medication-request-intent)

        The kind of medication order

        Typecode
        Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Fixed Valueorder
        36. MedicationRequest.category
        Definition

        Indicates the type of medication order and where the medication is expected to be consumed or administered.

        ShortType of medication usage
        Control10..1
        BindingThe codes SHOULD be taken from MedicationRequestCategoryhttp://hl7.org/fhir/ValueSet/medication-request-category|3.0.2
        (preferred to http://hl7.org/fhir/ValueSet/medication-request-category)

        A coded concept identifying where the medication ordered is expected to be consumed or administered

        TypeCodeableConcept
        38. MedicationRequest.category.coding
        Definition

        A reference to a code defined by a terminology system.

        ShortCode defined by a terminology system
        Comments

        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

        Control0..*
        TypeCoding
        Summarytrue
        Requirements

        Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

        SlicingThis element introduces a set of slices on MedicationRequest.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ code
        • 40. MedicationRequest.category.coding:medicationAgreementCode
          Slice NamemedicationAgreementCode
          Definition

          Category SNOMED code used for indexing/retrieval of the HCIM MedicationAgreement. The SNOMED code 16076005 for this resource is stated in the Medication Process v09.


          A reference to a code defined by a terminology system.

          ShortMedicationAgreementCodeCode defined by a terminology system
          Comments

          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

          Control0..*
          TypeCoding
          Summarytrue
          Requirements

          Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

          42. MedicationRequest.category.coding:medicationAgreementCode.system
          Definition

          The identification of the code system that defines the meaning of the symbol in the code.

          ShortIdentity of the terminology system
          Comments

          The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

          Control0..1
          Typeuri
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Need to be unambiguous about the source of the definition of the symbol.

          Fixed Valuehttp://snomed.info/sct
          44. MedicationRequest.category.coding:medicationAgreementCode.code
          Definition

          A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

          ShortSymbol in syntax defined by the system
          Control0..1
          Typecode
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Need to refer to a particular code in the system.

          Fixed Value16076005
          46. MedicationRequest.category.text
          Definition

          A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

          ShortPlain text representation of the concept
          Comments

          Very often the text is the same as a displayName of one of the codings.

          Control0..1
          Typestring
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

          48. MedicationRequest.medicationReference:medicationReference
          Slice NamemedicationReference
          Definition

          The medicine agreed upon to be used.


          Identifies the medication being requested. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medications.

          ShortAgreedMedicineMedication to be taken
          Comments

          If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended.  For example, if you require form or lot number or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource. .

          Control1..1
          TypeReference(Medication, Medication), CodeableConcept
          Must Supporttrue
          Summarytrue
          Alternate NamesAfgesprokengeneesmiddel
          50. MedicationRequest.medicationReference:medicationReference.display
          Definition

          Plain text narrative that identifies the resource in addition to the resource reference.

          ShortText alternative for the resource
          Comments

          This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

          Control0..1
          Typestring
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          52. MedicationRequest.subject
          Definition

          A link to a resource representing the person or set of individuals to whom the medication will be given.

          ShortWho or group medication request is for
          Comments

          The subject on a medication request is mandatory. For the secondary use case where the actual subject is not provided, there still must be an anonymized subject specified.

          Control1..1
          TypeReference(nl-core-patient, Group, Patient)
          Summarytrue
          54. MedicationRequest.authoredOn
          Definition

          The time at which the agreement was made.

          Appointment date + time are required (order of the appointments must be clear in cases with multiple appointments on one day)


          The date (and perhaps time) when the prescription was initially written or authored on.

          ShortMedicationAgreementDateTimeWhen request was initially authored
          Control10..1
          TypedateTime
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Alternate NamesAfspraakdatum
          56. MedicationRequest.requester
          Definition

          The health professional that entered the medication agreement with the patient.


          The individual, organization or device that initiated the request and has responsibility for its activation.

          ShortPrescriberWho/What requested the Request
          Comments

          Note that in FHIR STU3, there is an agent Reference type PractitionerRole missing. PractitionerRole, contrary to Practitioner, allows for specialism and organization. This issue has been fixed in FHIR R4. For FHIR STU3, you can use the practitionerrole-reference extension on requester.agent.

          Control0..1
          TypeBackboneElement
          Summarytrue
          Alternate NamesVoorschrijver
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
          mps-1: onBehalfOf can only be specified if agent is practitioner or device ((agent.resolve().empty()) or (agent.resolve() is Device) or (agent.resolve() is Practitioner) or onBehalfOf.exists().not())
          ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
          mps-1: onBehalfOf can only be specified if agent is practitioner or device ((agent.resolve().empty()) or (agent.resolve() is Device) or (agent.resolve() is Practitioner) or onBehalfOf.exists().not())
          58. MedicationRequest.requester.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          ShortExtensions that cannot be ignored
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
          Summarytrue
          Alternate Namesextensions, user content, modifiers
          60. MedicationRequest.requester.agent
          Definition

          The healthcare professional responsible for authorizing the initial prescription.

          ShortWho ordered the initial medication(s)
          Comments

          The health professional's speciality, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile.


          It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only.

          Control1..1
          TypeReference(nl-core-practitioner, nl-core-organization, nl-core-patient, nl-core-relatedperson, Device, Practitioner, Organization, Patient, RelatedPerson)
          Summarytrue
          62. MedicationRequest.requester.agent.extension:practitionerRole
          Slice NamepractitionerRole
          Definition

          Optional Extension Element - found in all resources.

          ShortOptional Extensions Element
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          64. MedicationRequest.requester.agent.display
          Definition

          Plain text narrative that identifies the resource in addition to the resource reference.

          ShortText alternative for the resource
          Comments

          This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

          Control0..1
          Typestring
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          66. MedicationRequest.dosageInstruction
          Definition

          Instructions for the use of the medication, e.g. dose and route of administration


          Indicates how the medication is to be used by the patient.

          ShortInstructionsForUseHow the medication should be taken
          Comments

          The wiki page https://informatiestandaarden.nictiz.nl/wiki/mp:V9.0Voorbeeldendoseringen provides dosage instruction examples. These examples consists of functional data and their representation in FHIR and CDA.


          There are examples where a medication request may include the option of an oral dose or an Intravenous or Intramuscular dose. For example, "Ondansetron 8mg orally or IV twice a day as needed for nausea" or "Compazine® (prochlorperazine) 5-10mg PO or 25mg PR bid prn nausea or vomiting". In these cases, two medication requests would be created that could be grouped together. The decision on which dose and route of administration to use is based on the patient's condition at the time the dose is needed.

          Control0..*
          This element is affected by the following invariants: ele-1
          TypeDosage(HCIM InstructionsForUse)
          Alternate NamesGebruiksinstructie
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
          68. MedicationRequest.dosageInstruction.text
          Definition

          Textual description of the complete instructions for use including the period of use.


          Free text dosage instructions e.g. SIG.

          ShortDescriptionFree text dosage instructions e.g. SIG
          Control0..1
          Typestring
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing.

          Alternate NamesOmschrijving
          70. MedicationRequest.dosageInstruction.asNeeded[x]
          Definition

          Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).

          ShortTake "as needed" (for x)
          Comments

          Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".

          Control0..1
          BindingFor example codes, see SNOMED CT Medication As Needed Reason Codeshttp://hl7.org/fhir/ValueSet/medication-as-needed-reason|3.0.2
          (example to http://hl7.org/fhir/ValueSet/medication-as-needed-reason|3.0.2)

          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.

          TypeCodeableConcept, boolean
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Summarytrue
          SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.asNeeded[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
          • type @ $this
          • 72. MedicationRequest.dosageInstruction.asNeeded[x]:asNeededCodeableConcept
            Slice NameasNeededCodeableConcept
            Definition

            As needed means that the dose is only to be administered under certain conditions.


            Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).

            ShortAsNeededTake "as needed" (for x)
            Comments

            Using the term 'as needed' or a specific reason (eg 'in case of pain') to use medication leads to ambiguity. It is not always clear whether the whole dose is 'as needed' or only part of the dose. For example: 1x daily 1-2 tablets as needed. This can mean: 1 tablet fixed per day and 1 tablet as needed or, as needed, a maximum of 2 tablets.As needed medication is not included in GDS. In the first situation, 1 tablet comes in the GDS (drug dispensing systems) and 1 tablet is delivered separately. In the second situation there is only separate delivery.The system must make sufficiently clear whether the entire instruction or part of the dose is necessary. The HCIM supports both options described above.


            Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".

            Control0..1
            BindingUnless not suitable, these codes SHALL be taken from For example codes, see ZonodigCriteriumCodelijsthttp://hl7.org/fhir/ValueSet/medication-as-needed-reason|3.0.2
            (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.12.4--20171231000000)

            ZonodigCriteriumCodelijst


            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.

            TypeCodeableConcept, boolean
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Summarytrue
            Alternate NamesZo nodig, Criterium
            74. MedicationRequest.dosageInstruction.route
            Definition

            The route through which the medication is administered (oral, nasal, intravenous, etc.)


            How drug should enter body.

            ShortRouteOfAdministrationHow drug should enter body
            Control0..1
            BindingUnless not suitable, these codes SHALL be taken from For example codes, see MedicatieToedieningswegCodelijsthttp://hl7.org/fhir/ValueSet/route-codes|3.0.2
            (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.12.1--20171231000000)

            ToedieningswegCodelijst


            A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

            TypeCodeableConcept
            Summarytrue
            Requirements

            A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

            Alternate NamesToedieningsweg
            ExampleExample of RouteOfAdministration: { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.4.9", "code" : "oraal", "display" : "Oraal" }] }
            76. MedicationRequest.dosageInstruction.route.text
            Definition

            A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

            ShortPlain text representation of the concept
            Comments

            Very often the text is the same as a displayName of one of the codings.

            Control0..1
            Typestring
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

            78. MedicationRequest.dosageInstruction.dose[x]
            Definition

            The dose indicates the dose amount per administration.

            The dosage is described in the unit accompanying the product; usually, this is just a number of units or doses. Liquids and other divisible products will usually include a unit of volume (preferably ""ml"").

            In many cases, the prescriber will want to indicate the dose in units of weight of the active ingredient.

            If only the ingredient is included and not the product, then the amount of that ingredient will be given. Paracetamol 1000mg is equivalent to 2 Paracetamol 500mg tablets or units.

            The dosage is sometimes given as a calculation, in which the patient’s body weight or body surface area is used as a parameter. The calculation is however no more than an aid in reaching a decision.

            In the event of constant administration, sometimes the dose is given in addition to the administration speed (infusion rate) (e.g. 20ml in a syringe or 500ml in a bag), but it is often also omitted.

            A general dosage recommendation such as ‘Use according to protocol’ or ‘See instructions’ can be sufficient. In that case, no dose is given.


            Amount of medication per dose.

            ShortDoseAmount of medication per dose
            Comments

            Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

            Control0..1
            TypeChoice of: Range, Quantity(SimpleQuantity)
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Summarytrue
            Requirements

            The amount of therapeutic or other substance given at one administration event.

            Alternate NamesKeerdosis
            SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.dose[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
            • type @ $this
            • 80. MedicationRequest.dosageInstruction.dose[x]:doseQuantity
              Slice NamedoseQuantity
              Definition

              Amount of medication per dose.

              ShortAmount of medication per dose
              Comments

              Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

              Control0..1
              BindingThe codes SHALL be taken from For codes, see G-Standaard Eenhedentabel
              (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

              GstdTabel902

              TypeQuantity(SimpleQuantity), Range
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Summarytrue
              Requirements

              The amount of therapeutic or other substance given at one administration event.

              82. MedicationRequest.dosageInstruction.dose[x]:doseRange
              Slice NamedoseRange
              Definition

              Amount of medication per dose.

              ShortAmount of medication per dose
              Comments

              Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

              Control0..1
              TypeRange, Quantity(SimpleQuantity)
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Summarytrue
              Requirements

              The amount of therapeutic or other substance given at one administration event.

              Guidance on how to interpret the contents of this table can be foundhere

              0. MedicationRequest
              2. MedicationRequest.extension:periodOfUse
              Slice NameperiodOfUse
              Must Supporttrue
              4. MedicationRequest.modifierExtension:stopType
              Slice NamestopType
              Must Supporttrue
              6. MedicationRequest.category
              8. MedicationRequest.category.text
              Must Supporttrue
              10. MedicationRequest.medicationReference
              TypeReference(Medication)
              Must Supporttrue
              12. MedicationRequest.medicationReference.display
              Must Supporttrue
              14. MedicationRequest.authoredOn
              Must Supporttrue
              16. MedicationRequest.requester
              18. MedicationRequest.requester.agent
              20. MedicationRequest.requester.agent.display
              Must Supporttrue
              22. MedicationRequest.dosageInstruction
              24. MedicationRequest.dosageInstruction.text
              Must Supporttrue
              26. MedicationRequest.dosageInstruction.route
              28. MedicationRequest.dosageInstruction.route.text
              Must Supporttrue

              Guidance on how to interpret the contents of this table can be foundhere

              0. MedicationRequest
              Definition

              A medication agreement is a prescriber’s proposal for a patient to use medication. An agreement to discontinue the use of medication is also a medication agreement.

              ShortMedicationAgreement
              Control0..*
              Alternate NamesPrescription, Order, Medicatieafspraak
              Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
              dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.empty())
              dom-4: 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-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
              2. MedicationRequest.id
              Definition

              The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

              ShortLogical id of this artifact
              Comments

              The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

              Control0..1
              Typeid
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              4. MedicationRequest.meta
              Definition

              The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

              ShortMetadata about the resource
              Control0..1
              TypeMeta
              Summarytrue
              6. MedicationRequest.implicitRules
              Definition

              A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

              ShortA set of rules under which this content was created
              Comments

              Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

              This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

              Control0..1
              Typeuri
              Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              8. MedicationRequest.language
              Definition

              The base language in which the resource is written.

              ShortLanguage of the resource content
              Comments

              Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

              Control0..1
              BindingUnless not suitable, these codes SHALL be taken from Common Languages
              (extensible to http://hl7.org/fhir/ValueSet/languages)

              A human language.

              Additional BindingsPurpose
              All LanguagesMax Binding
              Typecode
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              10. MedicationRequest.text
              Definition

              A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

              ShortText summary of the resource, for human interpretation
              Comments

              Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

              Control0..1
              This element is affected by the following invariants: dom-1
              TypeNarrative
              Alternate Namesnarrative, html, xhtml, display
              12. MedicationRequest.contained
              Definition

              These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

              ShortContained, inline Resources
              Comments

              This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

              Control0..*
              TypeResource
              Alternate Namesinline resources, anonymous resources, contained resources
              14. MedicationRequest.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              ShortAdditional Content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Alternate Namesextensions, user content
              SlicingThis element introduces a set of slices on MedicationRequest.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 16. MedicationRequest.extension:periodOfUse
                Slice NameperiodOfUse
                Definition

                An Extension

                ShortUsagePeriod
                Control0..1
                This element is affected by the following invariants: ele-1
                TypeExtension(HCIM Medication Period Of Use) (Extension Type: Period)
                Must Supporttrue
                Alternate NamesGebruiksperiode
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                18. MedicationRequest.extension:usageDuration
                Slice NameusageDuration
                Definition

                Duration: The intended duration of use. E.g. 5 days or 8 weeks. It is not allowed to indicate the duration in months, because different months have a variable duration in days.

                ShortDuration
                Comments

                According to the HCIM TimeInterval, a time interval is defined by either a start and end time, a start time and duration, or a duration and end time. As this HCIM is expressed by the periodOfUse and usageDuration extensions in this profile, this means that precisely two elements out of .valuePeriod.start, .valuePeriod.end (both in the periodOfUse extension) and .valueDuration (in the usageDuration extension) should be present in order to correctly represent the time interval in which the agreement is used (and in particular not all three elements).

                Control0..1
                This element is affected by the following invariants: ele-1
                TypeExtension(HCIM MedicationUse Duration) (Extension Type: Duration)
                Alternate Namesextensions, user content, Duur
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                20. MedicationRequest.extension:additionalInformation
                Slice NameadditionalInformation
                Definition

                Additional information includes details on the structure of the agreement made that are relevant for pharmacovigilance and fulfillment by the pharmacist. This can be used e.g. to indicate that there was a conscious decision to deviate from the norm or that the agreement is to be structured in a certain way.

                ShortMedicationAgreementAdditionalInformation
                Comments

                When choosing a medicine, you can deviate from what is expected or from what the standard is. For example, when the hospital uses a different formulary than the community pharmacy. For reasons of efficiency, for example, one gastric acid inhibitor has been chosen in the hospital: pantoprazole. Upon admission, a patient with omeprazole is converted to pantoprazole for the duration of the stay. When discharged, the patient goes back to omeprazole. It is clear that something can go wrong here and that the patient takes both omeprazole and pantoprazole when there is no intervention. In the hospital's medication agreement for pantoprazole a remark can be made about the deviation so that it is clear that pantoprazole is the substitute for omeprazole or that it should be used in addition to omeprazole. Another example are the half strengths. The hospital sometimes stocks tablets with half the strength of the normal trade preparation (own production). Where the patient enters the hospital on 25 mg chlortalidone, half a tablet once a day, he receives 12.5 mg intramural chlortalidone, one tablet once a day. Then the nursing does not have to break tablets in this case. Here there is a risk that the patient will use the 25 mg again at home, but then a whole tablet at a time in stead of half a tablet. By means of an explanation in the medication agreement (Additional information) of the last chlortalidone 25 mg, it can be indicated whether this has been a intended increase.

                Control0..*
                This element is affected by the following invariants: ele-1
                TypeExtension(HCIM AdditionalInformation) (Extension Type: CodeableConcept)
                Alternate Namesextensions, user content, MedicatieafspraakAanvullendeInformatie
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                22. MedicationRequest.extension:additionalInformation.id
                Definition

                unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                Shortxml:id (or equivalent in JSON)
                Control0..1
                Typestring
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                24. MedicationRequest.extension:additionalInformation.extension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                ShortAdditional Content defined by implementations
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..0
                TypeExtension
                Alternate Namesextensions, user content
                SlicingThis element introduces a set of slices on MedicationRequest.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 26. MedicationRequest.extension:additionalInformation.url
                  Definition

                  Source of the definition for the extension code - a logical name or a URL.

                  Shortidentifies the meaning of the extension
                  Comments

                  The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                  Control1..1
                  Typeuri
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/zib-Medication-AdditionalInformation
                  28. MedicationRequest.extension:additionalInformation.value[x]:valueCodeableConcept
                  Slice NamevalueCodeableConcept
                  Definition

                  Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                  ShortValue of extension
                  Control0..1
                  BindingUnless not suitable, these codes SHALL be taken from MedicatieafspraakAanvullendeInformatieCodelijst
                  (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.6.3--20171231000000)

                  MedicatieafspraakAanvullendeInformatieCodelijst

                  TypeCodeableConcept
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  ExampleExample of MedicationAgreementAdditionalInformation: { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.20.77.5.2.3.2050", "code" : "1", "display" : "Bewust hoge dosering" }] }
                  30. MedicationRequest.extension:medicationTreatment
                  Slice NamemedicationTreatment
                  Definition

                  This extension is to describe which overarching medication treatment this information is part of. This is done by the use of an identifier of that medication treatment.

                  ShortMedication Treatment
                  Comments

                  No HCIM concept is available for this element. Therefore a mapping to the relevant Medication Process data element is provided.

                  Control0..1
                  This element is affected by the following invariants: ele-1
                  TypeExtension(HCIM MedicationTreatment) (Extension Type: Identifier)
                  Alternate Namesextensions, user content, Medicamenteuze behandeling
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  32. MedicationRequest.extension:nl-core-episodeofcare
                  Slice Namenl-core-episodeofcare
                  Definition

                  Optional Extension Element - found in all resources.

                  ShortOptional Extensions Element
                  Comments

                  It is recommended to use the nl-core-episodeofcare extension to reference nl-core-episodeofcare (EpisodeOfCare) instances rather than the context element, as this approach will be enforced in FHIR R4.

                  Control0..*
                  This element is affected by the following invariants: ele-1
                  TypeExtension(http://nictiz.nl/fhir/StructureDefinition/extension-context-nl-core-episodeofcare)
                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  34. MedicationRequest.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  ShortExtensions that cannot be ignored
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                  Alternate Namesextensions, user content
                  SlicingThis element introduces a set of slices on MedicationRequest.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 36. MedicationRequest.modifierExtension:stopType
                    Slice NamestopType
                    Definition

                    The manner in which (and indicator that) this medication is discontinued (temporarily or permanently).

                    ShortStopType
                    Control0..1
                    This element is affected by the following invariants: ele-1
                    TypeExtension(HCIM Medication StopType) (Extension Type: CodeableConcept)
                    Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                    Must Supporttrue
                    LabelMedicatieafspraakStopType
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    38. MedicationRequest.modifierExtension:stopType.id
                    Definition

                    unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                    Shortxml:id (or equivalent in JSON)
                    Control0..1
                    Typestring
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    40. MedicationRequest.modifierExtension:stopType.extension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                    ShortAdditional Content defined by implementations
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..0
                    TypeExtension
                    Alternate Namesextensions, user content
                    SlicingThis element introduces a set of slices on MedicationRequest.modifierExtension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 42. MedicationRequest.modifierExtension:stopType.url
                      Definition

                      Source of the definition for the extension code - a logical name or a URL.

                      Shortidentifies the meaning of the extension
                      Comments

                      The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                      Control1..1
                      Typeuri
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/zib-Medication-StopType
                      44. MedicationRequest.modifierExtension:stopType.value[x]:valueCodeableConcept
                      Slice NamevalueCodeableConcept
                      Definition

                      Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                      ShortValue of extension
                      Control0..1
                      BindingThe codes SHALL be taken from Stoptype
                      (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.19--20160617101300)

                      StopType

                      TypeCodeableConcept
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      46. MedicationRequest.modifierExtension:repeatPeriodCyclicalSchedule
                      Slice NamerepeatPeriodCyclicalSchedule
                      Definition

                      The repeated period in a cyclical schedule (of one or more dosing instructions). A cyclic schedule is noted in days, the corresponding dosing duration is also in days.

                      Examples of a cyclical schedule: contraceptive pill (21 days, 1 pill 1x a day, then skip for 7 days, repeat), repeat period here is 28 days. RepeatPeriodCyclicalSchedule

                      ShortRepeatPeriodCyclicalSchedule
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(HCIM Medication RepeatPeriodCyclicalSchedule) (Extension Type: Duration)
                      Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                      LabelHerhaalperiodeCyclischSchema
                      Alternate Namesextensions, user content
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      48. MedicationRequest.identifier
                      Definition

                      This records identifiers associated with this medication request that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. For example a re-imbursement system might issue its own id for each prescription that is created. This is particularly important where FHIR only provides part of an entire workflow process where records must be tracked through an entire system.

                      ShortExternal ids for this request
                      NoteThis is a business identifier, not a resource identifier (see discussion)
                      Control0..*
                      TypeIdentifier
                      50. MedicationRequest.definition
                      Definition

                      Protocol or definition followed by this request.

                      ShortProtocol or definition
                      Control0..*
                      TypeReference(ActivityDefinition, PlanDefinition)
                      Summarytrue
                      52. MedicationRequest.basedOn
                      Definition

                      A plan or request that is fulfilled in whole or in part by this medication request.

                      ShortWhat request fulfills
                      Control0..*
                      TypeReference(CarePlan, MedicationRequest, ProcedureRequest, ReferralRequest)
                      Summarytrue
                      54. MedicationRequest.groupIdentifier
                      Definition

                      A shared identifier common to all requests that were authorized more or less simultaneously by a single author, representing the identifier of the requisition or prescription.

                      ShortComposite request this is part of
                      Control0..1
                      TypeIdentifier
                      Summarytrue
                      Requirements

                      Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.

                      56. MedicationRequest.status
                      Definition

                      A code specifying the current state of the order. Generally this will be active or completed state.

                      Shortactive | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
                      Comments

                      This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

                      Control0..1
                      BindingThe codes SHALL be taken from MedicationRequestStatus
                      (required to http://hl7.org/fhir/ValueSet/medication-request-status)

                      A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription

                      Typecode
                      Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      58. MedicationRequest.intent
                      Definition

                      Whether the request is a proposal, plan, or an original order.

                      Shortproposal | plan | order | instance-order
                      Comments

                      It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only.

                      An instance-order is an instantiation of a request or order and may be used to populate Medication Administration Record.

                      This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.

                      Control1..1
                      BindingThe codes SHALL be taken from MedicationRequestIntent
                      (required to http://hl7.org/fhir/ValueSet/medication-request-intent)

                      The kind of medication order

                      Typecode
                      Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Fixed Valueorder
                      60. MedicationRequest.category
                      Definition

                      Indicates the type of medication order and where the medication is expected to be consumed or administered.

                      ShortType of medication usage
                      Control1..1
                      BindingThe codes SHOULD be taken from MedicationRequestCategory
                      (preferred to http://hl7.org/fhir/ValueSet/medication-request-category)

                      A coded concept identifying where the medication ordered is expected to be consumed or administered

                      TypeCodeableConcept
                      62. MedicationRequest.category.id
                      Definition

                      unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                      Shortxml:id (or equivalent in JSON)
                      Control0..1
                      Typestring
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      XML FormatIn the XML format, this property is represented as an attribute.
                      64. MedicationRequest.category.extension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                      ShortAdditional Content defined by implementations
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Alternate Namesextensions, user content
                      SlicingThis element introduces a set of slices on MedicationRequest.category.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 66. MedicationRequest.category.coding
                        Definition

                        A reference to a code defined by a terminology system.

                        ShortCode defined by a terminology system
                        Comments

                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                        Control0..*
                        TypeCoding
                        Summarytrue
                        Requirements

                        Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                        SlicingThis element introduces a set of slices on MedicationRequest.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ code
                        • 68. MedicationRequest.category.coding:medicationAgreementCode
                          Slice NamemedicationAgreementCode
                          Definition

                          Category SNOMED code used for indexing/retrieval of the HCIM MedicationAgreement. The SNOMED code 16076005 for this resource is stated in the Medication Process v09.

                          ShortMedicationAgreementCode
                          Comments

                          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                          Control0..*
                          TypeCoding
                          Summarytrue
                          Requirements

                          Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                          70. MedicationRequest.category.coding:medicationAgreementCode.id
                          Definition

                          unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                          Shortxml:id (or equivalent in JSON)
                          Control0..1
                          Typestring
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          72. MedicationRequest.category.coding:medicationAgreementCode.extension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                          ShortAdditional Content defined by implementations
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control0..*
                          TypeExtension
                          Alternate Namesextensions, user content
                          SlicingThis element introduces a set of slices on MedicationRequest.category.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 74. MedicationRequest.category.coding:medicationAgreementCode.system
                            Definition

                            The identification of the code system that defines the meaning of the symbol in the code.

                            ShortIdentity of the terminology system
                            Comments

                            The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

                            Control0..1
                            Typeuri
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            Need to be unambiguous about the source of the definition of the symbol.

                            Fixed Valuehttp://snomed.info/sct
                            76. MedicationRequest.category.coding:medicationAgreementCode.version
                            Definition

                            The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                            ShortVersion of the system - if relevant
                            Comments

                            Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                            NoteThis is a business version Id, not a resource version Id (see discussion)
                            Control0..1
                            Typestring
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            78. MedicationRequest.category.coding:medicationAgreementCode.code
                            Definition

                            A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                            ShortSymbol in syntax defined by the system
                            Control0..1
                            Typecode
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            Need to refer to a particular code in the system.

                            Fixed Value16076005
                            80. MedicationRequest.category.coding:medicationAgreementCode.display
                            Definition

                            A representation of the meaning of the code in the system, following the rules of the system.

                            ShortRepresentation defined by the system
                            Control0..1
                            Typestring
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                            Default ValuePrescription (procedure)
                            82. MedicationRequest.category.coding:medicationAgreementCode.userSelected
                            Definition

                            Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

                            ShortIf this coding was chosen directly by the user
                            Comments

                            Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                            Control0..1
                            Typeboolean
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                            84. MedicationRequest.category.text
                            Definition

                            A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                            ShortPlain text representation of the concept
                            Comments

                            Very often the text is the same as a displayName of one of the codings.

                            Control0..1
                            Typestring
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Must Supporttrue
                            Summarytrue
                            Requirements

                            The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                            86. MedicationRequest.priority
                            Definition

                            Indicates how quickly the Medication Request should be addressed with respect to other requests.

                            Shortroutine | urgent | stat | asap
                            Control0..1
                            BindingThe codes SHALL be taken from MedicationRequestPriority
                            (required to http://hl7.org/fhir/ValueSet/medication-request-priority)

                            Identifies the level of importance to be assigned to actioning the request

                            Typecode
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            88. MedicationRequest.medicationReference:medicationReference
                            Slice NamemedicationReference
                            Definition

                            The medicine agreed upon to be used.

                            ShortAgreedMedicine
                            Control1..1
                            TypeReference(Medication)
                            Must Supporttrue
                            Summarytrue
                            Alternate NamesAfgesprokengeneesmiddel
                            90. MedicationRequest.medicationReference:medicationReference.id
                            Definition

                            unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                            Shortxml:id (or equivalent in JSON)
                            Control0..1
                            Typestring
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            XML FormatIn the XML format, this property is represented as an attribute.
                            92. MedicationRequest.medicationReference:medicationReference.extension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                            ShortAdditional Content defined by implementations
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Alternate Namesextensions, user content
                            SlicingThis element introduces a set of slices on MedicationRequest.medicationReference.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 94. MedicationRequest.medicationReference:medicationReference.reference
                              Definition

                              A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                              ShortLiteral reference, Relative, internal or absolute URL
                              Comments

                              Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                              Control0..1
                              This element is affected by the following invariants: ref-1
                              Typestring
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              96. MedicationRequest.medicationReference:medicationReference.identifier
                              Definition

                              An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                              ShortLogical reference, when literal reference is not known
                              Comments

                              When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                              When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                              Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                              NoteThis is a business identifier, not a resource identifier (see discussion)
                              Control0..1
                              TypeIdentifier
                              Summarytrue
                              98. MedicationRequest.medicationReference:medicationReference.display
                              Definition

                              Plain text narrative that identifies the resource in addition to the resource reference.

                              ShortText alternative for the resource
                              Comments

                              This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                              Control0..1
                              Typestring
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              Summarytrue
                              100. MedicationRequest.subject
                              Definition

                              A link to a resource representing the person or set of individuals to whom the medication will be given.

                              ShortWho or group medication request is for
                              Comments

                              The subject on a medication request is mandatory. For the secondary use case where the actual subject is not provided, there still must be an anonymized subject specified.

                              Control1..1
                              TypeReference(nl-core-patient, Group)
                              Summarytrue
                              102. MedicationRequest.context
                              Definition

                              A link to an encounter, or episode of care, that identifies the particular occurrence or set occurrences of contact between patient and health care provider.

                              ShortCreated during encounter/admission/stay
                              Comments

                              It is recommended to use the nl-core-episodeofcare extension to reference nl-core-episodeofcare (EpisodeOfCare) instances rather than the context element, as this approach will be enforced in FHIR R4.

                              Control0..1
                              TypeReference(HCIM Encounter, nl-core-episodeofcare)
                              104. MedicationRequest.supportingInformation
                              Definition

                              Include additional information (for example, patient height and weight) that supports the ordering of the medication.

                              ShortInformation to support ordering of the medication
                              Control0..*
                              TypeReference(Resource)
                              106. MedicationRequest.authoredOn
                              Definition

                              The time at which the agreement was made.

                              Appointment date + time are required (order of the appointments must be clear in cases with multiple appointments on one day)

                              ShortMedicationAgreementDateTime
                              Control1..1
                              TypedateTime
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              Summarytrue
                              Alternate NamesAfspraakdatum
                              108. MedicationRequest.requester
                              Definition

                              The health professional that entered the medication agreement with the patient.

                              ShortPrescriber
                              Comments

                              Note that in FHIR STU3, there is an agent Reference type PractitionerRole missing. PractitionerRole, contrary to Practitioner, allows for specialism and organization. This issue has been fixed in FHIR R4. For FHIR STU3, you can use the practitionerrole-reference extension on requester.agent.

                              Control0..1
                              TypeBackboneElement
                              Summarytrue
                              Alternate NamesVoorschrijver
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                              mps-1: onBehalfOf can only be specified if agent is practitioner or device ((agent.resolve().empty()) or (agent.resolve() is Device) or (agent.resolve() is Practitioner) or onBehalfOf.exists().not())
                              110. MedicationRequest.requester.id
                              Definition

                              unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                              Shortxml:id (or equivalent in JSON)
                              Control0..1
                              Typestring
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              XML FormatIn the XML format, this property is represented as an attribute.
                              112. MedicationRequest.requester.extension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                              ShortAdditional Content defined by implementations
                              Comments

                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                              Control0..*
                              TypeExtension
                              Alternate Namesextensions, user content
                              114. MedicationRequest.requester.modifierExtension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                              ShortExtensions that cannot be ignored
                              Comments

                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                              Control0..*
                              TypeExtension
                              Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                              Summarytrue
                              Alternate Namesextensions, user content, modifiers
                              116. MedicationRequest.requester.agent
                              Definition

                              The healthcare professional responsible for authorizing the initial prescription.

                              ShortWho ordered the initial medication(s)
                              Comments

                              The health professional's speciality, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile.

                              Control1..1
                              TypeReference(nl-core-practitioner, nl-core-organization, nl-core-patient, nl-core-relatedperson, Device)
                              Summarytrue
                              118. MedicationRequest.requester.agent.id
                              Definition

                              unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                              Shortxml:id (or equivalent in JSON)
                              Control0..1
                              Typestring
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              XML FormatIn the XML format, this property is represented as an attribute.
                              120. MedicationRequest.requester.agent.extension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                              ShortAdditional Content defined by implementations
                              Comments

                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                              Control0..*
                              TypeExtension
                              Alternate Namesextensions, user content
                              SlicingThis element introduces a set of slices on MedicationRequest.requester.agent.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 122. MedicationRequest.requester.agent.extension:practitionerRole
                                Slice NamepractitionerRole
                                Definition

                                Optional Extension Element - found in all resources.

                                ShortOptional Extensions Element
                                Comments

                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                Control0..1
                                This element is affected by the following invariants: ele-1
                                TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                                Alternate Namesextensions, user content
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                124. MedicationRequest.requester.agent.reference
                                Definition

                                A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                ShortLiteral reference, Relative, internal or absolute URL
                                Comments

                                Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                Control0..1
                                This element is affected by the following invariants: ref-1
                                Typestring
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summarytrue
                                126. MedicationRequest.requester.agent.identifier
                                Definition

                                An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                ShortLogical reference, when literal reference is not known
                                Comments

                                When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                NoteThis is a business identifier, not a resource identifier (see discussion)
                                Control0..1
                                TypeIdentifier
                                Summarytrue
                                128. MedicationRequest.requester.agent.display
                                Definition

                                Plain text narrative that identifies the resource in addition to the resource reference.

                                ShortText alternative for the resource
                                Comments

                                This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                Control0..1
                                Typestring
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Must Supporttrue
                                Summarytrue
                                130. MedicationRequest.requester.onBehalfOf
                                Definition

                                The organization the device or practitioner was acting on behalf of.

                                ShortOrganization agent is acting for
                                Control0..1
                                This element is affected by the following invariants: mps-1
                                TypeReference(nl-core-organization)
                                Summarytrue
                                Requirements

                                Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when authoring the request.

                                132. MedicationRequest.recorder
                                Definition

                                The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order.

                                ShortPerson who entered the request
                                Control0..1
                                TypeReference(nl-core-practitioner)
                                134. MedicationRequest.recorder.id
                                Definition

                                unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                Shortxml:id (or equivalent in JSON)
                                Control0..1
                                Typestring
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                XML FormatIn the XML format, this property is represented as an attribute.
                                136. MedicationRequest.recorder.extension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                ShortAdditional Content defined by implementations
                                Comments

                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                Control0..*
                                TypeExtension
                                Alternate Namesextensions, user content
                                SlicingThis element introduces a set of slices on MedicationRequest.recorder.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 138. MedicationRequest.recorder.extension:practitionerRole
                                  Slice NamepractitionerRole
                                  Definition

                                  Optional Extension Element - found in all resources.

                                  ShortOptional Extensions Element
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..1
                                  This element is affected by the following invariants: ele-1
                                  TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                                  Alternate Namesextensions, user content
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  140. MedicationRequest.recorder.reference
                                  Definition

                                  A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                  ShortLiteral reference, Relative, internal or absolute URL
                                  Comments

                                  Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                  Control0..1
                                  This element is affected by the following invariants: ref-1
                                  Typestring
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  142. MedicationRequest.recorder.identifier
                                  Definition

                                  An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                  ShortLogical reference, when literal reference is not known
                                  Comments

                                  When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                  When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                  Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                  NoteThis is a business identifier, not a resource identifier (see discussion)
                                  Control0..1
                                  TypeIdentifier
                                  Summarytrue
                                  144. MedicationRequest.recorder.display
                                  Definition

                                  Plain text narrative that identifies the resource in addition to the resource reference.

                                  ShortText alternative for the resource
                                  Comments

                                  This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                  Control0..1
                                  Typestring
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  146. MedicationRequest.reasonCode
                                  Definition

                                  Reason for this agreement. This can be the reason to start, change or stop the medication treatment.

                                  ShortReasonMedicationAgreement
                                  Comments

                                  This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference.

                                  Control0..*
                                  BindingUnless not suitable, these codes SHALL be taken from RedenMedicatieafspraakCodelijst
                                  (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.6.2--20171231000000)

                                  RedenWijzigenOfStakenCodelijst

                                  TypeCodeableConcept
                                  Alternate NamesRedenMedicatieafspraak
                                  148. MedicationRequest.reasonReference
                                  Definition

                                  The medical reason for the prescription or for use of the medication. This can be used to enter a medical indication which was the direct cause for prescription or for use of the medication in question.

                                  It can concern every type of problem (or condition) of the patient, almost all diagnoses, complaints or symptoms.

                                  Please note: The BST401T file of the G standard contains a “special reference” to indicate that “exchange of the reason for prescription is essential”.

                                  ShortPrescriptionReason
                                  Comments

                                  This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode.

                                  Control0..*
                                  TypeReference(Observation, HCIM Problem)
                                  Alternate NamesRedenVanVoorschrijven
                                  150. MedicationRequest.note
                                  Definition

                                  Explanation for the medication agreement.

                                  This explanation can contain e.g. information on why a prescriber makes a medication agreement that deviates from the norm.

                                  ShortComment
                                  Control0..*
                                  TypeAnnotation
                                  Alternate NamesToelichting
                                  152. MedicationRequest.dosageInstruction
                                  Definition

                                  Instructions for the use of the medication, e.g. dose and route of administration

                                  ShortInstructionsForUse
                                  Comments

                                  The wiki page https://informatiestandaarden.nictiz.nl/wiki/mp:V9.0Voorbeeldendoseringen provides dosage instruction examples. These examples consists of functional data and their representation in FHIR and CDA.

                                  Control0..*
                                  This element is affected by the following invariants: ele-1
                                  TypeDosage(HCIM InstructionsForUse)
                                  Alternate NamesGebruiksinstructie
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                  154. MedicationRequest.dosageInstruction.id
                                  Definition

                                  unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                  Shortxml:id (or equivalent in JSON)
                                  Control0..1
                                  Typestring
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  156. MedicationRequest.dosageInstruction.extension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                  ShortAdditional Content defined by implementations
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Alternate Namesextensions, user content
                                  SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 158. MedicationRequest.dosageInstruction.sequence
                                    Definition

                                    This indicates the sequence of the dosing instructions within the medication agreement.

                                    ShortSequenceNumber
                                    Control0..1
                                    Typeinteger
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

                                    If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.

                                    Alternate NamesVolgnummer
                                    160. MedicationRequest.dosageInstruction.text
                                    Definition

                                    Textual description of the complete instructions for use including the period of use.

                                    ShortDescription
                                    Control0..1
                                    Typestring
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supporttrue
                                    Summarytrue
                                    Requirements

                                    Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing.

                                    Alternate NamesOmschrijving
                                    162. MedicationRequest.dosageInstruction.additionalInstruction
                                    Definition

                                    The additional instructions contain extra information on the use of or considerations for the current prescription. This can also include all instructions for use. The text can come from the original 'paper' medication prescription, but can also be generated from the coded information. This concept may contain more information than what is structurally coded in the information below, but may not conflict with it. The instructions may not conflict with other components of the request for administration. The instructions can also refer to an existing protocol. The G standard contains many texts that can support this attribute, in for example G standard table 362, which contains texts from the general practitioners’ standard WCIA table 25. If desired, these texts can be used to structure this concept.

                                    ShortAdditionalInstructions
                                    Control0..*
                                    BindingUnless not suitable, these codes SHALL be taken from Aanvullende gebruiksinstructie
                                    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.9--20160407000000)
                                    TypeCodeableConcept
                                    Summarytrue
                                    Requirements

                                    Additional instruction such as "Swallow with plenty of water" which may or may not be coded.

                                    Alternate NamesAanvullendeInstructie
                                    164. MedicationRequest.dosageInstruction.patientInstruction
                                    Definition

                                    Instructions in terms that are understood by the patient or consumer.

                                    ShortPatient or consumer oriented instructions
                                    Control0..1
                                    Typestring
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    166. MedicationRequest.dosageInstruction.timing
                                    Definition

                                    Specifications of the times at which the medication is to be administered. This is indicated as follows: Time(s) (16:00) or indications (“before meals”) at which the medication is to be taken each day. A specific number of times the medication is to be taken each day (“3x a day“), indicated with the frequency A time interval between consecutive doses (“Every 2 hours”, “every 3 days”), indicated with the word Interval. Combined periods with an interval and duration (“1 daily for three out of four weeks: the pill schedule”) If a certain medication is not to be taken daily, the aforementioned can be combined with daily indications: One or more week days on which the medication is to be administered (e.g. “Monday, Wednesday, Friday”) ”3x a week”, “2x a month”. The specified administration “infinite” is automatically to be repeated until: The end date and time has been reached The total administration duration has been reached (14 days) A specific amount of administrations has been reached (“20 doses”, “one-time only”), to be entered in the NumberOfDoses concept.

                                    ShortWhen medication should be administered
                                    Comments

                                    This attribute may not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.

                                    Control0..1
                                    TypeTiming(HCIM AdministrationSchedule)
                                    Summarytrue
                                    Requirements

                                    The timing schedule for giving the medication to the patient. The Schedule data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

                                    168. MedicationRequest.dosageInstruction.asNeeded[x]
                                    Definition

                                    Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).

                                    ShortTake "as needed" (for x)
                                    Comments

                                    Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".

                                    Control0..1
                                    BindingFor example codes, see SNOMED CT Medication As Needed Reason Codes
                                    (example to http://hl7.org/fhir/ValueSet/medication-as-needed-reason|3.0.2)

                                    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.

                                    TypeCodeableConcept
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Summarytrue
                                    SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.asNeeded[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                    • type @ $this
                                    • 170. MedicationRequest.dosageInstruction.asNeeded[x]:asNeededCodeableConcept
                                      Slice NameasNeededCodeableConcept
                                      Definition

                                      As needed means that the dose is only to be administered under certain conditions.

                                      ShortAsNeeded
                                      Comments

                                      Using the term 'as needed' or a specific reason (eg 'in case of pain') to use medication leads to ambiguity. It is not always clear whether the whole dose is 'as needed' or only part of the dose. For example: 1x daily 1-2 tablets as needed. This can mean: 1 tablet fixed per day and 1 tablet as needed or, as needed, a maximum of 2 tablets.As needed medication is not included in GDS. In the first situation, 1 tablet comes in the GDS (drug dispensing systems) and 1 tablet is delivered separately. In the second situation there is only separate delivery.The system must make sufficiently clear whether the entire instruction or part of the dose is necessary. The HCIM supports both options described above.

                                      Control0..1
                                      BindingUnless not suitable, these codes SHALL be taken from ZonodigCriteriumCodelijst
                                      (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.12.4--20171231000000)

                                      ZonodigCriteriumCodelijst

                                      TypeCodeableConcept
                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                      Summarytrue
                                      Alternate NamesZo nodig, Criterium
                                      172. MedicationRequest.dosageInstruction.site
                                      Definition

                                      Body site to administer to.

                                      ShortBody site to administer to
                                      Comments

                                      If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension body-site-instance. May be a summary code, or a reference to a very precise definition of the location, or both.

                                      Control0..1
                                      BindingFor example codes, see SNOMED CT Anatomical Structure for Administration Site Codes
                                      (example to http://hl7.org/fhir/ValueSet/approach-site-codes|3.0.2)

                                      A coded concept describing the site location the medicine enters into or onto the body.

                                      TypeCodeableConcept
                                      Summarytrue
                                      Requirements

                                      A coded specification of the anatomic site where the medication first enters the body.

                                      174. MedicationRequest.dosageInstruction.route
                                      Definition

                                      The route through which the medication is administered (oral, nasal, intravenous, etc.)

                                      ShortRouteOfAdministration
                                      Control0..1
                                      BindingUnless not suitable, these codes SHALL be taken from MedicatieToedieningswegCodelijst
                                      (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.12.1--20171231000000)

                                      ToedieningswegCodelijst

                                      TypeCodeableConcept
                                      Summarytrue
                                      Requirements

                                      A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

                                      Alternate NamesToedieningsweg
                                      ExampleExample of RouteOfAdministration: { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.4.9", "code" : "oraal", "display" : "Oraal" }] }
                                      176. MedicationRequest.dosageInstruction.route.id
                                      Definition

                                      unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                      Shortxml:id (or equivalent in JSON)
                                      Control0..1
                                      Typestring
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      178. MedicationRequest.dosageInstruction.route.extension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                      ShortAdditional Content defined by implementations
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Alternate Namesextensions, user content
                                      SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.route.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                      • value @ url
                                      • 180. MedicationRequest.dosageInstruction.route.coding
                                        Definition

                                        A reference to a code defined by a terminology system.

                                        ShortCode defined by a terminology system
                                        Comments

                                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                        Control0..*
                                        TypeCoding
                                        Summarytrue
                                        Requirements

                                        Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                        182. MedicationRequest.dosageInstruction.route.text
                                        Definition

                                        A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                        ShortPlain text representation of the concept
                                        Comments

                                        Very often the text is the same as a displayName of one of the codings.

                                        Control0..1
                                        Typestring
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Must Supporttrue
                                        Summarytrue
                                        Requirements

                                        The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                        184. MedicationRequest.dosageInstruction.method
                                        Definition

                                        Technique for administering medication.

                                        ShortTechnique for administering medication
                                        Comments

                                        Terminologies used often pre-coordinate this term with the route and or form of administration.

                                        Control0..1
                                        BindingFor example codes, see SNOMED CT Administration Method Codes
                                        (example to http://hl7.org/fhir/ValueSet/administration-method-codes|3.0.2)

                                        A coded concept describing the technique by which the medicine is administered.

                                        TypeCodeableConcept
                                        Summarytrue
                                        Requirements

                                        A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.

                                        186. MedicationRequest.dosageInstruction.dose[x]
                                        Definition

                                        The dose indicates the dose amount per administration.

                                        The dosage is described in the unit accompanying the product; usually, this is just a number of units or doses. Liquids and other divisible products will usually include a unit of volume (preferably ""ml"").

                                        In many cases, the prescriber will want to indicate the dose in units of weight of the active ingredient.

                                        If only the ingredient is included and not the product, then the amount of that ingredient will be given. Paracetamol 1000mg is equivalent to 2 Paracetamol 500mg tablets or units.

                                        The dosage is sometimes given as a calculation, in which the patient’s body weight or body surface area is used as a parameter. The calculation is however no more than an aid in reaching a decision.

                                        In the event of constant administration, sometimes the dose is given in addition to the administration speed (infusion rate) (e.g. 20ml in a syringe or 500ml in a bag), but it is often also omitted.

                                        A general dosage recommendation such as ‘Use according to protocol’ or ‘See instructions’ can be sufficient. In that case, no dose is given.

                                        ShortDose
                                        Comments

                                        Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

                                        Control0..1
                                        TypeChoice of: Range, Quantity(SimpleQuantity)
                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                        Summarytrue
                                        Requirements

                                        The amount of therapeutic or other substance given at one administration event.

                                        Alternate NamesKeerdosis
                                        SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.dose[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                        • type @ $this
                                        • 188. MedicationRequest.dosageInstruction.dose[x]:doseQuantity
                                          Slice NamedoseQuantity
                                          Definition

                                          Amount of medication per dose.

                                          ShortAmount of medication per dose
                                          Comments

                                          Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

                                          Control0..1
                                          BindingThe codes SHALL be taken from G-Standaard Eenhedentabel
                                          (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

                                          GstdTabel902

                                          TypeQuantity(SimpleQuantity)
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          Summarytrue
                                          Requirements

                                          The amount of therapeutic or other substance given at one administration event.

                                          190. MedicationRequest.dosageInstruction.dose[x]:doseRange
                                          Slice NamedoseRange
                                          Definition

                                          Amount of medication per dose.

                                          ShortAmount of medication per dose
                                          Comments

                                          Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

                                          Control0..1
                                          TypeRange
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          Summarytrue
                                          Requirements

                                          The amount of therapeutic or other substance given at one administration event.

                                          192. MedicationRequest.dosageInstruction.dose[x]:doseRange.id
                                          Definition

                                          unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                          Shortxml:id (or equivalent in JSON)
                                          Control0..1
                                          Typestring
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          194. MedicationRequest.dosageInstruction.dose[x]:doseRange.extension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                          ShortAdditional Content defined by implementations
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Alternate Namesextensions, user content
                                          SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.dose[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 196. MedicationRequest.dosageInstruction.dose[x]:doseRange.low
                                            Definition

                                            The low limit. The boundary is inclusive.

                                            ShortLow limit
                                            Comments

                                            If the low element is missing, the low boundary is not known.

                                            Control0..1
                                            This element is affected by the following invariants: rng-2
                                            BindingThe codes SHALL be taken from G-Standaard Eenhedentabel
                                            (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

                                            GstdTabel902

                                            TypeQuantity(SimpleQuantity)
                                            Summarytrue
                                            198. MedicationRequest.dosageInstruction.dose[x]:doseRange.high
                                            Definition

                                            The high limit. The boundary is inclusive.

                                            ShortHigh limit
                                            Comments

                                            If the high element is missing, the high boundary is not known.

                                            Control0..1
                                            This element is affected by the following invariants: rng-2
                                            BindingThe codes SHALL be taken from G-Standaard Eenhedentabel
                                            (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

                                            GstdTabel902

                                            TypeQuantity(SimpleQuantity)
                                            Summarytrue
                                            200. MedicationRequest.dosageInstruction.maxDosePerPeriod
                                            Definition

                                            A maximum dose indicates the maximum duration a product can be used with an ‘as needed’ prescription.

                                            For example: - Max 6 units per day - Max 200ml per week

                                            ShortMaximumDose
                                            Comments

                                            This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

                                            Control0..1
                                            TypeRatio
                                            Summarytrue
                                            Requirements

                                            The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.

                                            Alternate NamesMaximale dosering, Maximale dosis (per dag enz.)
                                            202. MedicationRequest.dosageInstruction.maxDosePerPeriod.id
                                            Definition

                                            unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                            Shortxml:id (or equivalent in JSON)
                                            Control0..1
                                            Typestring
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            204. MedicationRequest.dosageInstruction.maxDosePerPeriod.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                            ShortAdditional Content defined by implementations
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Alternate Namesextensions, user content
                                            SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.maxDosePerPeriod.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                            • value @ url
                                            • 206. MedicationRequest.dosageInstruction.maxDosePerPeriod.numerator
                                              Definition

                                              The value of the numerator.

                                              ShortNumerator value
                                              Control0..1
                                              BindingThe codes SHALL be taken from G-Standaard Eenhedentabel
                                              (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

                                              GstdTabel902

                                              TypeQuantity
                                              Summarytrue
                                              208. MedicationRequest.dosageInstruction.maxDosePerPeriod.denominator
                                              Definition

                                              The value of the denominator.

                                              ShortDenominator value
                                              Control0..1
                                              TypeQuantity
                                              Summarytrue
                                              210. MedicationRequest.dosageInstruction.maxDosePerAdministration
                                              Definition

                                              Upper limit on medication per administration.

                                              ShortUpper limit on medication per administration
                                              Comments

                                              This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.

                                              Control0..1
                                              TypeQuantity(SimpleQuantity)
                                              Summarytrue
                                              Requirements

                                              The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.

                                              212. MedicationRequest.dosageInstruction.maxDosePerLifetime
                                              Definition

                                              Upper limit on medication per lifetime of the patient.

                                              ShortUpper limit on medication per lifetime of the patient
                                              Control0..1
                                              TypeQuantity(SimpleQuantity)
                                              Summarytrue
                                              Requirements

                                              The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.

                                              214. MedicationRequest.dosageInstruction.rate[x]
                                              Definition

                                              The administering speed is used in slow administration of liquid. In practice, the measuring unit is almost always ml/hour. Entering an interval (such as 0-10 ml/hour) is also a commonly used option. For example, with an administering speed of 10ml/hour: amount = 10, dose unit = ml time unit = hour

                                              ShortAdministeringSpeed
                                              Comments

                                              It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.

                                              Control0..1
                                              TypeChoice of: Ratio, Range, Quantity(SimpleQuantity)
                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                              Summarytrue
                                              Requirements

                                              Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

                                              Alternate NamesToedieningssnelheid, Inloopsnelheid
                                              216. MedicationRequest.dispenseRequest
                                              Definition

                                              Indicates the specific details for the dispense or medication supply part of a medication request (also known as a Medication Prescription or Medication Order). Note that this information is not always sent with the order. There may be in some settings (e.g. hospitals) institutional or system support for completing the dispense details in the pharmacy department.

                                              ShortMedication supply authorization
                                              Control0..1
                                              TypeBackboneElement
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                              218. MedicationRequest.dispenseRequest.id
                                              Definition

                                              unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                              Shortxml:id (or equivalent in JSON)
                                              Control0..1
                                              Typestring
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              220. MedicationRequest.dispenseRequest.extension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                              ShortAdditional Content defined by implementations
                                              Comments

                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                              Control0..*
                                              TypeExtension
                                              Alternate Namesextensions, user content
                                              222. MedicationRequest.dispenseRequest.modifierExtension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                              ShortExtensions that cannot be ignored
                                              Comments

                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                              Control0..*
                                              TypeExtension
                                              Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                              Summarytrue
                                              Alternate Namesextensions, user content, modifiers
                                              224. MedicationRequest.dispenseRequest.validityPeriod
                                              Definition

                                              This indicates the validity period of a prescription (stale dating the Prescription).

                                              ShortTime period supply is authorized for
                                              Comments

                                              It reflects the prescribers' perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations.

                                              Control0..1
                                              TypePeriod
                                              Requirements

                                              Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.

                                              226. MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
                                              Definition

                                              An integer indicating the number of times, in addition to the original dispense, (aka refills or repeats) that the patient can receive the prescribed medication. Usage Notes: This integer does not include the original order dispense. This means that if an order indicates dispense 30 tablets plus "3 repeats", then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets.

                                              ShortNumber of refills authorized
                                              Comments

                                              If displaying "number of authorized fills", add 1 to this number.

                                              Control0..1
                                              TypepositiveInt
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              228. MedicationRequest.dispenseRequest.quantity
                                              Definition

                                              The amount that is to be dispensed for one fill.

                                              ShortAmount of medication to supply per dispense
                                              Control0..1
                                              TypeQuantity(SimpleQuantity)
                                              230. MedicationRequest.dispenseRequest.expectedSupplyDuration
                                              Definition

                                              Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last.

                                              ShortNumber of days supply per dispense
                                              Comments

                                              In some situations, this attribute may be used instead of quantity to identify the amount supplied by how long it is expected to last, rather than the physical quantity issued, e.g. 90 days supply of medication (based on an ordered dosage) When possible, it is always better to specify quantity, as this tends to be more precise. expectedSupplyDuration will always be an estimate that can be influenced by external factors.

                                              Control0..1
                                              TypeDuration
                                              232. MedicationRequest.dispenseRequest.performer
                                              Definition

                                              Indicates the intended dispensing Organization specified by the prescriber.

                                              ShortIntended dispenser
                                              Control0..1
                                              TypeReference(Organization)
                                              234. MedicationRequest.substitution
                                              Definition

                                              Indicates whether or not substitution can or should be part of the dispense. In some cases substitution must happen, in other cases substitution must not happen. This block explains the prescriber's intent. If nothing is specified substitution may be done.

                                              ShortAny restrictions on medication substitution
                                              Control0..1
                                              TypeBackboneElement
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                              236. MedicationRequest.substitution.id
                                              Definition

                                              unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                              Shortxml:id (or equivalent in JSON)
                                              Control0..1
                                              Typestring
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              238. MedicationRequest.substitution.extension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                              ShortAdditional Content defined by implementations
                                              Comments

                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                              Control0..*
                                              TypeExtension
                                              Alternate Namesextensions, user content
                                              240. MedicationRequest.substitution.modifierExtension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                              ShortExtensions that cannot be ignored
                                              Comments

                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                              Control0..*
                                              TypeExtension
                                              Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                              Summarytrue
                                              Alternate Namesextensions, user content, modifiers
                                              242. MedicationRequest.substitution.allowed
                                              Definition

                                              True if the prescriber allows a different drug to be dispensed from what was prescribed.

                                              ShortWhether substitution is allowed or not
                                              Comments

                                              This element is labeled as a modifer because whether substitution is allow or not cannot be ignored.

                                              Control1..1
                                              Typeboolean
                                              Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              244. MedicationRequest.substitution.reason
                                              Definition

                                              Indicates the reason for the substitution, or why substitution must or must not be performed.

                                              ShortWhy should (not) substitution be made
                                              Control0..1
                                              BindingFor example codes, see SubstanceAdminSubstitutionReason
                                              (example to http://hl7.org/fhir/ValueSet/v3-SubstanceAdminSubstitutionReason)

                                              A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.

                                              TypeCodeableConcept
                                              246. MedicationRequest.priorPrescription
                                              Definition

                                              A link to a resource representing an earlier order related order or prescription.

                                              ShortAn order/prescription that is being replaced
                                              Control0..1
                                              TypeReference(MedicationRequest)
                                              248. MedicationRequest.detectedIssue
                                              Definition

                                              Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etc.

                                              ShortClinical Issue with action
                                              Control0..*
                                              TypeReference(DetectedIssue)
                                              Alternate NamesContraindication, Drug Utilization Review (DUR), Alert
                                              250. MedicationRequest.eventHistory
                                              Definition

                                              Links to Provenance records for past versions of this resource or fulfilling request or event resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resource.

                                              ShortA list of events of interest in the lifecycle
                                              Comments

                                              This may not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).

                                              Control0..*
                                              TypeReference(Provenance)