RIVO-Noord Zorgviewer Implementation Guide
1.23.0 - 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 1.23.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/RIVO-Noord/zorgviewer-ig/ and changes regularly. See the Directory of published versions

## Resource Profile: MedicationAgreement - Detailed Descriptions

Active as of 2026-03-30

Definitions for the MedicationRequest 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. MedicationRequest
Definition | A medication agreement is a prescriber’s proposal for a patient to use medication. An agreement to discontinue the use of medication is also a medication agreement. This is the base resource type for everything.
Short | MedicationAgreementBase Resource
Control | 0..*
Alternate Names | Prescription, Order, Medicatieafspraak
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()`)
2. MedicationRequest.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.
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. MedicationRequest.extension:periodOfUse
Slice Name | periodOfUse
Definition | Optional Extension Element - found in all resources.
Short | UsagePeriod
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(HCIM Medication Period Of Use) (Extension Type: Period)
Must Support | true
Alternate Names | Gebruiksperiode
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. MedicationRequest.extension:usageDuration
Slice Name | usageDuration
Definition | Duration: The intended duration of use. E.g. 5 days or 8 weeks. It is not allowed to indicate the duration in months, because different months have a variable duration in days.
Short | Duration
Comments | According to the HCIM TimeInterval, a time interval is defined by either a start and end time, a start time and duration, or a duration and end time. As this HCIM is expressed by the periodOfUse and usageDuration extensions in this profile, this means that precisely two elements out of `.valuePeriod.start`, `.valuePeriod.end` (both in the periodOfUse extension) and `.valueDuration` (in the usageDuration extension) should be present in order to correctly represent the time interval in which the agreement is used (and in particular not all three elements).
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, Duur
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()`)
8. MedicationRequest.extension:additionalInformation
Slice Name | additionalInformation
Definition | Additional information includes details on the structure of the agreement made that are relevant for pharmacovigilance and fulfillment by the pharmacist. This can be used e.g. to indicate that there was a conscious decision to deviate from the norm or that the agreement is to be structured in a certain way.
Short | MedicationAgreementAdditionalInformation
Comments | When choosing a medicine, you can deviate from what is expected or from what the standard is. For example, when the hospital uses a different formulary than the community pharmacy. For reasons of efficiency, for example, one gastric acid inhibitor has been chosen in the hospital: pantoprazole. Upon admission, a patient with omeprazole is converted to pantoprazole for the duration of the stay. When discharged, the patient goes back to omeprazole. It is clear that something can go wrong here and that the patient takes both omeprazole and pantoprazole when there is no intervention. In the hospital's medication agreement for pantoprazole a remark can be made about the deviation so that it is clear that pantoprazole is the substitute for omeprazole or that it should be used in addition to omeprazole. Another example are the half strengths. The hospital sometimes stocks tablets with half the strength of the normal trade preparation (own production). Where the patient enters the hospital on 25 mg chlortalidone, half a tablet once a day, he receives 12.5 mg intramural chlortalidone, one tablet once a day. Then the nursing does not have to break tablets in this case. Here there is a risk that the patient will use the 25 mg again at home, but then a whole tablet at a time in stead of half a tablet. By means of an explanation in the medication agreement (Additional information) of the last chlortalidone 25 mg, it can be indicated whether this has been a intended increase.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Extension(HCIM AdditionalInformation) (Extension Type: CodeableConcept)
Alternate Names | extensions, user content, MedicatieafspraakAanvullendeInformatie
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()`)
10. MedicationRequest.extension:additionalInformation.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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 `MedicationRequest.extension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
12. MedicationRequest.extension:additionalInformation.url
Definition | Source of the definition for the extension code - a logical name or a URL.
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-Medication-AdditionalInformation`
14. MedicationRequest.extension:additionalInformation.value[x]:valueCodeableConcept
Slice Name | valueCodeableConcept
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
Binding | Unless not suitable, these codes SHALL be taken from For codes, see MedicatieafspraakAanvullendeInformatieCodelijst (extensible to `http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.6.3--20171231000000` ) MedicatieafspraakAanvullendeInformatieCodelijst
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]
Example | Example of MedicationAgreementAdditionalInformation: { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.20.77.5.2.3.2050", "code" : "1", "display" : "Bewust hoge dosering" }] }
16. MedicationRequest.extension:medicationTreatment
Slice Name | medicationTreatment
Definition | This extension is to describe which overarching medication treatment this information is part of. This is done by the use of an identifier of that medication treatment.
Short | Medication Treatment
Comments | No HCIM concept is available for this element. Therefore a mapping to the relevant 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. MedicationRequest.extension:nl-core-episodeofcare
Slice Name | nl-core-episodeofcare
Definition | Optional Extension Element - found in all resources.
Short | Optional Extensions Element
Comments | It is recommended to use the nl-core-episodeofcare extension to reference nl-core-episodeofcare (EpisodeOfCare) instances rather than the `context` element, as this approach will be enforced in FHIR R4.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Extension(context extension for nl-core-episodeofcare) (Extension Type: Reference(nl-core-episodeofcare))
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()`)
20. MedicationRequest.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
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 `MedicationRequest.modifierExtension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
22. MedicationRequest.modifierExtension:stopType
Slice Name | stopType
Definition | The manner in which (and indicator that) this medication is discontinued (temporarily or permanently).
Short | StopType
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(HCIM Medication StopType) (Extension Type: CodeableConcept)
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Must Support | true
Label | MedicatieafspraakStopType
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()`)
24. MedicationRequest.modifierExtension:stopType.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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 `MedicationRequest.modifierExtension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
26. MedicationRequest.modifierExtension:stopType.url
Definition | Source of the definition for the extension code - a logical name or a URL.
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-Medication-StopType`
28. MedicationRequest.modifierExtension:stopType.value[x]:valueCodeableConcept
Slice Name | valueCodeableConcept
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
Binding | The codes SHALL be taken from For codes, see Stoptype (required to `http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.19--20160617101300` ) StopType
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]
30. MedicationRequest.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()`)
32. MedicationRequest.status
Definition | A code specifying the current state of the order. Generally this will be active or completed state.
Short | active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Control | 0..1
Binding | The codes SHALL be taken from MedicationRequestStatus http://hl7.org/fhir/ValueSet/medication-request-status|3.0.2 (required to `http://hl7.org/fhir/ValueSet/medication-request-status` ) A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription
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
34. MedicationRequest.intent
Definition | Whether the request is a proposal, plan, or an original order.
Short | proposal | plan | order | instance-order
Comments | It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only. An instance-order is an instantiation of a request or order and may be used to populate Medication Administration Record. This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.
Control | 1..1
Binding | The codes SHALL be taken from MedicationRequestIntent http://hl7.org/fhir/ValueSet/medication-request-intent|3.0.2 (required to `http://hl7.org/fhir/ValueSet/medication-request-intent` ) The kind of medication order
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
Fixed Value | `order`
36. MedicationRequest.category
Definition | Indicates the type of medication order 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 MedicationRequestCategory http://hl7.org/fhir/ValueSet/medication-request-category|3.0.2 (preferred to `http://hl7.org/fhir/ValueSet/medication-request-category` ) A coded concept identifying where the medication ordered is expected to be consumed or administered
Type | CodeableConcept
38. MedicationRequest.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 `MedicationRequest.category.coding`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ code
40. MedicationRequest.category.coding:medicationAgreementCode
Slice Name | medicationAgreementCode
Definition | Category SNOMED code used for indexing/retrieval of the HCIM MedicationAgreement. The SNOMED code 16076005 for this resource is stated in the Medication Process v09. A reference to a code defined by a terminology system.
Short | MedicationAgreementCodeCode 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.
42. MedicationRequest.category.coding:medicationAgreementCode.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 | `http://snomed.info/sct`
44. MedicationRequest.category.coding:medicationAgreementCode.code
Definition | A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
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 | `16076005`
46. MedicationRequest.category.text
Definition | A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
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.
48. MedicationRequest.medicationReference:medicationReference
Slice Name | medicationReference
Definition | The medicine agreed upon to be used. Identifies the medication being requested. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medications.
Short | AgreedMedicineMedication to be taken
Comments | If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example, if you require form or lot number or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource. .
Control | 1..1
Type | Reference(Medication, Medication), CodeableConcept
Must Support | true
Summary | true
Alternate Names | Afgesprokengeneesmiddel
50. MedicationRequest.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
52. MedicationRequest.subject
Definition | A link to a resource representing the person or set of individuals to whom the medication will be given.
Short | Who or group medication request is for
Comments | The subject on a medication request is mandatory. For the secondary use case where the actual subject is not provided, there still must be an anonymized subject specified.
Control | 1..1
Type | Reference(nl-core-patient, Group, Patient)
Summary | true
54. MedicationRequest.authoredOn
Definition | The time at which the agreement was made. Appointment date + time are required (order of the appointments must be clear in cases with multiple appointments on one day) The date (and perhaps time) when the prescription was initially written or authored on.
Short | MedicationAgreementDateTimeWhen request was initially authored
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 | Afspraakdatum
56. MedicationRequest.requester
Definition | The health professional that entered the medication agreement with the patient. The individual, organization or device that initiated the request and has responsibility for its activation.
Short | PrescriberWho/What requested the Request
Comments | Note that in FHIR STU3, there is an agent Reference type PractitionerRole missing. PractitionerRole, contrary to Practitioner, allows for specialism and organization. This issue has been fixed in FHIR R4. For FHIR STU3, you can use the practitionerrole-reference extension on requester.agent.
Control | 0..1
Type | BackboneElement
Summary | true
Alternate Names | Voorschrijver
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() | (children().count() > id.count())`) mps-1: onBehalfOf can only be specified if agent is practitioner or device (`(agent.resolve().empty()) or (agent.resolve() is Device) or (agent.resolve() is Practitioner) or onBehalfOf.exists().not()`) ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count())) mps-1: onBehalfOf can only be specified if agent is practitioner or device ((agent.resolve().empty()) or (agent.resolve() is Device) or (agent.resolve() is Practitioner) or onBehalfOf.exists().not())
58. MedicationRequest.requester.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
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
Summary | true
Alternate Names | extensions, user content, modifiers
60. MedicationRequest.requester.agent
Definition | The healthcare professional responsible for authorizing the initial prescription.
Short | Who ordered the initial medication(s)
Comments | The health professional's speciality, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile. It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only.
Control | 1..1
Type | Reference(nl-core-practitioner, nl-core-organization, nl-core-patient, nl-core-relatedperson, Device, Practitioner, Organization, Patient, RelatedPerson)
Summary | true
62. MedicationRequest.requester.agent.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(nl-core-practitionerrole))
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()`)
64. MedicationRequest.requester.agent.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
66. MedicationRequest.dosageInstruction
Definition | Instructions for the use of the medication, e.g. dose and route of administration Indicates how the medication is to be used by the patient.
Short | InstructionsForUseHow the medication should be taken
Comments | The wiki page https://informatiestandaarden.nictiz.nl/wiki/mp:V9.0Voorbeeldendoseringen provides dosage instruction examples. These examples consists of functional data and their representation in FHIR and CDA. There are examples where a medication request may include the option of an oral dose or an Intravenous or Intramuscular dose. For example, "Ondansetron 8mg orally or IV twice a day as needed for nausea" or "Compazine® (prochlorperazine) 5-10mg PO or 25mg PR bid prn nausea or vomiting". In these cases, two medication requests would be created that could be grouped together. The decision on which dose and route of administration to use is based on the patient's condition at the time the dose is needed.
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())`)
68. MedicationRequest.dosageInstruction.text
Definition | Textual description of the complete instructions for use including the period of use. Free text dosage instructions e.g. SIG.
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
70. MedicationRequest.dosageInstruction.asNeededCodeableConcept: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
Summary | true
Alternate Names | Zo nodig, Criterium
72. MedicationRequest.dosageInstruction.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" }] }
74. MedicationRequest.dosageInstruction.route.text
Definition | A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
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.
76. MedicationRequest.dosageInstruction.dose[x]
Definition | The dose indicates the dose amount per administration. The dosage is described in the unit accompanying the product; usually, this is just a number of units or doses. Liquids and other divisible products will usually include a unit of volume (preferably "ml"). In many cases, the prescriber will want to indicate the dose in units of weight of the active ingredient. If only the ingredient is included and not the product, then the amount of that ingredient will be given. Paracetamol 1000mg is equivalent to 2 Paracetamol 500mg tablets or units. The dosage is sometimes given as a calculation, in which the patient’s body weight or body surface area is used as a parameter. The calculation is however no more than an aid in reaching a decision. In the event of constant administration, sometimes the dose is given in addition to the administration speed (infusion rate) (e.g. 20ml in a syringe or 500ml in a bag), but it is often also omitted. A general dosage recommendation such as ‘Use according to protocol’ or ‘See instructions’ can be sufficient. In that case, no dose is given. Amount of medication per dose.
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 `MedicationRequest.dosageInstruction.dose[x]`. The slices areUnordered and Open, and can be differentiated using the following discriminators: type @ $this
78. MedicationRequest.dosageInstruction.dose[x]:doseQuantity
Slice Name | doseQuantity
Definition | The comparator is not used on a SimpleQuantity Amount of medication per dose.
Short | A fixed quantity (no comparator)Amount of medication per dose
Comments | The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator. 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 This element is affected by the following invariants: ele-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.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() | (children().count() > id.count())`) qty-3: If a code for the unit is present, the system SHALL also be present (`code.empty() or system.exists()`) sqty-1: The comparator is not used on a SimpleQuantity (`comparator.empty()`)
80. MedicationRequest.dosageInstruction.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. MedicationRequest
2. MedicationRequest.extension:periodOfUse
Slice Name | periodOfUse
Must Support | true
4. MedicationRequest.modifierExtension:stopType
Slice Name | stopType
Must Support | true
6. MedicationRequest.category
8. MedicationRequest.category.text
Must Support | true
10. MedicationRequest.medicationReference
Type | Reference(Medication)
Must Support | true
12. MedicationRequest.medicationReference.display
Must Support | true
14. MedicationRequest.authoredOn
Must Support | true
16. MedicationRequest.requester
18. MedicationRequest.requester.agent
20. MedicationRequest.requester.agent.display
Must Support | true
22. MedicationRequest.dosageInstruction
24. MedicationRequest.dosageInstruction.text
Must Support | true
26. MedicationRequest.dosageInstruction.route
28. MedicationRequest.dosageInstruction.route.text
Must Support | true

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

0. MedicationRequest
Definition | A medication agreement is a prescriber’s proposal for a patient to use medication. An agreement to discontinue the use of medication is also a medication agreement.
Short | MedicationAgreement
Control | 0..*
Alternate Names | Prescription, Order, Medicatieafspraak
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()`)
2. MedicationRequest.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. MedicationRequest.meta
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.
Short | Metadata about the resource
Control | 0..1
Type | Meta
Summary | true
6. MedicationRequest.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.
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. MedicationRequest.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. MedicationRequest.text
Definition | A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
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. MedicationRequest.contained
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
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. MedicationRequest.extension
Definition | May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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 `MedicationRequest.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
16. MedicationRequest.extension:periodOfUse
Slice Name | periodOfUse
Definition | Optional Extension Element - found in all resources.
Short | UsagePeriod
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(HCIM Medication Period Of Use) (Extension Type: Period)
Must Support | true
Alternate Names | Gebruiksperiode
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. MedicationRequest.extension:usageDuration
Slice Name | usageDuration
Definition | Duration: The intended duration of use. E.g. 5 days or 8 weeks. It is not allowed to indicate the duration in months, because different months have a variable duration in days.
Short | Duration
Comments | According to the HCIM TimeInterval, a time interval is defined by either a start and end time, a start time and duration, or a duration and end time. As this HCIM is expressed by the periodOfUse and usageDuration extensions in this profile, this means that precisely two elements out of `.valuePeriod.start`, `.valuePeriod.end` (both in the periodOfUse extension) and `.valueDuration` (in the usageDuration extension) should be present in order to correctly represent the time interval in which the agreement is used (and in particular not all three elements).
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, Duur
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. MedicationRequest.extension:additionalInformation
Slice Name | additionalInformation
Definition | Additional information includes details on the structure of the agreement made that are relevant for pharmacovigilance and fulfillment by the pharmacist. This can be used e.g. to indicate that there was a conscious decision to deviate from the norm or that the agreement is to be structured in a certain way.
Short | MedicationAgreementAdditionalInformation
Comments | When choosing a medicine, you can deviate from what is expected or from what the standard is. For example, when the hospital uses a different formulary than the community pharmacy. For reasons of efficiency, for example, one gastric acid inhibitor has been chosen in the hospital: pantoprazole. Upon admission, a patient with omeprazole is converted to pantoprazole for the duration of the stay. When discharged, the patient goes back to omeprazole. It is clear that something can go wrong here and that the patient takes both omeprazole and pantoprazole when there is no intervention. In the hospital's medication agreement for pantoprazole a remark can be made about the deviation so that it is clear that pantoprazole is the substitute for omeprazole or that it should be used in addition to omeprazole. Another example are the half strengths. The hospital sometimes stocks tablets with half the strength of the normal trade preparation (own production). Where the patient enters the hospital on 25 mg chlortalidone, half a tablet once a day, he receives 12.5 mg intramural chlortalidone, one tablet once a day. Then the nursing does not have to break tablets in this case. Here there is a risk that the patient will use the 25 mg again at home, but then a whole tablet at a time in stead of half a tablet. By means of an explanation in the medication agreement (Additional information) of the last chlortalidone 25 mg, it can be indicated whether this has been a intended increase.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Extension(HCIM AdditionalInformation) (Extension Type: CodeableConcept)
Alternate Names | extensions, user content, MedicatieafspraakAanvullendeInformatie
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()`)
22. MedicationRequest.extension:additionalInformation.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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.
24. MedicationRequest.extension:additionalInformation.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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 `MedicationRequest.extension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
26. MedicationRequest.extension:additionalInformation.url
Definition | Source of the definition for the extension code - a logical name or a URL.
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-Medication-AdditionalInformation`
28. MedicationRequest.extension:additionalInformation.value[x]:valueCodeableConcept
Slice Name | valueCodeableConcept
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
Binding | Unless not suitable, these codes SHALL be taken from MedicatieafspraakAanvullendeInformatieCodelijst (extensible to `http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.6.3--20171231000000` ) MedicatieafspraakAanvullendeInformatieCodelijst
Type | CodeableConcept
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Example | Example of MedicationAgreementAdditionalInformation: { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.3.11.60.20.77.5.2.3.2050", "code" : "1", "display" : "Bewust hoge dosering" }] }
30. MedicationRequest.extension:medicationTreatment
Slice Name | medicationTreatment
Definition | This extension is to describe which overarching medication treatment this information is part of. This is done by the use of an identifier of that medication treatment.
Short | Medication Treatment
Comments | No HCIM concept is available for this element. Therefore a mapping to the relevant 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. MedicationRequest.extension:nl-core-episodeofcare
Slice Name | nl-core-episodeofcare
Definition | Optional Extension Element - found in all resources.
Short | Optional Extensions Element
Comments | It is recommended to use the nl-core-episodeofcare extension to reference nl-core-episodeofcare (EpisodeOfCare) instances rather than the `context` element, as this approach will be enforced in FHIR R4.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Extension(context extension for nl-core-episodeofcare) (Extension Type: Reference(nl-core-episodeofcare))
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()`)
34. MedicationRequest.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
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 `MedicationRequest.modifierExtension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
36. MedicationRequest.modifierExtension:stopType
Slice Name | stopType
Definition | The manner in which (and indicator that) this medication is discontinued (temporarily or permanently).
Short | StopType
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(HCIM Medication StopType) (Extension Type: CodeableConcept)
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Must Support | true
Label | MedicatieafspraakStopType
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()`)
38. MedicationRequest.modifierExtension:stopType.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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.
40. MedicationRequest.modifierExtension:stopType.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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 `MedicationRequest.modifierExtension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
42. MedicationRequest.modifierExtension:stopType.url
Definition | Source of the definition for the extension code - a logical name or a URL.
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-Medication-StopType`
44. MedicationRequest.modifierExtension:stopType.value[x]:valueCodeableConcept
Slice Name | valueCodeableConcept
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
Binding | The codes SHALL be taken from Stoptype (required to `http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.19--20160617101300` ) StopType
Type | CodeableConcept
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
46. MedicationRequest.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()`)
48. MedicationRequest.identifier
Definition | This records identifiers associated with this medication request that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. For example a re-imbursement system might issue its own id for each prescription that is created. This is particularly important where FHIR only provides part of an entire workflow process where records must be tracked through an entire system.
Short | External ids for this request
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
50. MedicationRequest.definition
Definition | Protocol or definition followed by this request.
Short | Protocol or definition
Control | 0..*
Type | Reference(ActivityDefinition, PlanDefinition)
Summary | true
52. MedicationRequest.basedOn
Definition | A plan or request that is fulfilled in whole or in part by this medication request.
Short | What request fulfills
Control | 0..*
Type | Reference(CarePlan, MedicationRequest, ProcedureRequest, ReferralRequest)
Summary | true
54. MedicationRequest.groupIdentifier
Definition | A shared identifier common to all requests that were authorized more or less simultaneously by a single author, representing the identifier of the requisition or prescription.
Short | Composite request this is part of
Control | 0..1
Type | Identifier
Summary | true
Requirements | Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.
56. MedicationRequest.status
Definition | A code specifying the current state of the order. Generally this will be active or completed state.
Short | active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Control | 0..1
Binding | The codes SHALL be taken from MedicationRequestStatus (required to `http://hl7.org/fhir/ValueSet/medication-request-status` ) A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription
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
58. MedicationRequest.intent
Definition | Whether the request is a proposal, plan, or an original order.
Short | proposal | plan | order | instance-order
Comments | It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only. An instance-order is an instantiation of a request or order and may be used to populate Medication Administration Record. This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.
Control | 1..1
Binding | The codes SHALL be taken from MedicationRequestIntent (required to `http://hl7.org/fhir/ValueSet/medication-request-intent` ) The kind of medication order
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
Fixed Value | `order`
60. MedicationRequest.category
Definition | Indicates the type of medication order 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 MedicationRequestCategory (preferred to `http://hl7.org/fhir/ValueSet/medication-request-category` ) A coded concept identifying where the medication ordered is expected to be consumed or administered
Type | CodeableConcept
62. MedicationRequest.category.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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.
64. MedicationRequest.category.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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 `MedicationRequest.category.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
66. MedicationRequest.category.coding
Definition | A reference to a code defined by a terminology system.
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 `MedicationRequest.category.coding`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ code
68. MedicationRequest.category.coding:medicationAgreementCode
Slice Name | medicationAgreementCode
Definition | Category SNOMED code used for indexing/retrieval of the HCIM MedicationAgreement. The SNOMED code 16076005 for this resource is stated in the Medication Process v09.
Short | MedicationAgreementCode
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.
70. MedicationRequest.category.coding:medicationAgreementCode.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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.
72. MedicationRequest.category.coding:medicationAgreementCode.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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 `MedicationRequest.category.coding.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
74. MedicationRequest.category.coding:medicationAgreementCode.system
Definition | The identification of the code system that defines the meaning of the symbol in the code.
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 | `http://snomed.info/sct`
76. MedicationRequest.category.coding:medicationAgreementCode.version
Definition | The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
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
78. MedicationRequest.category.coding:medicationAgreementCode.code
Definition | A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
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 | `16076005`
80. MedicationRequest.category.coding:medicationAgreementCode.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.
Default Value | `Prescription (procedure)`
82. MedicationRequest.category.coding:medicationAgreementCode.userSelected
Definition | Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).
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.
84. MedicationRequest.category.text
Definition | A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
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.
86. MedicationRequest.priority
Definition | Indicates how quickly the Medication Request should be addressed with respect to other requests.
Short | routine | urgent | stat | asap
Control | 0..1
Binding | The codes SHALL be taken from MedicationRequestPriority (required to `http://hl7.org/fhir/ValueSet/medication-request-priority` ) Identifies the level of importance to be assigned to actioning the request
Type | code
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
88. MedicationRequest.medicationReference:medicationReference
Slice Name | medicationReference
Definition | The medicine agreed upon to be used.
Short | AgreedMedicine
Control | 1..1
Type | Reference(Medication)
Must Support | true
Summary | true
Alternate Names | Afgesprokengeneesmiddel
90. MedicationRequest.medicationReference:medicationReference.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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.
92. MedicationRequest.medicationReference:medicationReference.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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 `MedicationRequest.medicationReference.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
94. MedicationRequest.medicationReference:medicationReference.reference
Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
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
96. MedicationRequest.medicationReference:medicationReference.identifier
Definition | An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
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
98. MedicationRequest.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
100. MedicationRequest.subject
Definition | A link to a resource representing the person or set of individuals to whom the medication will be given.
Short | Who or group medication request is for
Comments | The subject on a medication request is mandatory. For the secondary use case where the actual subject is not provided, there still must be an anonymized subject specified.
Control | 1..1
Type | Reference(nl-core-patient, Group)
Summary | true
102. MedicationRequest.context
Definition | A link to an encounter, or episode of care, that identifies the particular occurrence or set occurrences of contact between patient and health care provider.
Short | Created during encounter/admission/stay
Comments | It is recommended to use the nl-core-episodeofcare extension to reference nl-core-episodeofcare (EpisodeOfCare) instances rather than the `context` element, as this approach will be enforced in FHIR R4.
Control | 0..1
Type | Reference(HCIM Encounter, nl-core-episodeofcare)
104. MedicationRequest.supportingInformation
Definition | Include additional information (for example, patient height and weight) that supports the ordering of the medication.
Short | Information to support ordering of the medication
Control | 0..*
Type | Reference(Resource)
106. MedicationRequest.authoredOn
Definition | The time at which the agreement was made. Appointment date + time are required (order of the appointments must be clear in cases with multiple appointments on one day)
Short | MedicationAgreementDateTime
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 | Afspraakdatum
108. MedicationRequest.requester
Definition | The health professional that entered the medication agreement with the patient.
Short | Prescriber
Comments | Note that in FHIR STU3, there is an agent Reference type PractitionerRole missing. PractitionerRole, contrary to Practitioner, allows for specialism and organization. This issue has been fixed in FHIR R4. For FHIR STU3, you can use the practitionerrole-reference extension on requester.agent.
Control | 0..1
Type | BackboneElement
Summary | true
Alternate Names | Voorschrijver
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() | (children().count() > id.count())`) mps-1: onBehalfOf can only be specified if agent is practitioner or device (`(agent.resolve().empty()) or (agent.resolve() is Device) or (agent.resolve() is Practitioner) or onBehalfOf.exists().not()`)
110. MedicationRequest.requester.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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.
112. MedicationRequest.requester.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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
114. MedicationRequest.requester.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
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
Summary | true
Alternate Names | extensions, user content, modifiers
116. MedicationRequest.requester.agent
Definition | The healthcare professional responsible for authorizing the initial prescription.
Short | Who ordered the initial medication(s)
Comments | The health professional's speciality, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile.
Control | 1..1
Type | Reference(nl-core-practitioner, nl-core-organization, nl-core-patient, nl-core-relatedperson, Device)
Summary | true
118. MedicationRequest.requester.agent.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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. MedicationRequest.requester.agent.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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 `MedicationRequest.requester.agent.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
122. MedicationRequest.requester.agent.extension:practitionerRole
Slice 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(nl-core-practitionerrole))
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. MedicationRequest.requester.agent.reference
Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
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. MedicationRequest.requester.agent.identifier
Definition | An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
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. MedicationRequest.requester.agent.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
130. MedicationRequest.requester.onBehalfOf
Definition | The organization the device or practitioner was acting on behalf of.
Short | Organization agent is acting for
Control | 0..1 This element is affected by the following invariants: mps-1
Type | Reference(nl-core-organization)
Summary | true
Requirements | Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when authoring the request.
132. MedicationRequest.recorder
Definition | The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order.
Short | Person who entered the request
Control | 0..1
Type | Reference(nl-core-practitioner)
134. MedicationRequest.recorder.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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.
136. MedicationRequest.recorder.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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 `MedicationRequest.recorder.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
138. MedicationRequest.recorder.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(nl-core-practitionerrole))
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()`)
140. MedicationRequest.recorder.reference
Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
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
142. MedicationRequest.recorder.identifier
Definition | An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
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
144. MedicationRequest.recorder.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
146. MedicationRequest.reasonCode
Definition | Reason for this agreement. This can be the reason to start, change or stop the medication treatment.
Short | ReasonMedicationAgreement
Comments | This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference.
Control | 0..*
Binding | Unless not suitable, these codes SHALL be taken from RedenMedicatieafspraakCodelijst (extensible to `http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.6.2--20171231000000` ) RedenWijzigenOfStakenCodelijst
Type | CodeableConcept
Alternate Names | RedenMedicatieafspraak
148. MedicationRequest.reasonReference
Definition | The medical reason for the prescription or for use of the medication. This can be used to enter a medical indication which was the direct cause for prescription or for use of the medication in question. It can concern every type of problem (or condition) of the patient, almost all diagnoses, complaints or symptoms. Please note: The BST401T file of the G standard contains a “special reference” to indicate that “exchange of the reason for prescription is essential”.
Short | PrescriptionReason
Comments | This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode.
Control | 0..*
Type | Reference(Observation, HCIM Problem)
Alternate Names | RedenVanVoorschrijven
150. MedicationRequest.note
Definition | Explanation for the medication agreement. This explanation can contain e.g. information on why a prescriber makes a medication agreement that deviates from the norm.
Short | Comment
Control | 0..*
Type | Annotation
Alternate Names | Toelichting
152. MedicationRequest.dosageInstruction
Definition | Instructions for the use of the medication, e.g. dose and route of administration
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. MedicationRequest.dosageInstruction.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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. MedicationRequest.dosageInstruction.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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 `MedicationRequest.dosageInstruction.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
158. MedicationRequest.dosageInstruction.sequence
Definition | This indicates the sequence of the dosing instructions within the medication agreement.
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. MedicationRequest.dosageInstruction.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. MedicationRequest.dosageInstruction.additionalInstruction
Definition | The additional instructions contain extra information on the use of or considerations for the current prescription. This can also include all instructions for use. The text can come from the original 'paper' medication prescription, but can also be generated from the coded information. This concept may contain more information than what is structurally coded in the information below, but may not conflict with it. The instructions may not conflict with other components of the request for administration. The instructions can also refer to an existing protocol. The G standard contains many texts that can support this attribute, in for example G standard table 362, which contains texts from the general practitioners’ standard WCIA table 25. If desired, these texts can be used to structure this concept.
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` ) A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
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. MedicationRequest.dosageInstruction.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. MedicationRequest.dosageInstruction.timing
Definition | Specifications of the times at which the medication is to be administered. This is indicated as follows: Time(s) (16:00) or indications (“before meals”) at which the medication is to be taken each day. A specific number of times the medication is to be taken each day (“3x a day“), indicated with the frequency A time interval between consecutive doses (“Every 2 hours”, “every 3 days”), indicated with the word Interval. Combined periods with an interval and duration (“1 daily for three out of four weeks: the pill schedule”) If a certain medication is not to be taken daily, the aforementioned can be combined with daily indications: One or more week days on which the medication is to be administered (e.g. “Monday, Wednesday, Friday”) ”3x a week”, “2x a month”. The specified administration “infinite” is automatically to be repeated until: The end date and time has been reached The total administration duration has been reached (14 days) A specific amount of administrations has been reached (“20 doses”, “one-time only”), to be entered in the NumberOfDoses concept.
Short | AdministeringSchedule
Comments | A timing schedule can be either a list of events - intervals on which the event occurs, or a single event with repeating criteria or just repeating criteria with no actual event. When both event and a repeating specification are provided, the list of events should be understood as an interpretation of the information in the repeat structure.
Control | 0..1 This element is affected by the following invariants: ele-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.
Alternate Names | Toedieningsschema
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() | (children().count() > id.count())`)
168. MedicationRequest.dosageInstruction.asNeededCodeableConcept: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
Summary | true
Alternate Names | Zo nodig, Criterium
170. MedicationRequest.dosageInstruction.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` ) 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.
172. MedicationRequest.dosageInstruction.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" }] }
174. MedicationRequest.dosageInstruction.route.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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.
176. MedicationRequest.dosageInstruction.route.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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 `MedicationRequest.dosageInstruction.route.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
178. MedicationRequest.dosageInstruction.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.
180. MedicationRequest.dosageInstruction.route.text
Definition | A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
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.
182. MedicationRequest.dosageInstruction.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` ) 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.
184. MedicationRequest.dosageInstruction.dose[x]
Definition | The dose indicates the dose amount per administration. The dosage is described in the unit accompanying the product; usually, this is just a number of units or doses. Liquids and other divisible products will usually include a unit of volume (preferably "ml"). In many cases, the prescriber will want to indicate the dose in units of weight of the active ingredient. If only the ingredient is included and not the product, then the amount of that ingredient will be given. Paracetamol 1000mg is equivalent to 2 Paracetamol 500mg tablets or units. The dosage is sometimes given as a calculation, in which the patient’s body weight or body surface area is used as a parameter. The calculation is however no more than an aid in reaching a decision. In the event of constant administration, sometimes the dose is given in addition to the administration speed (infusion rate) (e.g. 20ml in a syringe or 500ml in a bag), but it is often also omitted. A general dosage recommendation such as ‘Use according to protocol’ or ‘See instructions’ can be sufficient. In that case, no dose is given.
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 `MedicationRequest.dosageInstruction.dose[x]`. The slices areUnordered and Open, and can be differentiated using the following discriminators: type @ $this
186. MedicationRequest.dosageInstruction.dose[x]:doseQuantity
Slice Name | doseQuantity
Definition | The comparator is not used on a SimpleQuantity
Short | A fixed quantity (no comparator)
Comments | The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
Control | 0..1 This element is affected by the following invariants: ele-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.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() | (children().count() > id.count())`) qty-3: If a code for the unit is present, the system SHALL also be present (`code.empty() or system.exists()`) sqty-1: The comparator is not used on a SimpleQuantity (`comparator.empty()`)
188. MedicationRequest.dosageInstruction.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.
190. MedicationRequest.dosageInstruction.dose[x]:doseRange.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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.
192. MedicationRequest.dosageInstruction.dose[x]:doseRange.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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 `MedicationRequest.dosageInstruction.dose[x].extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
194. MedicationRequest.dosageInstruction.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
196. MedicationRequest.dosageInstruction.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
198. MedicationRequest.dosageInstruction.maxDosePerPeriod
Definition | A maximum dose indicates the maximum duration a product can be used with an ‘as needed’ prescription. For example: - Max 6 units per day - Max 200ml per week
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.)
200. MedicationRequest.dosageInstruction.maxDosePerPeriod.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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.
202. MedicationRequest.dosageInstruction.maxDosePerPeriod.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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 `MedicationRequest.dosageInstruction.maxDosePerPeriod.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
204. MedicationRequest.dosageInstruction.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
206. MedicationRequest.dosageInstruction.maxDosePerPeriod.denominator
Definition | The value of the denominator.
Short | Denominator value
Control | 0..1
Type | Quantity
Summary | true
208. MedicationRequest.dosageInstruction.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.
210. MedicationRequest.dosageInstruction.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.
212. MedicationRequest.dosageInstruction.rate[x]
Definition | The administering speed is used in slow administration of liquid. In practice, the measuring unit is almost always ml/hour. Entering an interval (such as 0-10 ml/hour) is also a commonly used option. For example, with an administering speed of 10ml/hour: amount = 10, dose unit = ml time unit = hour
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
214. MedicationRequest.dispenseRequest
Definition | Indicates the specific details for the dispense or medication supply part of a medication request (also known as a Medication Prescription or Medication Order). Note that this information is not always sent with the order. There may be in some settings (e.g. hospitals) institutional or system support for completing the dispense details in the pharmacy department.
Short | Medication supply authorization
Control | 0..1
Type | BackboneElement
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() | (children().count() > id.count())`)
216. MedicationRequest.dispenseRequest.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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.
218. MedicationRequest.dispenseRequest.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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
220. MedicationRequest.dispenseRequest.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
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
Summary | true
Alternate Names | extensions, user content, modifiers
222. MedicationRequest.dispenseRequest.validityPeriod
Definition | This indicates the validity period of a prescription (stale dating the Prescription).
Short | Time period supply is authorized for
Comments | It reflects the prescribers' perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations.
Control | 0..1
Type | Period
Requirements | Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.
224. MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
Definition | An integer indicating the number of times, in addition to the original dispense, (aka refills or repeats) that the patient can receive the prescribed medication. Usage Notes: This integer does not include the original order dispense. This means that if an order indicates dispense 30 tablets plus "3 repeats", then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets.
Short | Number of refills authorized
Comments | If displaying "number of authorized fills", add 1 to this number.
Control | 0..1
Type | positiveInt
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
226. MedicationRequest.dispenseRequest.quantity
Definition | The amount that is to be dispensed for one fill.
Short | Amount of medication to supply per dispense
Control | 0..1
Type | Quantity(SimpleQuantity)
228. MedicationRequest.dispenseRequest.expectedSupplyDuration
Definition | Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last.
Short | Number of days supply per dispense
Comments | In some situations, this attribute may be used instead of quantity to identify the amount supplied by how long it is expected to last, rather than the physical quantity issued, e.g. 90 days supply of medication (based on an ordered dosage) When possible, it is always better to specify quantity, as this tends to be more precise. expectedSupplyDuration will always be an estimate that can be influenced by external factors.
Control | 0..1
Type | Duration
230. MedicationRequest.dispenseRequest.performer
Definition | Indicates the intended dispensing Organization specified by the prescriber.
Short | Intended dispenser
Control | 0..1
Type | Reference(Organization)
232. MedicationRequest.substitution
Definition | Indicates whether or not substitution can or should be part of the dispense. In some cases substitution must happen, in other cases substitution must not happen. This block explains the prescriber's intent. If nothing is specified substitution may be done.
Short | Any restrictions on medication substitution
Control | 0..1
Type | BackboneElement
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() | (children().count() > id.count())`)
234. MedicationRequest.substitution.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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.
236. MedicationRequest.substitution.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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
238. MedicationRequest.substitution.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
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
Summary | true
Alternate Names | extensions, user content, modifiers
240. MedicationRequest.substitution.allowed
Definition | True if the prescriber allows a different drug to be dispensed from what was prescribed.
Short | Whether substitution is allowed or not
Comments | This element is labeled as a modifer because whether substitution is allow or not cannot be ignored.
Control | 1..1
Type | boolean
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
242. MedicationRequest.substitution.reason
Definition | Indicates the reason for the substitution, or why substitution must or must not be performed.
Short | Why should (not) substitution be made
Control | 0..1
Binding | For example codes, see SubstanceAdminSubstitutionReason (example to `http://hl7.org/fhir/ValueSet/v3-SubstanceAdminSubstitutionReason` ) A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
Type | CodeableConcept
244. MedicationRequest.priorPrescription
Definition | A link to a resource representing an earlier order related order or prescription.
Short | An order/prescription that is being replaced
Control | 0..1
Type | Reference(MedicationRequest)
246. MedicationRequest.detectedIssue
Definition | Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etc.
Short | Clinical Issue with action
Control | 0..*
Type | Reference(DetectedIssue)
Alternate Names | Contraindication, Drug Utilization Review (DUR), Alert
248. MedicationRequest.eventHistory
Definition | Links to Provenance records for past versions of this resource or fulfilling request or event resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resource.
Short | A list of events of interest in the lifecycle
Comments | This may not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).
Control | 0..*
Type | Reference(Provenance)