Generated Narrative: StructureDefinition ee-tis-medication-statement Name Flags Card. Type Description & Constraints MedicationStatement 0..* MedicationStatement Record of medication being taken by a patient #xD; text 0..1 Narrative MedicationStatement is part of Medication Scheme representing one treatmentline #xD; Slices for extension 1..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:extensionEETISPrescriptionValidityTime 0..1 dateTime Validity end date of the prescription(s) in one MedicationStatement. URL: https://fhir.ee/StructureDefinition/ee-tis-prescription-validity-time #xD; extension:extensionEETISMedicationRemainder 0..1 (Complex) Medication left on prescription calculated in days. URL: https://fhir.ee/StructureDefinition/ee-tis-medication-remainder #xD; extension:extensionEETISTotalPrescribedAmount 0..* SimpleQuantity How much in total there is medication prescribed on one Medication Request. Used for calculating the current status of how much medication is left on one Medication Statement row. URL: https://fhir.ee/StructureDefinition/ee-tis-total-prescribed-amount #xD; extension:extensionEETISDispensationAuthorization 1..1 CodeableConcept Defines the authorization of the prescription. URL: https://fhir.ee/StructureDefinition/ee-tis-dispensation-authorization Binding: ER_Volituse liik (required) #xD; extension:extensionEETISCancelledStatusReason 0..1 CodeableConcept Reason for cancelling the prescription. URL: https://fhir.ee/StructureDefinition/ee-tis-cancelled-status-reason Binding: ER_Annulleerimise põhjendused (preferred) #xD; extension:extensionEETISReimbursementRate 0..1 (Complex) Reimbursement rate and reason of prescription medicine. Also speciality of prescriber if available. URL: https://fhir.ee/StructureDefinition/ee-tis-reimbursement-rate #xD; extension:extensionEETISUnauthorizedProductRequest 0..1 (Complex) Müügiloata ravimi taotlus. URL: https://fhir.ee/StructureDefinition/ee-tis-unauthorized-product-request #xD; extension:extensionEETISSubstitution 0..1 (Complex) Reason for not allowing the substitution of medication. URL: https://fhir.ee/StructureDefinition/ee-tis-substitution #xD; extension:extensionEETISVerification 0..* (Complex) Verification of medication scheme URL: https://fhir.ee/StructureDefinition/ee-tis-verification #xD; extension:extensionEETISPrescriptionIntent 0..* code Extension URL: https://fhir.ee/StructureDefinition/ee-tis-prescription-intent Binding: MedicationRequestIntent (preferred) #xD; extension:ExtensionEETISPrescriptionChange 0..* (Complex) Changes on prescription - who changed, when and reason. URL: https://fhir.ee/StructureDefinition/ee-tis-prescription-change #xD; extension:ExtensionEETISGroupedItems 0..* (Complex) Used when there is a need to group several items that contain data about the same line of medication prescribed to the patient. URL: https://fhir.ee/StructureDefinition/ee-tis-grouped-items #xD; identifier 0..* Identifier Identifier is prescription number (ee RETSEPTINUMBER), if the MedicationStatement is generated from RETSEPTIKESKUS prescriptions. In history view identifier system must be used in order to group medications eg. in same dose form etc. #xD; partOf 0..* Reference(EETISMedicationStatement) Part of referenced event #xD; status 1..1 code A code representing the status of recording the medication statement. recorded = KINNITATUD; draft = KINNITAMATA #xD; Slices for category 3..* CodeableConcept Type of medication statement Slice: Unordered, Open by value:$this #xD; category:courseOfTherapyType 1..* CodeableConcept What type of medication course is. RAVIKUURI TÜÜP. LOEND. pidev | fikseeritud | vajadusel | muutuv | ühekordne | Binding: ER_Ravikuuritüüp (required) #xD; category:prescriptionCategory 1..* CodeableConcept Whether the prescription is for regular medication, narcotics or medical device.RETSEPTI LIIK. LOEND. tavaretsept | narkootilise ravimi retsept | meditsiiniseadme retsept Binding: ER_Retsepti liik (required) #xD; category:repeatCategory 1..* CodeableConcept Whether the prescription is one-time prescription or multiple.RETSEPTI KORDSUS. LOEND. 1-kordne | 2-kordne | 3-kordne | 6-kordne Binding: ER_Retsepti kordsus (required) #xD; category:statementOriginCategory 0..* CodeableConcept Category defining the origin of MedicationStatement. USED ONLY when medication scheme line is based on patient's statement. Binding: Ravimi andmete tüüp (required) #xD; medication 1..1 CodeableReference(EETISMedicationEPC | EETISMedicationExtemporal) What medication was taken #xD; subject 1..1 Reference(EE MPI Patient Verified) Who is/was taking the medication #xD; encounter 0..0 Encounter associated with MedicationStatement #xD; effective[x] 1..1 Period Time period when the treatment line begins and ends #xD; informationSource 0..* Reference(EEBase Practitioner(2.0.0) | EETISPractitionerRole) Initial author of the MedicationStatement. The person or organization that provided the information about the taking of this medication. Note: Use derivedFrom when a MedicationStatement is derived from other resources, e.g. Claim or MedicationRequest. #xD; derivedFrom 0..* Reference(EETISPrescription) {r} Prescriptions created elsewhere than in TJT. Link to information used to derive the MedicationStatement #xD; reason 0..* CodeableReference(Condition | Observation | DiagnosticReport) Diagnose for medication. ICD-10 codes from Estonian Prescription Centre. Reimbursement of medication depends on which ICD-10 code is used. Binding: RHK-10 (preferred) #xD; note 0..* Annotation Siia saab kirjutada märkusi ravimiskeemi rea kohta. #xD; author[x] 1..1 Reference(Practitioner | PractitionerRole | Patient | RelatedPerson | Organization), string Individual responsible for the annotation #xD; relatedClinicalInformation 0..0 Link to information relevant to the usage of a medication #xD; dosage 0..* EETISDosage Indicates how the medication is/was or should be taken by the patient. #xD; additionalInstruction 0..* CodeableConcept Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps"). #xD; maxDosePerAdministration #xD; unit 0..0 Unit representation #xD; adherence 0..0 Indicates whether the medication is or is not being consumed or administered #xD; Documentation for this format
Ravimiskeemi rida. One or more Medication Statements form patient's Medication Scheme.
Record of medication being taken by a patient
A record of a medication that is being consumed by a patient. A MedicationStatement may indicate that the patient may be taking the medication now or has taken the medication in the past or will be taking the medication in the future. The source of this information can be the patient, significant other (such as a family member or spouse), or a clinician. A common scenario where this information is captured is during the history taking process during a patient visit or stay. The medication information may come from sources such as the patient's memory, from a prescription bottle, or from a list of medications the patient, clinician or other party maintains. The primary difference between a medicationstatement and a medicationadministration is that the medication administration has complete administration information and is based on actual administration information from the person who administered the medication. A medicationstatement is often, if not always, less specific. There is no required date/time when the medication was administered, in fact we only know that a source has reported the patient is taking this medication, where details such as time, quantity, or rate or even medication product may be incomplete or missing or less precise. As stated earlier, the Medication Statement information may come from the patient's memory, from a prescription bottle or from a list of medications the patient, clinician or other party maintains. Medication administration is more formal and is not missing detailed information. The MedicationStatement resource was previously called MedicationStatement.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
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()
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
Entity, Role, or Act,SubstanceAdministration
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
The base language in which the resource is written.
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).
MedicationStatement is part of Medication Scheme representing one treatmentline
A human-readable narrative that contains a summary of the resource and can 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.
Contained resources do not have a 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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.
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. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.
Must have either extensions or value[x], not both
Validity end date of the prescription(s) in one MedicationStatement.
Medication left on prescription calculated in days.
How much in total there is medication prescribed on one Medication Request. Used for calculating the current status of how much medication is left on one Medication Statement row.
Kui palju on ravimit koguseliselt välja kirutatud - näiteks 120 tabletti. Selle pealt saab arvutada JÄÄKI. Väljakirjutatud kogus.
Defines the authorization of the prescription.
Volituse liik. Digiretsepti koostamisel on patsiendil võimalik piirata ravimi väljaostu õiguseid. Vaikimisi on küll kõik retseptid avalikud, kuid seda staatust saab muuta arst retsepti koostamisel või patsient terviseportaalis.
Reimbursement rate and reason of prescription medicine. Also speciality of prescriber if available.
Ravimi soodustuse määr protsentides Retseptikeskuse loendist "Soodustuste määrad" ning tingimused "Vajalikud tingimused" -loendist soodustuse saamiseks. Juhul kui retseptid genereeritakse, siis ka soodustuse määraja erialakood.
Used for requesting marketing permit for unauthorized medication.
Reason for not allowing the substitution of medication.
Optional Extension Element - found in all resources.
Kas retsept on "order" või "proposal". Viimane on müügiloata ravimite puhul. Intent of prescription.
Changes on prescription - who changed, when and reason.
Retsepti muutmine, kes muutis, millal ja põhjus loendist.
Used when there is a need to group several items that contain data about the same line of medication prescribed to the patient.
Grupeerija. Viide ravimiskeemi reale, kus mitu ravimiskeemi rida on kokku grupeeritud.
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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
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.
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Identifier is prescription number (ee RETSEPTINUMBER), if the MedicationStatement is generated from RETSEPTIKESKUS prescriptions. In history view identifier system must be used in order to group medications eg. in same dose form etc.
Identifiers associated with this Medication Statement 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. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.
This is a business identifier, not a resource identifier.
A larger event of which this particular MedicationStatement is a component or step.
.outboundRelationship[typeCode=COMP]/target[classCode=SPLY or SBADM or PROC or OBS,moodCode=EVN]
A code representing the status of recording the medication statement. recorded = KINNITATUD; draft = KINNITAMATA
recorded = Kinnitatud; draft = Kinnitamata. Retseptikeskuse retsepti põhjal genereeritud kinnitamata rida on staatuses recorded/kinnitatud.
This status concerns just the recording of the medication statement. MedicationStatement.adherence should be used for indicating a patient's adherence to the information in this resource. Note, the statuses are different than in previous releases for MedicationStatement or MedicationStatement. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
A coded concept indicating the current status of a MedicationStatement.
Type of medication statement (for example, drug classification like ATC, where meds would be administered, legal category of the medication.).
A coded concept identifying where the medication included in the MedicationStatement is expected to be consumed or administered.
.inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication statement"].value
What type of medication course is. RAVIKUURI TÜÜP. LOEND. pidev | fikseeritud | vajadusel | muutuv | ühekordne |
RAVIKUURI TÜÜP. LOEND. pidev | fikseeritud | vajadusel | muutuv | ühekordne |
Whether the prescription is for regular medication, narcotics or medical device.RETSEPTI LIIK. LOEND. tavaretsept | narkootilise ravimi retsept | meditsiiniseadme retsept
RETSEPTI LIIK. LOEND. tavaretsept | narkootilise ravimi retsept | meditsiiniseadme retsept
Whether the prescription is one-time prescription or multiple.RETSEPTI KORDSUS. LOEND. 1-kordne | 2-kordne | 3-kordne | 6-kordne
RETSEPTI KORDSUS. LOEND. 1-kordne | 2-kordne | 3-kordne | 6-kordne
Category defining the origin of MedicationStatement. USED ONLY when medication scheme line is based on patient's statement.
Seda kategooriat kasutada AINULT juhul, kui ravimiskeemi rida genereeritakse patsiendi sõnul. Kasutada koodi |ASK| loendist ravimi-andmete-tyyp. Retseptikeskuse retseptidest loodud ravimiskeemi rea puhul jääb see kategooria TÜHJAKS.
Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.
If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example, if you require form or lot number, then you must reference the Medication resource.
A coded concept identifying the substance or product being taken.
.participation[typeCode=CSM].role[classCode=ADMM or MANU]
The person, animal or group who is/was taking the medication.
Encounter associated with MedicationStatement
The encounter that establishes the context for this MedicationStatement.
.inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]
Time period when the treatment line begins and ends
This attribute reflects the period over which the patient consumed the medication and is expected to be populated on the majority of Medication Statements. If the medication is still being taken and is expected to continue indefinitely at the time the usage is recorded, the "end" date will be omitted. If the end date is known, then it is included as the "end date". The date/time attribute supports a variety of dates - year, year/month and exact date. If something more than this is required, this should be conveyed as text.
The date when the Medication Statement was asserted by the information source.
Initial author of the MedicationStatement. The person or organization that provided the information about the taking of this medication. Note: Use derivedFrom when a MedicationStatement is derived from other resources, e.g. Claim or MedicationRequest.
AUTOR KES KOOSTAB RAVIMISKEEMI REA (arst). Ravimiskeemi rea (algne) koostaja.
.participation[typeCode=INF].role[classCode=PAT, or codes for Practitioner or Related Person (if PAT is the informer, then syntax for self-reported =true)
Prescriptions created elsewhere than in TJT. Link to information used to derive the MedicationStatement
Likely references would be to MedicationRequest, MedicationDispense, Claim, Observation or QuestionnaireAnswers. The most common use cases for deriving a MedicationStatement comes from creating a MedicationStatement from a MedicationRequest or from a lab observation or a claim. it should be noted that the amount of information that is available varies from the type resource that you derive the MedicationStatement from.
Diagnose for medication. ICD-10 codes from Estonian Prescription Centre. Reimbursement of medication depends on which ICD-10 code is used.
Diagnoosikoodid (RHK-10) DIAGNOOSIKOOD retseptikeskusest
This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonForUseReference.
Siia saab kirjutada märkusi ravimiskeemi rea kohta.
Provides extra information about the Medication Statement that is not conveyed by the other attributes.
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Individual responsible for the annotation
The individual responsible for making the annotation.
Organization is used when there's no need for specific attribution as to who made the comment.
Indicates when this particular annotation was made.
The annotation - text content (as markdown)
The text of the annotation in markdown format.
Link to information relevant to the usage of a medication
Link to information that is relevant to a medication statement, for example, illicit drug use, gestational age, etc.
Full representation of the dosage instructions
The full representation of the dose of the medication included in all dosage instructions. To be used when multiple dosage instructions are included to represent complex dosing such as increasing or tapering doses.
The content of the renderedDosageInstructions must not be different than the dose represented in the dosageInstruction content.
Indicates how the medication is/was or should be taken by the patient.
The dates included in the dosage on a Medication Statement reflect the dates for a given dose. For example, "from November 1, 2016 to November 3, 2016, take one tablet daily and from November 4, 2016 to November 7, 2016, take two tablets daily." It is expected that this specificity may only be populated where the patient brings in their labeled container or where the Medication Statement is derived from a MedicationRequest.
Extensions that cannot be ignored even if unrecognized
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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
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.
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. Additional information about administration or preparation of the medication should be included as text.
Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").
Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or take "immediately following drug x") should be populated in dosage.text.
Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.
A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
Patient or consumer oriented instructions
This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.
The timing schedule for giving the medication to the patient. This 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.
Identifies specific times when the event occurs.
In a Medication Administration Record, for instance, you need to take a general specification, and turn it into a precise specification.
Many timing schedules are determined by regular repetitions.
if there's a duration, there needs to be duration units
duration.empty() or durationUnit.exists()
if there's a period, there needs to be period units
If there's a periodMax, there must be a period
If there's a durationMax, there must be a duration
durationMax.empty() or duration.exists()
If there's a countMax, there must be a count
If there's an offset, there must be a when (and not C, CM, CD, CV)
offset.empty() or (when.exists() and when.select($this in ('C' | 'CM' | 'CD' | 'CV')).allFalse())
If there's a timeOfDay, there cannot be a when, or vice versa
Length/Range of lengths, or (Start and/or end) limits.
Ravikuuri piirid (pikkus/ulatus/kestus). Either a duration for the length of the timing schedule, a range of possible length, or outer bounds for start and/or end limits of the timing schedule.
If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.
Repetitions may be limited by end time or total occurrences.
MAKSIMAALNE KORDUSTE ARV. If present, indicates that the count is a range - so to perform the action between [count] and [countMax] times.
KESTUS. How long this thing happens for when it happens. If durationMax is present, this element indicates the lower bound of the allowed range of the duration.
For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).
Some activities are not instantaneous and need to be maintained for a period of time.
MAKSIMAALNE KESTUS. If present, indicates that the duration is a range - so to perform the action between [duration] and [durationMax] time length.
KESTUS ja ÜHIK. The units of time for the duration, in UCUM units Normal practice is to use the 'mo' code as a calendar month when calculating the next occurrence.
Indicates the number of repetitions that should occur within a period. I.e. Event occurs frequency times per period
SAGEDUS. Ühekordse annuse kordsus/annustamiste arv perioodis. The number of times to repeat the action within the specified period. If frequencyMax is present, this element indicates the lower bound of the allowed range of the frequency.
If no frequency is stated, the assumption is that the event occurs once per period, but systems SHOULD always be specific about this
Event occurs up to frequencyMax times per period
MAKSIMAALNE ANNUSTAMISTE ARV. If present, indicates that the frequency is a range - so to repeat between [frequency] and [frequencyMax] times within the period or period range.
The duration to which the frequency applies. I.e. Event occurs frequency times per period
KUI SAGEDASTI ANNUSTATAKSE JA ÜHIK. Indicates the duration of time over which repetitions are to occur; e.g. to express "3 times per day", 3 would be the frequency and "1 day" would be the period. If periodMax is present, this element indicates the lower bound of the allowed range of the period length.
MAKSIMAALNE PERIOOD ANNUSTAMISE VAHEL. If present, indicates that the period is a range from [period] to [periodMax], allowing expressing concepts such as "do this once every 3-5 days.
s | min | h | d | wk | mo | a - unit of time (UCUM)
The units of time for the period in UCUM units Normal practice is to use the 'mo' code as a calendar month when calculating the next occurrence.
If one or more days of week is provided, then the action happens only on the specified day(s).
NÄDALAPÄEV. If one or more days of week is provided, then the action happens only on the specified day(s).
If no days are specified, the action is assumed to happen every day as otherwise specified.
Specified time of day for action to take place.
PÄEVA OSA. Specified time of day for action to take place.
When time of day is specified, it is inferred that the action happens every day (as filtered by dayofWeek) on the specified times. If there's a timeOfDay, there cannot be a when, or vice versa.
When more than one event is listed, the event is tied to the union of the specified events.
Timings are frequently determined by occurrences such as waking, eating and sleep.
Real-world event relating to the schedule.
C | BID | TID | QID | AM | PM | QD | QOD | +
A code for the timing schedule (or just text in code.text). Some codes such as BID are ubiquitous, but many institutions define their own additional codes. If a code is provided, the code is understood to be a complete statement of whatever is specified in the structured timing data, and either the code or the data may be used to interpret the Timing, with the exception that .repeat.bounds still applies over the code (and is not contained in the code).
BID etc. are defined as 'at institutionally specified times'. For example, an institution may choose that BID is "always at 7am and 6pm". If it is inappropriate for this choice to be made, the code BID should not be used. Instead, a distinct organization-specific code should be used in place of the HL7-defined BID code and/or a structured representation should be used (in this case, specifying the two event times).
Code for a known / defined timing pattern.
Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated.
.outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept
Indicates whether the Medication is only taken based on a precondition for taking the Medication (CodeableConcept).
Can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be False, then the dose is given according to the schedule and is not "prn" or "as needed".
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.
If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [http://hl7.org/fhir/StructureDefinition/bodySite](http://hl7.org/fhir/extensions/StructureDefinition-bodySite.html). May be a summary code, or a reference to a very precise definition of the location, or both.
A coded specification of the anatomic site where the medication first enters the body.
A coded concept describing the site location the medicine enters into or onto the body.
A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.
A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
Terminologies used often pre-coordinate this term with the route and or form of administration.
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.
A coded concept describing the technique by which the medicine is administered.
Amount of medication administered, to be administered or typical amount to be administered
SubstanceAdministration.doseQuantity; SubstanceAdministration.RateQuantity
The kind of dose or rate specified, for example, ordered or calculated.
If the type is not populated, assume to be "ordered".
RAVIMI KOGUS ANNUSE KOHTA. Loendis on koodid nagu näiteks TA -tablett, TK - tükk, CP- kapsel, MA - mõõtannus jne. Amount of medication per dose.
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.
The amount of therapeutic or other substance given at one administration event.
MANUSTAMISE KIIRUS. Amount of medication per unit of time.
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. It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammar where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.
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.
Upper limit on medication per unit of time
MAKSIMAALNE ANNUS PERIOODIS. Upper limit on medication per unit of time.
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".
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.
Upper limit on medication per administration
MAKSIMAALNE ANNUS ÜHE ANNUSTAMISE KOHTA. Upper limit on medication per administration.
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.
The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.
Numerical value (with implicit precision)
The value of the measured amount. The value includes an implicit precision in the presentation of the value.
The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).
Precision is handled implicitly in almost all cases of measurement.
PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value
< | <= | >= | > | ad - how to understand the value
Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.
If there is no comparator, then there is no modification of the value
This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
How the Quantity should be understood and represented.
There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.
The identification of the system that provides the coded form of the unit.
Need to know the system that defines the coded form of the unit.
CO.codeSystem, PQ.translation.codeSystem
A computer processable form of the unit in some unit representation system.
The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.
Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.
PQ.code, MO.currency, PQ.translation.code
Upper limit on medication per lifetime of the patient
MAKSIMAALNE ANNUS ELUS. Upper limit on medication per lifetime of the patient.
The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.
Indicates whether the medication is or is not being consumed or administered
Indicates whether the medication is or is not being consumed or administered.
This element can be used to indicate whether a patient is following a course of treatment as instructed/prescribed or whether they are taking medications of their own volition. It can also be used to indicate that a patient is not taking a medication, either because they were told not to or because they decided on their own.
Type of the adherence for the medication.
Details of the reason for the current use of the medication
Captures the reason for the current use or adherence of a medication.
This is generally only used for "exception" statuses such as "entered-in-error". The reason for performing the event at all is captured in reasonCode, not here.
.inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCode