RIVO-Noord Zorgviewer Implementation Guide
1.22.0 - CI build

RIVO-Noord Zorgviewer Implementation Guide, published by RIVO-NN HL7NL. This guide is not an authorized publication; it is the continuous build for version 1.22.0 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: MedicationUse - Detailed Descriptions

Active as of 2026-01-12

Definitions for the MedicationStatement resource profile.

- Key Elements Table
- Differential Elements Table
- Snapshot Elements Table

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

0. MedicationStatement
Definition | MedicationUse is a statement on the historic, current or intended use of a certain medicine. This is the base resource type for everything.
Short | MedicationUseBase Resource
Comments | When interpreting a medicationStatement, the value of the status and NotTaken needed to be considered: MedicationStatement.status + MedicationStatement.wasNotTaken Status=Active + NotTaken=T = Not currently taking Status=Completed + NotTaken=T = Not taken in the past Status=Intended + NotTaken=T = No intention of taking Status=Active + NotTaken=F = Taking, but not as prescribed Status=Active + NotTaken=F = Taking Status=Intended +NotTaken= F = Will be taking (not started) Status=Completed + NotTaken=F = Taken in past Status=In Error + NotTaken=N/A = In Error.
Control | 0..*
Alternate Names | Medicatiegebruik
Invariants | dom-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()`) mst-1: Reason not taken is only permitted if Taken is No (`reasonNotTaken.exists().not() or (taken = 'n')`)
2. MedicationStatement.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.
Short | A 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.
Control | 0..1
Type | uri
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
4. MedicationStatement.extension:asAgreedIndicator
Slice Name | asAgreedIndicator
Definition | Is the medicine used as outlined in the medication agreement?
Short | AsAgreedIndicator
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.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(HCIM As AgreedIndicator) (Extension Type: boolean)
Alternate Names | extensions, user content, VolgensAfspraakIndicator
Invariants | ele-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. MedicationStatement.extension:asAgreedIndicator.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.
Short | Additional 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.
Control | 0..0*
Type | Extension
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `MedicationStatement.extension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
8. MedicationStatement.extension:asAgreedIndicator.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies 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.
Control | 1..1
Type | uri
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
Fixed Value | `http://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-AsAgreedIndicator`
10. MedicationStatement.extension:asAgreedIndicator.value[x]:valueBoolean
Slice Name | valueBoolean
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).
Short | Value of extension
Control | 0..1
Type | boolean, 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, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Example | Example of asAgreed: true
12. MedicationStatement.extension:prescriber
Slice Name | prescriber
Definition | The healthcare professional responsible for authorizing the initial prescription.
Short | Who ordered the initial medication(s)
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(HCIM MedicationUse Prescriber) (Extension Type: Reference)
Must Support | true
Invariants | ele-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()`)
14. MedicationStatement.extension:author
Slice Name | author
Definition | The author of this MedicationStatement. This is either a patient, a health professional or a healthcare provicer.
Short | Author
Comments | The health professional's specialty, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(HCIM MedicationUse Author) (Extension Type: Reference)
Alternate Names | extensions, user content, Auteur
Invariants | ele-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()`)
16. MedicationStatement.extension:medicationTreatment
Slice Name | medicationTreatment
Definition | This extension is to describe which overarching medical treatment this information is part of. This is done by the use of an identifier of that medical treatment.
Short | Medical Treatment
Comments | No HCIM concept is available for this element. Therefore a mapping to the relevant element Medication Process data element is provided.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(HCIM MedicationTreatment) (Extension Type: Identifier)
Alternate Names | extensions, user content, Medicamenteuze Behandeling
Invariants | ele-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. MedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse
Slice Name | reasonForChangeOrDiscontinuationOfUse
Definition | Reason for changing or discontinuing use of medication.
Short | ReasonForChangeOrDiscontinuationOfUse
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.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Extension(HCIM MedicationUse ReasonForChangeOrDiscontinuationOfUse) (Extension Type: CodeableConcept)
Alternate Names | extensions, user content, RedenWijzigenOfStoppenGebruik, Reden wijzigen of stoppen gebruik
Invariants | ele-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. MedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.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.
Short | Additional 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.
Control | 0..0*
Type | Extension
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `MedicationStatement.extension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
22. MedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies 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.
Control | 1..1
Type | uri
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
Fixed Value | `http://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-ReasonForChangeOrDiscontinuationOfUse`
24. MedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.value[x]:valueCodeableConcept
Slice Name | valueCodeableConcept
Definition | Reason for changing or discontinuing use of medication. Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).
Short | ReasonForChangeOrDiscontinuationOfUseValue of extension
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from For codes, see RedenWijzigenOfStoppenGebruikCodelijst (extensible to `http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.11.2--20171231000000` ) ReasonForChangeOrDiscontinuationOfUseCodeList
Type | CodeableConcept, 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] Note | SeeChoice of Data Typesfor further information about how to use [x]
Alternate Names | Reden wijzigen of stoppen gebruik
Example | Example of ReasonForChangeOrDiscontinuationOfUse: { "coding" : [{ "system" : "http://snomed.info/sct", "code" : "79899007", "display" : "Drug interaction (finding)" }] }
26. MedicationStatement.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.
Short | Extensions 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.
Control | 0..*
Type | Extension
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `MedicationStatement.modifierExtension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
28. MedicationStatement.modifierExtension:repeatPeriodCyclicalSchedule
Slice Name | repeatPeriodCyclicalSchedule
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
Short | RepeatPeriodCyclicalSchedule
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.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(HCIM Medication RepeatPeriodCyclicalSchedule) (Extension Type: Duration)
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Label | HerhaalperiodeCyclischSchema
Alternate Names | extensions, user content
Invariants | ele-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()`)
30. MedicationStatement.status
Definition | A code representing the patient or other source's judgment about the state of the medication used that this statement is about. Generally this will be active or completed.
Short | MedicationUseStopTypeactive | completed | entered-in-error | intended | stopped | on-hold
Comments | MedicationStatement is a statement at a point in time. The status is only representative at the point when it was asserted. The value set for MedicationStatement.status contains codes that assert the status of the use of the medication by the patient (for example, stopped or on hold) as well as codes that assert the status of the medication statement itself (for example, entered in error). This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. This element is also used for the concept 'Stop type'; the manner in which this medication is discontinued (temporary or definitive). MedicationStatement is a statement at a point in time. The status is only representative at the point when it was asserted. The value set for MedicationStatement.status contains codes that assert the status of the use of the medication by the patient (for example, stopped or on hold) as well as codes that assert the status of the medication statement itself (for example, entered in error). This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Control | 1..1
Binding | The codes SHALL be taken from MedicationStatementStatus http://hl7.org/fhir/ValueSet/medication-statement-status|3.0.2 (required to `http://hl7.org/fhir/ValueSet/medication-statement-status` ) Allergy Intolerance critically Code list A coded concept indicating the current status of a MedicationStatement.
Type | code
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Alternate Names | MedicatieGebruikStopType
32. MedicationStatement.category
Definition | Indicates where type of medication statement and where the medication is expected to be consumed or administered.
Short | Type of medication usage
Control | 10..1
Binding | The codes SHOULD be taken from MedicationStatementCategory http://hl7.org/fhir/ValueSet/medication-statement-category|3.0.2 (preferred to `http://hl7.org/fhir/ValueSet/medication-statement-category` ) A coded concept identifying where the medication included in the medicationstatement is expected to be consumed or administered
Type | CodeableConcept
Summary | true
34. MedicationStatement.category.coding
Definition | A reference to a code defined by a terminology system.
Short | Code 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.
Control | 0..*
Type | Coding
Summary | true
Requirements | Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.
Slicing | This element introduces a set of slices on `MedicationStatement.category.coding`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ code
36. MedicationStatement.category.coding:medicationUseCode
Slice Name | medicationUseCode
Definition | Category code used for indexing/retrieval of the HCIM MedicationUse. The system and code are stated in the Medication Process v09. A reference to a code defined by a terminology system.
Short | MedicationUseCodeCode 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.
Control | 0..*
Type | Coding
Summary | true
Requirements | Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.
38. MedicationStatement.category.coding:medicationUseCode.system
Definition | The identification of the code system that defines the meaning of the symbol in the code.
Short | Identity 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.
Control | 0..1
Type | uri
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Need to be unambiguous about the source of the definition of the symbol.
Fixed Value | `urn:oid:2.16.840.1.113883.2.4.3.11.60.20.77.5.3`
40. MedicationStatement.category.coding:medicationUseCode.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).
Short | Symbol in syntax defined by the system
Control | 0..1
Type | code
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Need to refer to a particular code in the system.
Fixed Value | `6`
42. MedicationStatement.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.
Short | Plain text representation of the concept
Comments | Very often the text is the same as a displayName of one of the codings.
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
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.
44. MedicationStatement.medicationReference:medicationReference
Slice Name | medicationReference
Definition | Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.
Short | ProductUsedWhat medication was 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, then you must reference the Medication resource. .
Control | 1..1
Type | Reference(Medication, Medication), CodeableConcept
Must Support | true
Summary | true
Alternate Names | Gebruiksproduct
46. MedicationStatement.medicationReference:medicationReference.display
Definition | Plain text narrative that identifies the resource in addition to the resource reference.
Short | Text 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.
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
48. MedicationStatement.effectivePeriod:effectivePeriod
Slice Name | effectivePeriod
Definition | Medication use can be recorded for a certain moment or over a certain period. Thus, medication use can be recorded multiple times during the use of medication. The usage period is the period or moment over which the data is recorded. Start date: This is the time at which the agreement was to take effect (or took effect or will take effect). 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. End date: The time at which the period of use ends (or ended or will end). To avoid confusion between 'to' and 'up to', the submission of time is always mandatory for the end date. The interval of time during which it is being asserted that the patient was taking the medication (or was not taking, when the wasNotGiven element is true).
Short | PeriodOfUseThe date/time or interval when the medication was taken
Comments | This attribute reflects the period over which the patient consumed the medication and is expected to be populated on the majority of Medication Statements. If the medication is still being taken at the time the statement is recorded, the "end" date will be omitted.
Control | 0..1
Type | Period, dateTime
Must Support | true
Summary | true
Alternate Names | Gebruiksperiode
50. MedicationStatement.effectivePeriod:effectivePeriod.extension:Duration
Slice Name | Duration
Definition | 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.
Short | Duration
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.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(HCIM MedicationUse Duration) (Extension Type: Duration)
Alternate Names | extensions, user content, tijdsDuur
Invariants | ele-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()`)
52. MedicationStatement.effectivePeriod:effectivePeriod.extension:Duration.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.
Short | Additional 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.
Control | 0..0*
Type | Extension
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `MedicationStatement.effectivePeriod.extension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
54. MedicationStatement.effectivePeriod:effectivePeriod.extension:Duration.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies 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.
Control | 1..1
Type | uri
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
Fixed Value | `http://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-Duration`
56. MedicationStatement.effectivePeriod:effectivePeriod.extension:Duration.value[x]:valueDuration
Slice Name | valueDuration
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).
Short | UsageDurationValue of extension
Control | 0..1
Type | Duration, 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, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Alternate Names | Gebruiksduur
Example | Example of Duration: { "value" : 3, "unit" : "day", "system" : "http://unitsofmeasure.org", "code" : "d" }
58. MedicationStatement.effectivePeriod:effectivePeriod.start
Definition | This is the time at which the agreement was to take effect (or took effect or will take effect). The start of the period. The boundary is inclusive.
Short | StartDateStarting time with inclusive boundary
Comments | If the low element is missing, the meaning is that the low boundary is not known.
Control | 0..1 This element is affected by the following invariants: per-1
Type | dateTime
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Alternate Names | Ingangsdatum
60. MedicationStatement.effectivePeriod:effectivePeriod.end
Definition | The time at which the period of use ends (or ended or will end). To avoid confusion between 'to' and 'up to', the submission of time is always mandatory for the end date. The end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
Short | EndDateEnd time with inclusive boundary, if not ongoing
Comments | The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.
Control | 0..1 This element is affected by the following invariants: per-1
Type | dateTime
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Alternate Names | Einddatum
Meaning if Missing | If the end of the period is missing, it means that the period is ongoing
62. MedicationStatement.dateAsserted
Definition | Date on which this use is entered. The date when the medication statement was asserted by the information source.
Short | MedicationUseDateTimeWhen the statement was asserted?
Control | 10..1
Type | dateTime
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Alternate Names | Registratiedatum
Example | Example of MedicationUseDateTime: 2017-06-14
64. MedicationStatement.subject
Definition | The person, animal or group who is/was taking the medication.
Short | Who is/was taking the medication
Control | 1..1
Type | Reference(nl-core-patient, Patient, Group)
Summary | true
66. MedicationStatement.taken
Definition | Is this medicine used or not? Indicator of the certainty of whether the medication was taken by the patient.
Short | UseIndicatory | n | unk | na
Comments | This element is labeled as a modifier because it indicates that the medication was not taken.
Control | 1..1
Binding | The codes SHALL be taken from MedicationStatementTaken http://hl7.org/fhir/ValueSet/medication-statement-taken|3.0.2 (required to `http://hl7.org/fhir/ValueSet/medication-statement-taken` ) A coded concept identifying level of certainty if patient has taken or has not taken the medication
Type | code
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Alternate Names | GebruikIndicator
Example | Example of taken: y
68. MedicationStatement.dosage
Definition | Instructions for the use of the medication, e.g. dose and route of administration. In the event of medication use, this is the pattern of use established by the patient or which the patient followed Indicates how the medication is/was or should be taken by the patient.
Short | InstructionsForUseDetails of how medication is/was taken or 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. The dates included in the dosage on a Medication Statement reflect the dates for a given dose. For example, "from November 1, 2016 to November 3, 2016, take one tablet daily and from November 4, 2016 to November 7, 2016, take two tablets daily." It is expected that this specificity may only be populated where the patient brings in their labeled container or where the Medication Statement is derived from a MedicationRequest.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Dosage(HCIM InstructionsForUse)
Alternate Names | Gebruiksinstructie
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() | (children().count() > id.count())`)
70. MedicationStatement.dosage.text
Definition | Textual description of the complete instructions for use including the period of use. Free text dosage instructions e.g. SIG.
Short | DescriptionFree text dosage instructions e.g. SIG
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
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 Names | Omschrijving
72. MedicationStatement.dosage.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).
Short | Take "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".
Control | 0..1
Binding | For example codes, see SNOMED CT Medication As Needed Reason Codes http://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.
Type | CodeableConcept, boolean
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Summary | true
Slicing | This element introduces a set of slices on `MedicationStatement.dosage.asNeeded[x]`. The slices areUnordered and Closed, and can be differentiated using the following discriminators: type @ $this
74. MedicationStatement.dosage.asNeeded[x]:asNeededCodeableConcept
Slice Name | asNeededCodeableConcept
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).
Short | AsNeededTake "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".
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from For example codes, see ZonodigCriteriumCodelijst http://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.
Type | CodeableConcept, boolean
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Summary | true
Alternate Names | Zo nodig, Criterium
76. MedicationStatement.dosage.route
Definition | The route through which the medication is administered (oral, nasal, intravenous, etc.) How drug should enter body.
Short | RouteOfAdministrationHow drug should enter body
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from For example codes, see MedicatieToedieningswegCodelijst http://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.
Type | CodeableConcept
Summary | true
Requirements | A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.
Alternate Names | Toedieningsweg
Example | Example of RouteOfAdministration: { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.4.9", "code" : "oraal", "display" : "Oraal" }] }
78. MedicationStatement.dosage.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.
Short | Plain text representation of the concept
Comments | Very often the text is the same as a displayName of one of the codings.
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
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.
80. MedicationStatement.dosage.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.
Short | DoseAmount 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.
Control | 0..1
Type | Choice of: Range, Quantity(SimpleQuantity)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Summary | true
Requirements | The amount of therapeutic or other substance given at one administration event.
Alternate Names | Keerdosis
Slicing | This element introduces a set of slices on `MedicationStatement.dosage.dose[x]`. The slices areUnordered and Closed, and can be differentiated using the following discriminators: type @ $this
82. MedicationStatement.dosage.dose[x]:doseQuantity
Slice Name | doseQuantity
Definition | Amount of medication per dose.
Short | Amount 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.
Control | 0..1
Binding | The 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
Type | Quantity(SimpleQuantity), Range
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Summary | true
Requirements | The amount of therapeutic or other substance given at one administration event.
84. MedicationStatement.dosage.dose[x]:doseRange
Slice Name | doseRange
Definition | Amount of medication per dose.
Short | Amount 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.
Control | 0..1
Type | Range, Quantity(SimpleQuantity)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Summary | true
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. MedicationStatement
2. MedicationStatement.extension:prescriber
Slice Name | prescriber
Must Support | true
4. MedicationStatement.category
6. MedicationStatement.category.text
Must Support | true
8. MedicationStatement.medicationReference
Type | Reference(Medication)
Must Support | true
10. MedicationStatement.medicationReference.display
Must Support | true
12. MedicationStatement.effectivePeriod
Must Support | true
14. MedicationStatement.effectivePeriod.start
Must Support | true
16. MedicationStatement.effectivePeriod.end
Must Support | true
18. MedicationStatement.dateAsserted
Must Support | true
20. MedicationStatement.dosage
22. MedicationStatement.dosage.text
Must Support | true
24. MedicationStatement.dosage.route
26. MedicationStatement.dosage.route.text
Must Support | true

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

0. MedicationStatement
Definition | MedicationUse is a statement on the historic, current or intended use of a certain medicine.
Short | MedicationUse
Comments | When interpreting a medicationStatement, the value of the status and NotTaken needed to be considered: MedicationStatement.status + MedicationStatement.wasNotTaken Status=Active + NotTaken=T = Not currently taking Status=Completed + NotTaken=T = Not taken in the past Status=Intended + NotTaken=T = No intention of taking Status=Active + NotTaken=F = Taking, but not as prescribed Status=Active + NotTaken=F = Taking Status=Intended +NotTaken= F = Will be taking (not started) Status=Completed + NotTaken=F = Taken in past Status=In Error + NotTaken=N/A = In Error.
Control | 0..*
Alternate Names | Medicatiegebruik
Invariants | dom-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()`) mst-1: Reason not taken is only permitted if Taken is No (`reasonNotTaken.exists().not() or (taken = 'n')`)
2. MedicationStatement.id
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Short | Logical 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.
Control | 0..1
Type | id
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
4. MedicationStatement.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.
Short | Metadata about the resource
Control | 0..1
Type | Meta
Summary | true
6. MedicationStatement.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.
Short | A 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.
Control | 0..1
Type | uri
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
8. MedicationStatement.language
Definition | The base language in which the resource is written.
Short | Language 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).
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from Common Languages (extensible to `http://hl7.org/fhir/ValueSet/languages` ) A human language.
Additional Bindings | Purpose
All Languages | Max Binding
Type | code
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
10. MedicationStatement.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.
Short | Text 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.
Control | 0..1 This element is affected by the following invariants: dom-1
Type | Narrative
Alternate Names | narrative, html, xhtml, display
12. MedicationStatement.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.
Short | Contained, 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.
Control | 0..*
Type | Resource
Alternate Names | inline resources, anonymous resources, contained resources
14. MedicationStatement.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `MedicationStatement.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
16. MedicationStatement.extension:asAgreedIndicator
Slice Name | asAgreedIndicator
Definition | Is the medicine used as outlined in the medication agreement?
Short | AsAgreedIndicator
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.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(HCIM As AgreedIndicator) (Extension Type: boolean)
Alternate Names | extensions, user content, VolgensAfspraakIndicator
Invariants | ele-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. MedicationStatement.extension:asAgreedIndicator.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
20. MedicationStatement.extension:asAgreedIndicator.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.
Short | Additional 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.
Control | 0..0
Type | Extension
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `MedicationStatement.extension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
22. MedicationStatement.extension:asAgreedIndicator.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies 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.
Control | 1..1
Type | uri
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
Fixed Value | `http://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-AsAgreedIndicator`
24. MedicationStatement.extension:asAgreedIndicator.value[x]:valueBoolean
Slice Name | valueBoolean
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).
Short | Value of extension
Control | 0..1
Type | boolean
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Example | Example of asAgreed: true
26. MedicationStatement.extension:prescriber
Slice Name | prescriber
Definition | The healthcare professional responsible for authorizing the initial prescription.
Short | Who ordered the initial medication(s)
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(HCIM MedicationUse Prescriber) (Extension Type: Reference)
Must Support | true
Invariants | ele-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()`)
28. MedicationStatement.extension:author
Slice Name | author
Definition | The author of this MedicationStatement. This is either a patient, a health professional or a healthcare provicer.
Short | Author
Comments | The health professional's specialty, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(HCIM MedicationUse Author) (Extension Type: Reference)
Alternate Names | extensions, user content, Auteur
Invariants | ele-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()`)
30. MedicationStatement.extension:medicationTreatment
Slice Name | medicationTreatment
Definition | This extension is to describe which overarching medical treatment this information is part of. This is done by the use of an identifier of that medical treatment.
Short | Medical Treatment
Comments | No HCIM concept is available for this element. Therefore a mapping to the relevant element Medication Process data element is provided.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(HCIM MedicationTreatment) (Extension Type: Identifier)
Alternate Names | extensions, user content, Medicamenteuze Behandeling
Invariants | ele-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. MedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse
Slice Name | reasonForChangeOrDiscontinuationOfUse
Definition | Reason for changing or discontinuing use of medication.
Short | ReasonForChangeOrDiscontinuationOfUse
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.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Extension(HCIM MedicationUse ReasonForChangeOrDiscontinuationOfUse) (Extension Type: CodeableConcept)
Alternate Names | extensions, user content, RedenWijzigenOfStoppenGebruik, Reden wijzigen of stoppen gebruik
Invariants | ele-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. MedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
36. MedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.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.
Short | Additional 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.
Control | 0..0
Type | Extension
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `MedicationStatement.extension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
38. MedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies 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.
Control | 1..1
Type | uri
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
Fixed Value | `http://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-ReasonForChangeOrDiscontinuationOfUse`
40. MedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.value[x]:valueCodeableConcept
Slice Name | valueCodeableConcept
Definition | Reason for changing or discontinuing use of medication.
Short | ReasonForChangeOrDiscontinuationOfUse
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from RedenWijzigenOfStoppenGebruikCodelijst (extensible to `http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.11.2--20171231000000` ) ReasonForChangeOrDiscontinuationOfUseCodeList
Type | CodeableConcept
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Alternate Names | Reden wijzigen of stoppen gebruik
Example | Example of ReasonForChangeOrDiscontinuationOfUse: { "coding" : [{ "system" : "http://snomed.info/sct", "code" : "79899007", "display" : "Drug interaction (finding)" }] }
42. MedicationStatement.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.
Short | Extensions 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.
Control | 0..*
Type | Extension
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `MedicationStatement.modifierExtension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
44. MedicationStatement.modifierExtension:repeatPeriodCyclicalSchedule
Slice Name | repeatPeriodCyclicalSchedule
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
Short | RepeatPeriodCyclicalSchedule
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.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(HCIM Medication RepeatPeriodCyclicalSchedule) (Extension Type: Duration)
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Label | HerhaalperiodeCyclischSchema
Alternate Names | extensions, user content
Invariants | ele-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()`)
46. MedicationStatement.identifier
Definition | External identifier - FHIR will generate its own internal identifiers (probably URLs) which do not need to be explicitly managed by the resource. The identifier here is one that would be used by another non-FHIR system - for example an automated medication pump would provide a record each time it operated; an administration while the patient was off the ward might be made with a different system and entered after the event. Particularly important if these records have to be updated.
Short | External identifier
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
Summary | true
48. MedicationStatement.basedOn
Definition | A plan, proposal or order that is fulfilled in whole or in part by this event.
Short | Fulfils plan, proposal or order
Control | 0..*
Type | Reference(MedicationRequest, CarePlan, ProcedureRequest, ReferralRequest)
Summary | true
Requirements | Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.
50. MedicationStatement.partOf
Definition | A larger event of which this particular event is a component or step.
Short | Part of referenced event
Control | 0..*
Type | Reference(MedicationAdministration, MedicationDispense, MedicationStatement, Procedure, Observation)
Summary | true
Requirements | This should not be used when indicating which resource a MedicationStatement has been derived from. If that is the use case, then MedicationStatement.derivedFrom should be used.
52. MedicationStatement.context
Definition | The encounter or episode of care that establishes the context for this MedicationStatement.
Short | Encounter / Episode associated with MedicationStatement
Control | 0..1
Type | Reference(Encounter, EpisodeOfCare)
Summary | true
54. MedicationStatement.status
Definition | A code representing the patient or other source's judgment about the state of the medication used that this statement is about. Generally this will be active or completed.
Short | MedicationUseStopType
Comments | MedicationStatement is a statement at a point in time. The status is only representative at the point when it was asserted. The value set for MedicationStatement.status contains codes that assert the status of the use of the medication by the patient (for example, stopped or on hold) as well as codes that assert the status of the medication statement itself (for example, entered in error). This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. This element is also used for the concept 'Stop type'; the manner in which this medication is discontinued (temporary or definitive).
Control | 1..1
Binding | The codes SHALL be taken from MedicationStatementStatus (required to `http://hl7.org/fhir/ValueSet/medication-statement-status` ) Allergy Intolerance critically Code list
Type | code
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Alternate Names | MedicatieGebruikStopType
56. MedicationStatement.category
Definition | Indicates where type of medication statement and where the medication is expected to be consumed or administered.
Short | Type of medication usage
Control | 1..1
Binding | The codes SHOULD be taken from MedicationStatementCategory (preferred to `http://hl7.org/fhir/ValueSet/medication-statement-category` ) A coded concept identifying where the medication included in the medicationstatement is expected to be consumed or administered
Type | CodeableConcept
Summary | true
58. MedicationStatement.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.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
60. MedicationStatement.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `MedicationStatement.category.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
62. MedicationStatement.category.coding
Definition | A reference to a code defined by a terminology system.
Short | Code 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.
Control | 0..*
Type | Coding
Summary | true
Requirements | Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.
Slicing | This element introduces a set of slices on `MedicationStatement.category.coding`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ code
64. MedicationStatement.category.coding:medicationUseCode
Slice Name | medicationUseCode
Definition | Category code used for indexing/retrieval of the HCIM MedicationUse. The system and code are stated in the Medication Process v09.
Short | MedicationUseCode
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.
Control | 0..*
Type | Coding
Summary | true
Requirements | Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.
66. MedicationStatement.category.coding:medicationUseCode.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
68. MedicationStatement.category.coding:medicationUseCode.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `MedicationStatement.category.coding.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
70. MedicationStatement.category.coding:medicationUseCode.system
Definition | The identification of the code system that defines the meaning of the symbol in the code.
Short | Identity 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.
Control | 0..1
Type | uri
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Need to be unambiguous about the source of the definition of the symbol.
Fixed Value | `urn:oid:2.16.840.1.113883.2.4.3.11.60.20.77.5.3`
72. MedicationStatement.category.coding:medicationUseCode.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.
Short | Version 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.
Note | This is a business version Id, not a resource version Id (see discussion)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
74. MedicationStatement.category.coding:medicationUseCode.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).
Short | Symbol in syntax defined by the system
Control | 0..1
Type | code
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Need to refer to a particular code in the system.
Fixed Value | `6`
76. MedicationStatement.category.coding:medicationUseCode.display
Definition | A representation of the meaning of the code in the system, following the rules of the system.
Short | Representation defined by the system
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
78. MedicationStatement.category.coding:medicationUseCode.userSelected
Definition | Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).
Short | If 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.
Control | 0..1
Type | boolean
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
80. MedicationStatement.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.
Short | Plain text representation of the concept
Comments | Very often the text is the same as a displayName of one of the codings.
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
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.
82. MedicationStatement.medicationReference:medicationReference
Slice Name | medicationReference
Definition | Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.
Short | ProductUsed
Control | 1..1
Type | Reference(Medication)
Must Support | true
Summary | true
Alternate Names | Gebruiksproduct
84. MedicationStatement.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.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
86. MedicationStatement.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `MedicationStatement.medicationReference.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
88. MedicationStatement.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.
Short | Literal 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.
Control | 0..1 This element is affected by the following invariants: ref-1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
90. MedicationStatement.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.
Short | Logical 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.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..1
Type | Identifier
Summary | true
92. MedicationStatement.medicationReference:medicationReference.display
Definition | Plain text narrative that identifies the resource in addition to the resource reference.
Short | Text 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.
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
94. MedicationStatement.effectivePeriod:effectivePeriod
Slice Name | effectivePeriod
Definition | Medication use can be recorded for a certain moment or over a certain period. Thus, medication use can be recorded multiple times during the use of medication. The usage period is the period or moment over which the data is recorded. Start date: This is the time at which the agreement was to take effect (or took effect or will take effect). 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. End date: The time at which the period of use ends (or ended or will end). To avoid confusion between 'to' and 'up to', the submission of time is always mandatory for the end date.
Short | PeriodOfUse
Comments | This attribute reflects the period over which the patient consumed the medication and is expected to be populated on the majority of Medication Statements. If the medication is still being taken at the time the statement is recorded, the "end" date will be omitted.
Control | 0..1
Type | Period
Must Support | true
Summary | true
Alternate Names | Gebruiksperiode
96. MedicationStatement.effectivePeriod:effectivePeriod.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
98. MedicationStatement.effectivePeriod:effectivePeriod.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `MedicationStatement.effectivePeriod.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
100. MedicationStatement.effectivePeriod:effectivePeriod.extension:Duration
Slice Name | Duration
Definition | 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.
Short | Duration
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.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(HCIM MedicationUse Duration) (Extension Type: Duration)
Alternate Names | extensions, user content, tijdsDuur
Invariants | ele-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()`)
102. MedicationStatement.effectivePeriod:effectivePeriod.extension:Duration.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
104. MedicationStatement.effectivePeriod:effectivePeriod.extension:Duration.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.
Short | Additional 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.
Control | 0..0
Type | Extension
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `MedicationStatement.effectivePeriod.extension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
106. MedicationStatement.effectivePeriod:effectivePeriod.extension:Duration.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies 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.
Control | 1..1
Type | uri
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
Fixed Value | `http://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-Duration`
108. MedicationStatement.effectivePeriod:effectivePeriod.extension:Duration.value[x]:valueDuration
Slice Name | valueDuration
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).
Short | UsageDuration
Control | 0..1
Type | Duration
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Alternate Names | Gebruiksduur
Example | Example of Duration: { "value" : 3, "unit" : "day", "system" : "http://unitsofmeasure.org", "code" : "d" }
110. MedicationStatement.effectivePeriod:effectivePeriod.start
Definition | This is the time at which the agreement was to take effect (or took effect or will take effect).
Short | StartDate
Comments | If the low element is missing, the meaning is that the low boundary is not known.
Control | 0..1 This element is affected by the following invariants: per-1
Type | dateTime
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Alternate Names | Ingangsdatum
112. MedicationStatement.effectivePeriod:effectivePeriod.end
Definition | The time at which the period of use ends (or ended or will end). To avoid confusion between 'to' and 'up to', the submission of time is always mandatory for the end date.
Short | EndDate
Comments | The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.
Control | 0..1 This element is affected by the following invariants: per-1
Type | dateTime
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Alternate Names | Einddatum
Meaning if Missing | If the end of the period is missing, it means that the period is ongoing
114. MedicationStatement.dateAsserted
Definition | Date on which this use is entered.
Short | MedicationUseDateTime
Control | 1..1
Type | dateTime
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Alternate Names | Registratiedatum
Example | Example of MedicationUseDateTime: 2017-06-14
116. MedicationStatement.informationSource
Definition | The person or organization that provided the information about the taking of this medication. Note: Use derivedFrom when a MedicationStatement is derived from other resources, e.g Claim or MedicationRequest.
Short | Person or organization that provided the information about the taking of this medication
Comments | If a health professional is the informationSource the PractitionerRole reference extension can be used for a PractitionerRole reference. The health professional's specialty, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile.
Control | 0..1
Type | Reference(nl-core-patient, nl-core-practitioner, nl-core-relatedperson, nl-core-organization)
118. MedicationStatement.informationSource.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
120. MedicationStatement.informationSource.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `MedicationStatement.informationSource.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
122. MedicationStatement.informationSource.extension:practitionerRole
Slice Name | practitionerRole
Definition | Optional Extension Element - found in all resources.
Short | Optional 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.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(PractitionerRole Reference) (Extension Type: Reference)
Alternate Names | extensions, user content
Invariants | ele-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. MedicationStatement.informationSource.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.
Short | Literal 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.
Control | 0..1 This element is affected by the following invariants: ref-1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
126. MedicationStatement.informationSource.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.
Short | Logical 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.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..1
Type | Identifier
Summary | true
128. MedicationStatement.informationSource.display
Definition | Plain text narrative that identifies the resource in addition to the resource reference.
Short | Text 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.
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
130. MedicationStatement.subject
Definition | The person, animal or group who is/was taking the medication.
Short | Who is/was taking the medication
Control | 1..1
Type | Reference(nl-core-patient)
Summary | true
132. MedicationStatement.derivedFrom
Definition | Allows linking the MedicationStatement to the underlying MedicationRequest, or to other information that supports or is used to derive the MedicationStatement.
Short | Additional supporting information
Comments | Likely references would be to MedicationRequest, MedicationDispense, Claim, Observation or QuestionnaireAnswers. The most common use cases for deriving a MedicationStatement comes from creating a MedicationStatement from a MedicationRequest or from a lab observation or a claim. it should be noted that the amount of information that is available varies from the type resource that you derive the MedicationStatement from.
Control | 0..*
Type | Reference(Resource)
134. MedicationStatement.taken
Definition | Is this medicine used or not?
Short | UseIndicator
Comments | This element is labeled as a modifier because it indicates that the medication was not taken.
Control | 1..1
Binding | The codes SHALL be taken from MedicationStatementTaken (required to `http://hl7.org/fhir/ValueSet/medication-statement-taken` ) A coded concept identifying level of certainty if patient has taken or has not taken the medication
Type | code
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Alternate Names | GebruikIndicator
Example | Example of taken: y
136. MedicationStatement.reasonNotTaken
Definition | A code indicating why the medication was not taken.
Short | True if asserting medication was not given
Control | 0..* This element is affected by the following invariants: mst-1
Binding | For example codes, see SNOMED CT Drugs not taken/completed Codes (example to `http://hl7.org/fhir/ValueSet/reason-medication-not-taken-codes` ) A coded concept indicating the reason why the medication was not taken
Type | CodeableConcept
138. MedicationStatement.reasonCode
Definition | A reason for why the medication is being/was taken.
Short | Reason for why the medication is being/was taken
Comments | This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonForUseReference.
Control | 0..*
Binding | For example codes, see Condition/Problem/Diagnosis Codes (example to `http://hl7.org/fhir/ValueSet/condition-code` ) A coded concept identifying why the medication is being taken.
Type | CodeableConcept
140. MedicationStatement.reasonCode.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
142. MedicationStatement.reasonCode.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `MedicationStatement.reasonCode.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
144. MedicationStatement.reasonCode.coding
Definition | A reference to a code defined by a terminology system.
Short | Code 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.
Control | 0..*
Type | Coding
Summary | true
Requirements | Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.
146. MedicationStatement.reasonCode.text
Definition | The reason for using the medication, particularly in self-care medicine purchased by the patient themselves.
Short | ReasonForUse
Comments | Very often the text is the same as a displayName of one of the codings.
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
Alternate Names | RedenGebruik
148. MedicationStatement.reasonReference
Definition | Condition or observation that supports why the medication is being/was taken.
Short | Condition or observation that supports why the medication is being/was taken
Comments | This is a reference to a condition that is the reason why the medication is being/was taken. If only a code exists, use reasonForUseCode.
Control | 0..*
Type | Reference(Condition, Observation)
150. MedicationStatement.note
Definition | Comments on the medication use.
Short | Comment
Control | 0..*
Type | Annotation
Alternate Names | Toelichting
152. MedicationStatement.dosage
Definition | Instructions for the use of the medication, e.g. dose and route of administration. In the event of medication use, this is the pattern of use established by the patient or which the patient followed
Short | InstructionsForUse
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.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Dosage(HCIM InstructionsForUse)
Alternate Names | Gebruiksinstructie
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() | (children().count() > id.count())`)
154. MedicationStatement.dosage.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
156. MedicationStatement.dosage.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `MedicationStatement.dosage.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
158. MedicationStatement.dosage.sequence
Definition | This indicates the sequence of the dosing instructions within the medication agreement.
Short | SequenceNumber
Control | 0..1
Type | integer
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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 Names | Volgnummer
160. MedicationStatement.dosage.text
Definition | Textual description of the complete instructions for use including the period of use.
Short | Description
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
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 Names | Omschrijving
162. MedicationStatement.dosage.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.
Short | AdditionalInstructions
Control | 0..*
Binding | Unless 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` )
Type | CodeableConcept
Summary | true
Requirements | Additional instruction such as "Swallow with plenty of water" which may or may not be coded.
Alternate Names | AanvullendeInstructie
164. MedicationStatement.dosage.patientInstruction
Definition | Instructions in terms that are understood by the patient or consumer.
Short | Patient or consumer oriented instructions
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
166. MedicationStatement.dosage.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.
Short | When 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.
Control | 0..1
Type | Timing(HCIM AdministrationSchedule)
Summary | true
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. MedicationStatement.dosage.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).
Short | Take "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".
Control | 0..1
Binding | For 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.
Type | CodeableConcept
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Summary | true
Slicing | This element introduces a set of slices on `MedicationStatement.dosage.asNeeded[x]`. The slices areUnordered and Closed, and can be differentiated using the following discriminators: type @ $this
170. MedicationStatement.dosage.asNeeded[x]:asNeededCodeableConcept
Slice Name | asNeededCodeableConcept
Definition | As needed means that the dose is only to be administered under certain conditions.
Short | AsNeeded
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.
Control | 0..1
Binding | Unless 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
Type | CodeableConcept
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Summary | true
Alternate Names | Zo nodig, Criterium
172. MedicationStatement.dosage.site
Definition | Body site to administer to.
Short | Body 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.
Control | 0..1
Binding | For 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.
Type | CodeableConcept
Summary | true
Requirements | A coded specification of the anatomic site where the medication first enters the body.
174. MedicationStatement.dosage.route
Definition | The route through which the medication is administered (oral, nasal, intravenous, etc.)
Short | RouteOfAdministration
Control | 0..1
Binding | Unless 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
Type | CodeableConcept
Summary | true
Requirements | A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.
Alternate Names | Toedieningsweg
Example | Example of RouteOfAdministration: { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.4.9", "code" : "oraal", "display" : "Oraal" }] }
176. MedicationStatement.dosage.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.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
178. MedicationStatement.dosage.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `MedicationStatement.dosage.route.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
180. MedicationStatement.dosage.route.coding
Definition | A reference to a code defined by a terminology system.
Short | Code 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.
Control | 0..*
Type | Coding
Summary | true
Requirements | Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.
182. MedicationStatement.dosage.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.
Short | Plain text representation of the concept
Comments | Very often the text is the same as a displayName of one of the codings.
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
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. MedicationStatement.dosage.method
Definition | Technique for administering medication.
Short | Technique for administering medication
Comments | Terminologies used often pre-coordinate this term with the route and or form of administration.
Control | 0..1
Binding | For 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.
Type | CodeableConcept
Summary | true
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. MedicationStatement.dosage.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.
Short | 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.
Control | 0..1
Type | Choice of: Range, Quantity(SimpleQuantity)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Summary | true
Requirements | The amount of therapeutic or other substance given at one administration event.
Alternate Names | Keerdosis
Slicing | This element introduces a set of slices on `MedicationStatement.dosage.dose[x]`. The slices areUnordered and Closed, and can be differentiated using the following discriminators: type @ $this
188. MedicationStatement.dosage.dose[x]:doseQuantity
Slice Name | doseQuantity
Definition | Amount of medication per dose.
Short | Amount 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.
Control | 0..1
Binding | The 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
Type | Quantity(SimpleQuantity)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Summary | true
Requirements | The amount of therapeutic or other substance given at one administration event.
190. MedicationStatement.dosage.dose[x]:doseRange
Slice Name | doseRange
Definition | Amount of medication per dose.
Short | Amount 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.
Control | 0..1
Type | Range
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Summary | true
Requirements | The amount of therapeutic or other substance given at one administration event.
192. MedicationStatement.dosage.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.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
194. MedicationStatement.dosage.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `MedicationStatement.dosage.dose[x].extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
196. MedicationStatement.dosage.dose[x]:doseRange.low
Definition | The low limit. The boundary is inclusive.
Short | Low limit
Comments | If the low element is missing, the low boundary is not known.
Control | 0..1 This element is affected by the following invariants: rng-2
Binding | The 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
Type | Quantity(SimpleQuantity)
Summary | true
198. MedicationStatement.dosage.dose[x]:doseRange.high
Definition | The high limit. The boundary is inclusive.
Short | High limit
Comments | If the high element is missing, the high boundary is not known.
Control | 0..1 This element is affected by the following invariants: rng-2
Binding | The 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
Type | Quantity(SimpleQuantity)
Summary | true
200. MedicationStatement.dosage.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
Short | MaximumDose
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".
Control | 0..1
Type | Ratio
Summary | true
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 Names | Maximale dosering, Maximale dosis (per dag enz.)
202. MedicationStatement.dosage.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.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
204. MedicationStatement.dosage.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `MedicationStatement.dosage.maxDosePerPeriod.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
206. MedicationStatement.dosage.maxDosePerPeriod.numerator
Definition | The value of the numerator.
Short | Numerator value
Control | 0..1
Binding | The 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
Type | Quantity
Summary | true
208. MedicationStatement.dosage.maxDosePerPeriod.denominator
Definition | The value of the denominator.
Short | Denominator value
Control | 0..1
Type | Quantity
Summary | true
210. MedicationStatement.dosage.maxDosePerAdministration
Definition | Upper limit on medication per administration.
Short | Upper 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.
Control | 0..1
Type | Quantity(SimpleQuantity)
Summary | true
Requirements | The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.
212. MedicationStatement.dosage.maxDosePerLifetime
Definition | Upper limit on medication per lifetime of the patient.
Short | Upper limit on medication per lifetime of the patient
Control | 0..1
Type | Quantity(SimpleQuantity)
Summary | true
Requirements | The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.
214. MedicationStatement.dosage.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
Short | AdministeringSpeed
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.
Control | 0..1
Type | Choice of: Ratio, Range, Quantity(SimpleQuantity)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Summary | true
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 Names | Toedieningssnelheid, Inloopsnelheid