LK NEHR Sri Lanka Patient Summary (IPS based) Implementation Guide
0.1.0 - STU1 Sri Lanka flag

LK NEHR Sri Lanka Patient Summary (IPS based) Implementation Guide, published by Ministry of Health, Sri Lanka. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/lk-gov-health-hiu/lk-nehr-fhir-ips/ and changes regularly. See the Directory of published versions

Resource Profile: MedicationRequests - Detailed Descriptions

Active as of 2024-11-14

Definitions for the medication-request resource profile.

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

0. MedicationRequest
2. MedicationRequest.identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
Control1..?
SlicingThis element introduces a set of slices on MedicationRequest.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ system
  • 4. MedicationRequest.identifier:RequestID
    Slice NameRequestID
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control1..1
    6. MedicationRequest.identifier:RequestID.type
    8. MedicationRequest.identifier:RequestID.type.coding
    10. MedicationRequest.identifier:RequestID.type.coding.system
    Pattern Valuehttp://terminology.hl7.org/CodeSystem/v2-0203
    12. MedicationRequest.identifier:RequestID.type.coding.code
    Pattern ValueFILL
    14. MedicationRequest.identifier:RequestID.type.coding.display
    Pattern ValueFiller Identifier
    16. MedicationRequest.identifier:RequestID.type.text
    Pattern ValuePrescription identifier
    18. MedicationRequest.identifier:RequestID.system
    Control1..?
    Pattern Valuehttp://fhir.health.gov.lk/ips/identifier/medication
    20. MedicationRequest.identifier:RequestID.value
    Control1..?
    22. MedicationRequest.medication[x]
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    SlicingThis element introduces a set of slices on MedicationRequest.medication[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • type @ $this
    • 24. MedicationRequest.medication[x]:medicationCodeableConcept
      Slice NamemedicationCodeableConcept
      Control1..1
      BindingUnless not suitable, these codes SHALL be taken from Medication Names For Pharmacy
      (extensible to http://fhir.health.gov.lk/ips/ValueSet/vs-medication-name-msd)
      TypeCodeableConcept
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      26. MedicationRequest.subject
      TypeReference(Patient)
      28. MedicationRequest.encounter
      Control1..?
      TypeReference(Target Facility Encounter)
      30. MedicationRequest.authoredOn
      Control1..?
      32. MedicationRequest.requester
      Definition

      reason(s) why this should be supported.

      TypeReference(Practitioner, Patient, Device Information)
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      34. MedicationRequest.performer
      Definition

      reason(s) why this should be supported.

      TypeReference(Practitioner, Patient, Device Information)
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      36. MedicationRequest.recorder
      Definition

      reason(s) why this should be supported.

      TypeReference(Practitioner)
      Must Supporttrue
      38. MedicationRequest.note
      Definition

      reason(s) why this should be supported.

      Must Supporttrue
      40. MedicationRequest.dosageInstruction
      42. MedicationRequest.dosageInstruction.timing
      InvariantsMedicationRequest-DosageInstruction-1: If the Repeat Frequency does not exist then the Timing Code SHALL be present. (repeat.frequency.exists().not() implies code.exists())
      44. MedicationRequest.dosageInstruction.timing.repeat
      46. MedicationRequest.dosageInstruction.timing.repeat.count
      Control1..?
      48. MedicationRequest.dosageInstruction.timing.repeat.duration
      Control1..?
      50. MedicationRequest.dosageInstruction.timing.repeat.durationUnit
      Control1..?
      52. MedicationRequest.dosageInstruction.timing.repeat.frequency
      Definition

      reason(s) why this should be supported.

      Must Supporttrue
      54. MedicationRequest.dosageInstruction.timing.repeat.period
      Definition

      reason(s) why this should be supported.

      Must Supporttrue
      56. MedicationRequest.dosageInstruction.timing.repeat.periodUnit
      Definition

      reason(s) why this should be supported.

      Must Supporttrue
      58. MedicationRequest.dosageInstruction.timing.code
      Definition

      reason(s) why this should be supported.

      BindingThe codes SHOULD be taken from Drug Frequency Codes
      (preferred to http://fhir.health.gov.lk/ips/ValueSet/vs-drug-frequency)
      Must Supporttrue
      60. MedicationRequest.dosageInstruction.doseAndRate
      62. MedicationRequest.dosageInstruction.doseAndRate.dose[x]
      Control1..?
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.doseAndRate.dose[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • type @ $this
      • 64. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity
        Slice NamedoseQuantity
        Control1..1
        TypeQuantity(SimpleQuantity)
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        66. MedicationRequest.dispenseRequest
        68. MedicationRequest.dispenseRequest.quantity
        Definition

        reason(s) why this should be supported.

        Must Supporttrue

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

        0. MedicationRequest
        Definition

        An order or request for both supply of the medication and the instructions for administration of the medication to a patient. The resource is called "MedicationRequest" rather than "MedicationPrescription" or "MedicationOrder" to generalize the use across inpatient and outpatient settings, including care plans, etc., and to harmonize with workflow patterns.

        ShortOrdering of medication for patient or group
        Control0..*
        Is Modifierfalse
        Summaryfalse
        Alternate NamesPrescription, Order
        Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
        dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
        dom-6: A resource should have narrative for robust management (text.`div`.exists())
        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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

        ShortA set of rules under which this content was created
        Comments

        Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

        Control0..1
        Typeuri
        Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        4. 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 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 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.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored
        Comments

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

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Summaryfalse
        Requirements

        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.

        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        6. MedicationRequest.identifier
        Definition

        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. 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.

        ShortExternal ids for this request
        Comments

        This is a business identifier, not a resource identifier.

        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control10..*
        TypeIdentifier
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on MedicationRequest.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ system
        • 8. MedicationRequest.identifier:RequestID
          Slice NameRequestID
          Definition

          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. 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.

          ShortExternal ids for this request
          Comments

          This is a business identifier, not a resource identifier.

          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control10..1*
          TypeIdentifier
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          10. MedicationRequest.identifier:RequestID.use
          Definition

          The purpose of this identifier.

          Shortusual | official | temp | secondary | old (If known)
          Comments

          Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

          Control0..1
          BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
          (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

          Identifies the purpose for this identifier, if known .

          Typecode
          Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          12. MedicationRequest.identifier:RequestID.system
          Definition

          Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

          ShortThe namespace for the identifier value
          Comments

          Identifier.system is always case sensitive.

          Control10..1
          Typeuri
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

          Pattern Valuehttp://fhir.health.gov.lk/ips/identifier/medication
          Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          14. MedicationRequest.identifier:RequestID.value
          Definition

          The portion of the identifier typically relevant to the user and which is unique within the context of the system.

          ShortThe value that is unique
          Comments

          If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

          Control10..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Example<br/><b>General</b>:123456
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          16. MedicationRequest.status
          Definition

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

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

          In the scope of the IPS the entered-in-error concept is not allowed.


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

          Control1..1
          BindingThe codes SHALL be taken from medicationrequest Statushttp://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1
          (required to http://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1)

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

          Typecode
          Is Modifiertrue because This element is labeled 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
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          18. MedicationRequest.intent
          Definition

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

          Shortproposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
          Comments

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

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

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

          Control1..1
          BindingThe codes SHALL be taken from medicationRequest Intenthttp://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1
          (required to http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1)

          The kind of medication order.

          Typecode
          Is Modifiertrue because This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          20. MedicationRequest.doNotPerform
          Definition

          If true indicates that the provider is asking for the medication request not to occur.

          ShortTrue if request is prohibiting action
          Comments

          If do not perform is not specified, the request is a positive request e.g. "do perform".

          Control0..1
          Typeboolean
          Is Modifiertrue because This element is labeled as a modifier because this element negates the request to occur (ie, this is a request for the medication not to be ordered or prescribed, etc)
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          22. MedicationRequest.medication[x]
          Definition

          Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code. To improve global interoperability is strongly encouraged that the reference to a medication resource is used, limiting the usage of the medicationCodeableConcept only to the cases in which no other information than a simple code is available.


          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.

          ShortMedication to be taken
          Comments

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

          Control1..1
          BindingThe codes SHOULD be taken from For example codes, see Medications - SNOMED CT + Absent/Unknown (IPS)http://hl7.org/fhir/ValueSet/medication-codes
          (preferred to http://hl7.org/fhir/uv/ips/ValueSet/medication-snomed-absent-unknown-uv-ips)

          SNOMED CT medications (Pharmaceutical / biologic product) or a code for absent/unknown medication


          A coded concept identifying substance or product that can be ordered.

          TypeCodeableConcept, Reference(Medication)
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on MedicationRequest.medication[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
          • type @ $this
          • 24. MedicationRequest.medication[x]:medicationCodeableConcept
            Slice NamemedicationCodeableConcept
            Definition

            Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code. To improve global interoperability is strongly encouraged that the reference to a medication resource is used, limiting the usage of the medicationCodeableConcept only to the cases in which no other information than a simple code is available.


            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.

            ShortMedication to be taken
            Comments

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

            Control1..1
            BindingUnless not suitable, these codes SHALL be taken from For example codes, see Medication Names For Pharmacyhttp://hl7.org/fhir/ValueSet/medication-codes
            (extensible to http://fhir.health.gov.lk/ips/ValueSet/vs-medication-name-msd)
            TypeCodeableConcept, Reference(Medication)
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            26. MedicationRequest.subject
            Definition

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

            ShortWho or group medication request is for
            Comments

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

            Control1..1
            TypeReference(Patient, Patient, Group)
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            28. MedicationRequest.subject.reference
            Definition

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

            ShortLiteral reference, Relative, internal or absolute URL
            Comments

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

            Control10..1
            This element is affected by the following invariants: ref-1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            30. MedicationRequest.encounter
            Definition

            The Encounter during which this [x] was created or to which the creation of this record is tightly associated.

            ShortEncounter created as part of encounter/admission/stay
            Comments

            This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter." If there is a need to link to episodes of care they will be handled with an extension.

            Control10..1
            TypeReference(Target Facility Encounter, Encounter)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            32. MedicationRequest.authoredOn
            Definition

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

            ShortWhen request was initially authored
            Control10..1
            TypedateTime
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            34. MedicationRequest.requester
            Definition

            reason(s) why this should be supported.


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

            ShortWho/What requested the Request
            Control0..1
            TypeReference(Practitioner, Patient, Device Information, Practitioner, PractitionerRole, Organization, Patient, RelatedPerson, Device)
            Is Modifierfalse
            Must Supporttrue
            Must Support TypesNo must-support rules about the choice of types/profiles
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            36. MedicationRequest.performer
            Definition

            reason(s) why this should be supported.


            The specified desired performer of the medication treatment (e.g. the performer of the medication administration).

            ShortIntended performer of administration
            Control0..1
            TypeReference(Practitioner, Patient, Device Information, Practitioner, PractitionerRole, Organization, Patient, Device, RelatedPerson, CareTeam)
            Is Modifierfalse
            Must Supporttrue
            Must Support TypesNo must-support rules about the choice of types/profiles
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            38. MedicationRequest.recorder
            Definition

            reason(s) why this should be supported.


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

            ShortPerson who entered the request
            Control0..1
            TypeReference(Practitioner, Practitioner, PractitionerRole)
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            40. MedicationRequest.note
            Definition

            reason(s) why this should be supported.


            Extra information about the prescription that could not be conveyed by the other attributes.

            ShortInformation about the prescription
            Control0..*
            TypeAnnotation
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            42. MedicationRequest.dosageInstruction
            Definition

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

            ShortHow the medication should be taken
            Comments

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

            Control0..*
            TypeDosage
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            44. MedicationRequest.dosageInstruction.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 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 manageable, 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).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

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

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Requirements

            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.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            46. MedicationRequest.dosageInstruction.text
            Definition

            Free text dosage instructions e.g. SIG.

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

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

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            48. MedicationRequest.dosageInstruction.timing
            Definition

            When medication should be administered.

            ShortWhen medication should be administered
            Comments

            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.

            Control0..1
            TypeTiming
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

            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.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            MedicationRequest-DosageInstruction-1: If the Repeat Frequency does not exist then the Timing Code SHALL be present. (repeat.frequency.exists().not() implies code.exists())
            50. MedicationRequest.dosageInstruction.timing.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 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 manageable, 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).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

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

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Requirements

            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.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            52. MedicationRequest.dosageInstruction.timing.repeat
            Definition

            A set of rules that describe when the event is scheduled.

            ShortWhen the event is to occur
            Control0..1
            TypeElement
            Is Modifierfalse
            Summarytrue
            Requirements

            Many timing schedules are determined by regular repetitions.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            tim-1: if there's a duration, there needs to be duration units (duration.empty() or durationUnit.exists())
            tim-2: if there's a period, there needs to be period units (period.empty() or periodUnit.exists())
            tim-4: duration SHALL be a non-negative value (duration.exists() implies duration >= 0)
            tim-5: period SHALL be a non-negative value (period.exists() implies period >= 0)
            tim-6: If there's a periodMax, there must be a period (periodMax.empty() or period.exists())
            tim-7: If there's a durationMax, there must be a duration (durationMax.empty() or duration.exists())
            tim-8: If there's a countMax, there must be a count (countMax.empty() or count.exists())
            tim-9: If there's an offset, there must be a when (and not C, CM, CD, CV) (offset.empty() or (when.exists() and ((when in ('C' | 'CM' | 'CD' | 'CV')).not())))
            tim-10: If there's a timeOfDay, there cannot be a when, or vice versa (timeOfDay.empty() or when.empty())
            tim-1: if there's a duration, there needs to be duration units (duration.empty() or durationUnit.exists())
            tim-2: if there's a period, there needs to be period units (period.empty() or periodUnit.exists())
            tim-4: duration SHALL be a non-negative value (duration.exists() implies duration >= 0)
            tim-5: period SHALL be a non-negative value (period.exists() implies period >= 0)
            tim-6: If there's a periodMax, there must be a period (periodMax.empty() or period.exists())
            tim-7: If there's a durationMax, there must be a duration (durationMax.empty() or duration.exists())
            tim-8: If there's a countMax, there must be a count (countMax.empty() or count.exists())
            tim-9: If there's an offset, there must be a when (and not C, CM, CD, CV) (offset.empty() or (when.exists() and ((when in ('C' | 'CM' | 'CD' | 'CV')).not())))
            tim-10: If there's a timeOfDay, there cannot be a when, or vice versa (timeOfDay.empty() or when.empty())
            54. MedicationRequest.dosageInstruction.timing.repeat.count
            Definition

            A total count of the desired number of repetitions across the duration of the entire timing specification. If countMax is present, this element indicates the lower bound of the allowed range of count values.

            ShortNumber of times to repeat
            Comments

            If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.

            Control10..1
            TypepositiveInt
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Repetitions may be limited by end time or total occurrences.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            56. MedicationRequest.dosageInstruction.timing.repeat.duration
            Definition

            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.

            ShortHow long when it happens
            Comments

            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).

            Control10..1
            Typedecimal
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Some activities are not instantaneous and need to be maintained for a period of time.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            58. MedicationRequest.dosageInstruction.timing.repeat.durationUnit
            Definition

            The units of time for the duration, in UCUM units.

            Shorts | min | h | d | wk | mo | a - unit of time (UCUM)
            Control10..1
            BindingThe codes SHALL be taken from UnitsOfTimehttp://hl7.org/fhir/ValueSet/units-of-time|4.0.1
            (required to http://hl7.org/fhir/ValueSet/units-of-time|4.0.1)

            A unit of time (units from UCUM).

            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            60. MedicationRequest.dosageInstruction.timing.repeat.frequency
            Definition

            reason(s) why this should be supported.


            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.

            ShortEvent occurs frequency times per period
            Control0..1
            TypepositiveInt
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Meaning if MissingIf no frequency is stated, the assumption is that the event occurs once per period, but systems SHOULD always be specific about this
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            62. MedicationRequest.dosageInstruction.timing.repeat.period
            Definition

            reason(s) why this should be supported.


            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.

            ShortEvent occurs frequency times per period
            Control0..1
            Typedecimal
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            64. MedicationRequest.dosageInstruction.timing.repeat.periodUnit
            Definition

            reason(s) why this should be supported.


            The units of time for the period in UCUM units.

            Shorts | min | h | d | wk | mo | a - unit of time (UCUM)
            Control0..1
            BindingThe codes SHALL be taken from UnitsOfTimehttp://hl7.org/fhir/ValueSet/units-of-time|4.0.1
            (required to http://hl7.org/fhir/ValueSet/units-of-time|4.0.1)

            A unit of time (units from UCUM).

            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            66. MedicationRequest.dosageInstruction.timing.code
            Definition

            reason(s) why this should be supported.


            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).

            ShortBID | TID | QID | AM | PM | QD | QOD | +
            Comments

            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).

            Control0..1
            BindingThe codes SHOULD be taken from Drug Frequency Codeshttp://hl7.org/fhir/ValueSet/timing-abbreviation
            (preferred to http://fhir.health.gov.lk/ips/ValueSet/vs-drug-frequency)
            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            68. MedicationRequest.dispenseRequest
            Definition

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

            ShortMedication supply authorization
            Control0..1
            TypeBackboneElement
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            70. 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 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 manageable, 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).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

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

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Requirements

            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.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            72. MedicationRequest.dispenseRequest.quantity
            Definition

            reason(s) why this should be supported.


            The amount that is to be dispensed for one fill.

            ShortAmount of medication to supply per dispense
            Control0..1
            TypeQuantity(SimpleQuantity)
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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

            0. MedicationRequest
            Definition

            An order or request for both supply of the medication and the instructions for administration of the medication to a patient. The resource is called "MedicationRequest" rather than "MedicationPrescription" or "MedicationOrder" to generalize the use across inpatient and outpatient settings, including care plans, etc., and to harmonize with workflow patterns.

            ShortOrdering of medication for patient or group
            Control0..*
            Is Modifierfalse
            Summaryfalse
            Alternate NamesPrescription, Order
            Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
            dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
            dom-6: A resource should have narrative for robust management (text.`div`.exists())
            2. MedicationRequest.id
            Definition

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

            ShortLogical id of this artifact
            Comments

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

            Control0..1
            Typeid
            Is Modifierfalse
            Summarytrue
            4. MedicationRequest.meta
            Definition

            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.

            ShortMetadata about the resource
            Control0..1
            TypeMeta
            Is Modifierfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

            ShortA set of rules under which this content was created
            Comments

            Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

            Control0..1
            Typeuri
            Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            8. MedicationRequest.language
            Definition

            The base language in which the resource is written.

            ShortLanguage of the resource content
            Comments

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

            Control0..1
            BindingThe codes SHOULD be taken from CommonLanguages
            (preferred to http://hl7.org/fhir/ValueSet/languages)

            A human language.

            Additional BindingsPurpose
            AllLanguagesMax Binding
            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            10. MedicationRequest.text
            Definition

            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.

            ShortText summary of the resource, for human interpretation
            Comments

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

            Control0..1
            TypeNarrative
            Is Modifierfalse
            Summaryfalse
            Alternate Namesnarrative, html, xhtml, display
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            12. MedicationRequest.contained
            Definition

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

            ShortContained, inline Resources
            Comments

            This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

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

            May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

            ShortAdditional content defined by implementations
            Comments

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

            Control0..*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Alternate Namesextensions, user content
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            16. 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 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 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.

            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

            ShortExtensions that cannot be ignored
            Comments

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

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
            Summaryfalse
            Requirements

            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.

            Alternate Namesextensions, user content
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            18. MedicationRequest.identifier
            Definition

            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. 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.

            ShortExternal ids for this request
            Comments

            This is a business identifier, not a resource identifier.

            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control1..*
            TypeIdentifier
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            SlicingThis element introduces a set of slices on MedicationRequest.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ system
            • 20. MedicationRequest.identifier:RequestID
              Slice NameRequestID
              Definition

              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. 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.

              ShortExternal ids for this request
              Comments

              This is a business identifier, not a resource identifier.

              NoteThis is a business identifier, not a resource identifier (see discussion)
              Control1..1
              TypeIdentifier
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              22. MedicationRequest.identifier:RequestID.id
              Definition

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

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              24. MedicationRequest.identifier:RequestID.extension
              Definition

              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 manageable, 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.

              ShortAdditional content defined by implementations
              Comments

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

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              SlicingThis element introduces a set of slices on MedicationRequest.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 26. MedicationRequest.identifier:RequestID.use
                Definition

                The purpose of this identifier.

                Shortusual | official | temp | secondary | old (If known)
                Comments

                Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                Control0..1
                BindingThe codes SHALL be taken from IdentifierUse
                (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                Identifies the purpose for this identifier, if known .

                Typecode
                Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

                Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                28. MedicationRequest.identifier:RequestID.type
                Definition

                A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                ShortDescription of identifier
                Comments

                This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                Control0..1
                BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                TypeCodeableConcept
                Is Modifierfalse
                Summarytrue
                Requirements

                Allows users to make use of identifiers when the identifier system is not known.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                30. MedicationRequest.identifier:RequestID.type.id
                Definition

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

                ShortUnique id for inter-element referencing
                Control0..1
                Typestring
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                32. MedicationRequest.identifier:RequestID.type.extension
                Definition

                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 manageable, 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.

                ShortAdditional content defined by implementations
                Comments

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

                Control0..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Alternate Namesextensions, user content
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                SlicingThis element introduces a set of slices on MedicationRequest.identifier.type.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 34. MedicationRequest.identifier:RequestID.type.coding
                  Definition

                  A reference to a code defined by a terminology system.

                  ShortCode defined by a terminology system
                  Comments

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

                  Control0..*
                  TypeCoding
                  Is Modifierfalse
                  Summarytrue
                  Requirements

                  Allows for alternative encodings within a code system, and translations to other code systems.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  36. MedicationRequest.identifier:RequestID.type.coding.id
                  Definition

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

                  ShortUnique id for inter-element referencing
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  38. MedicationRequest.identifier:RequestID.type.coding.extension
                  Definition

                  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 manageable, 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.

                  ShortAdditional content defined by implementations
                  Comments

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

                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  SlicingThis element introduces a set of slices on MedicationRequest.identifier.type.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 40. MedicationRequest.identifier:RequestID.type.coding.system
                    Definition

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

                    ShortIdentity of the terminology system
                    Comments

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

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

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

                    Pattern Valuehttp://terminology.hl7.org/CodeSystem/v2-0203
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    42. MedicationRequest.identifier:RequestID.type.coding.version
                    Definition

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

                    ShortVersion of the system - if relevant
                    Comments

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

                    NoteThis is a business version Id, not a resource version Id (see discussion)
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    44. MedicationRequest.identifier:RequestID.type.coding.code
                    Definition

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

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

                    Need to refer to a particular code in the system.

                    Pattern ValueFILL
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    46. MedicationRequest.identifier:RequestID.type.coding.display
                    Definition

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

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

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

                    Pattern ValueFiller Identifier
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    48. MedicationRequest.identifier:RequestID.type.coding.userSelected
                    Definition

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

                    ShortIf this coding was chosen directly by the user
                    Comments

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

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

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

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    50. MedicationRequest.identifier:RequestID.type.text
                    Definition

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

                    ShortPlain text representation of the concept
                    Comments

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

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

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

                    Pattern ValuePrescription identifier
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    52. MedicationRequest.identifier:RequestID.system
                    Definition

                    Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                    ShortThe namespace for the identifier value
                    Comments

                    Identifier.system is always case sensitive.

                    Control1..1
                    Typeuri
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Requirements

                    There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                    Pattern Valuehttp://fhir.health.gov.lk/ips/identifier/medication
                    Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    54. MedicationRequest.identifier:RequestID.value
                    Definition

                    The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                    ShortThe value that is unique
                    Comments

                    If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                    Control1..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Example<br/><b>General</b>:123456
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    56. MedicationRequest.identifier:RequestID.period
                    Definition

                    Time period during which identifier is/was valid for use.

                    ShortTime period when id is/was valid for use
                    Control0..1
                    TypePeriod
                    Is Modifierfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    58. MedicationRequest.identifier:RequestID.assigner
                    Definition

                    Organization that issued/manages the identifier.

                    ShortOrganization that issued id (may be just text)
                    Comments

                    The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                    Control0..1
                    TypeReference(Organization)
                    Is Modifierfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    60. MedicationRequest.status
                    Definition

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

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

                    In the scope of the IPS the entered-in-error concept is not allowed.

                    Control1..1
                    BindingThe codes SHALL be taken from medicationrequest Status
                    (required to http://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1)

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

                    Typecode
                    Is Modifiertrue because This element is labeled 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
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    62. MedicationRequest.statusReason
                    Definition

                    Captures the reason for the current state of the MedicationRequest.

                    ShortReason for current status
                    Comments

                    This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the MedicationRequest was created at all is captured in reasonCode, not here.

                    Control0..1
                    BindingFor example codes, see medicationRequest Status Reason Codes
                    (example to http://hl7.org/fhir/ValueSet/medicationrequest-status-reason)

                    Identifies the reasons for a given status.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    64. MedicationRequest.intent
                    Definition

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

                    Shortproposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
                    Comments

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

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

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

                    Control1..1
                    BindingThe codes SHALL be taken from medicationRequest Intent
                    (required to http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1)

                    The kind of medication order.

                    Typecode
                    Is Modifiertrue because This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    66. MedicationRequest.category
                    Definition

                    Indicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).

                    ShortType of medication usage
                    Comments

                    The category can be used to include where the medication is expected to be consumed or other types of requests.

                    Control0..*
                    BindingFor example codes, see medicationRequest Category Codes
                    (example to http://hl7.org/fhir/ValueSet/medicationrequest-category)

                    A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    68. MedicationRequest.priority
                    Definition

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

                    Shortroutine | urgent | asap | stat
                    Control0..1
                    BindingThe codes SHALL be taken from RequestPriority
                    (required to http://hl7.org/fhir/ValueSet/request-priority|4.0.1)

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

                    Typecode
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    70. MedicationRequest.doNotPerform
                    Definition

                    If true indicates that the provider is asking for the medication request not to occur.

                    ShortTrue if request is prohibiting action
                    Comments

                    If do not perform is not specified, the request is a positive request e.g. "do perform".

                    Control0..1
                    Typeboolean
                    Is Modifiertrue because This element is labeled as a modifier because this element negates the request to occur (ie, this is a request for the medication not to be ordered or prescribed, etc)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    72. MedicationRequest.reported[x]
                    Definition

                    Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the report.

                    ShortReported rather than primary record
                    Control0..1
                    TypeChoice of: boolean, Reference(Patient, Practitioner, PractitionerRole, RelatedPerson, Organization)
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    74. MedicationRequest.medication[x]
                    Definition

                    Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code. To improve global interoperability is strongly encouraged that the reference to a medication resource is used, limiting the usage of the medicationCodeableConcept only to the cases in which no other information than a simple code is available.

                    ShortMedication to be taken
                    Comments

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

                    Control1..1
                    BindingThe codes SHOULD be taken from Medications - SNOMED CT + Absent/Unknown (IPS)
                    (preferred to http://hl7.org/fhir/uv/ips/ValueSet/medication-snomed-absent-unknown-uv-ips)

                    SNOMED CT medications (Pharmaceutical / biologic product) or a code for absent/unknown medication

                    TypeCodeableConcept
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifierfalse
                    Must Supporttrue
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    SlicingThis element introduces a set of slices on MedicationRequest.medication[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                    • type @ $this
                    • 76. MedicationRequest.medication[x]:medicationCodeableConcept
                      Slice NamemedicationCodeableConcept
                      Definition

                      Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code. To improve global interoperability is strongly encouraged that the reference to a medication resource is used, limiting the usage of the medicationCodeableConcept only to the cases in which no other information than a simple code is available.

                      ShortMedication to be taken
                      Comments

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

                      Control1..1
                      BindingUnless not suitable, these codes SHALL be taken from Medication Names For Pharmacy
                      (extensible to http://fhir.health.gov.lk/ips/ValueSet/vs-medication-name-msd)
                      TypeCodeableConcept
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifierfalse
                      Must Supporttrue
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      78. MedicationRequest.subject
                      Definition

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

                      ShortWho or group medication request is for
                      Comments

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

                      Control1..1
                      TypeReference(Patient)
                      Is Modifierfalse
                      Must Supporttrue
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      80. MedicationRequest.subject.id
                      Definition

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

                      ShortUnique id for inter-element referencing
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      82. MedicationRequest.subject.extension
                      Definition

                      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 manageable, 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.

                      ShortAdditional content defined by implementations
                      Comments

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

                      Control0..*
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Alternate Namesextensions, user content
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      SlicingThis element introduces a set of slices on MedicationRequest.subject.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 84. MedicationRequest.subject.reference
                        Definition

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

                        ShortLiteral reference, Relative, internal or absolute URL
                        Comments

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

                        Control1..1
                        This element is affected by the following invariants: ref-1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        86. MedicationRequest.subject.type
                        Definition

                        The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                        The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                        ShortType the reference refers to (e.g. "Patient")
                        Comments

                        This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                        Control0..1
                        BindingUnless not suitable, these codes SHALL be taken from ResourceType
                        (extensible to http://hl7.org/fhir/ValueSet/resource-types)

                        Aa resource (or, for logical models, the URI of the logical model).

                        Typeuri
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        88. MedicationRequest.subject.identifier
                        Definition

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

                        ShortLogical reference, when literal reference is not known
                        Comments

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

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

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

                        Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                        NoteThis is a business identifier, not a resource identifier (see discussion)
                        Control0..1
                        TypeIdentifier
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        90. MedicationRequest.subject.display
                        Definition

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

                        ShortText alternative for the resource
                        Comments

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

                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        92. MedicationRequest.encounter
                        Definition

                        The Encounter during which this [x] was created or to which the creation of this record is tightly associated.

                        ShortEncounter created as part of encounter/admission/stay
                        Comments

                        This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter." If there is a need to link to episodes of care they will be handled with an extension.

                        Control1..1
                        TypeReference(Target Facility Encounter)
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        94. MedicationRequest.supportingInformation
                        Definition

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

                        ShortInformation to support ordering of the medication
                        Control0..*
                        TypeReference(Resource)
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        96. MedicationRequest.authoredOn
                        Definition

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

                        ShortWhen request was initially authored
                        Control1..1
                        TypedateTime
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        98. MedicationRequest.requester
                        Definition

                        reason(s) why this should be supported.

                        ShortWho/What requested the Request
                        Control0..1
                        TypeReference(Practitioner, Patient, Device Information)
                        Is Modifierfalse
                        Must Supporttrue
                        Must Support TypesNo must-support rules about the choice of types/profiles
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        100. MedicationRequest.performer
                        Definition

                        reason(s) why this should be supported.

                        ShortIntended performer of administration
                        Control0..1
                        TypeReference(Practitioner, Patient, Device Information)
                        Is Modifierfalse
                        Must Supporttrue
                        Must Support TypesNo must-support rules about the choice of types/profiles
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        102. MedicationRequest.performerType
                        Definition

                        Indicates the type of performer of the administration of the medication.

                        ShortDesired kind of performer of the medication administration
                        Comments

                        If specified without indicating a performer, this indicates that the performer must be of the specified type. If specified with a performer then it indicates the requirements of the performer if the designated performer is not available.

                        Control0..1
                        BindingFor example codes, see ProcedurePerformerRoleCodes
                        (example to http://hl7.org/fhir/ValueSet/performer-role)

                        Identifies the type of individual that is desired to administer the medication.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        104. MedicationRequest.recorder
                        Definition

                        reason(s) why this should be supported.

                        ShortPerson who entered the request
                        Control0..1
                        TypeReference(Practitioner)
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        106. MedicationRequest.reasonCode
                        Definition

                        The reason or the indication for ordering or not ordering the medication.

                        ShortReason or indication for ordering or not ordering the medication
                        Comments

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

                        Control0..*
                        BindingFor example codes, see Condition/Problem/DiagnosisCodes
                        (example to http://hl7.org/fhir/ValueSet/condition-code)

                        A coded concept indicating why the medication was ordered.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        108. MedicationRequest.reasonReference
                        Definition

                        Condition or observation that supports why the medication was ordered.

                        ShortCondition or observation that supports why the prescription is being written
                        Comments

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

                        Control0..*
                        TypeReference(Condition, Observation)
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        110. MedicationRequest.instantiatesCanonical
                        Definition

                        The URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest.

                        ShortInstantiates FHIR protocol or definition
                        Control0..*
                        Typecanonical
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        112. MedicationRequest.instantiatesUri
                        Definition

                        The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this MedicationRequest.

                        ShortInstantiates external protocol or definition
                        Control0..*
                        Typeuri
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        114. MedicationRequest.basedOn
                        Definition

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

                        ShortWhat request fulfills
                        Control0..*
                        TypeReference(CarePlan, MedicationRequest, ServiceRequest, ImmunizationRecommendation)
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        116. MedicationRequest.groupIdentifier
                        Definition

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

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

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

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        118. MedicationRequest.courseOfTherapyType
                        Definition

                        The description of the overall patte3rn of the administration of the medication to the patient.

                        ShortOverall pattern of medication administration
                        Comments

                        This attribute should not be confused with the protocol of the medication.

                        Control0..1
                        BindingFor example codes, see medicationRequest Course of Therapy Codes
                        (example to http://hl7.org/fhir/ValueSet/medicationrequest-course-of-therapy)

                        Identifies the overall pattern of medication administratio.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        120. MedicationRequest.insurance
                        Definition

                        Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service.

                        ShortAssociated insurance coverage
                        Control0..*
                        TypeReference(Coverage, ClaimResponse)
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        122. MedicationRequest.note
                        Definition

                        reason(s) why this should be supported.

                        ShortInformation about the prescription
                        Control0..*
                        TypeAnnotation
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        124. MedicationRequest.dosageInstruction
                        Definition

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

                        ShortHow the medication should be taken
                        Comments

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

                        Control0..*
                        TypeDosage
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        126. 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.

                        ShortUnique id for inter-element referencing
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        128. MedicationRequest.dosageInstruction.extension
                        Definition

                        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 manageable, 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.

                        ShortAdditional content defined by implementations
                        Comments

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

                        Control0..*
                        TypeExtension
                        Is Modifierfalse
                        Summaryfalse
                        Alternate Namesextensions, user content
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 130. MedicationRequest.dosageInstruction.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 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 manageable, 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).

                          ShortExtensions that cannot be ignored even if unrecognized
                          Comments

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

                          Control0..*
                          TypeExtension
                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                          Summarytrue
                          Requirements

                          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.

                          Alternate Namesextensions, user content, modifiers
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          132. MedicationRequest.dosageInstruction.sequence
                          Definition

                          Indicates the order in which the dosage instructions should be applied or interpreted.

                          ShortThe order of the dosage instructions
                          Control0..1
                          Typeinteger
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Requirements

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

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          134. MedicationRequest.dosageInstruction.text
                          Definition

                          Free text dosage instructions e.g. SIG.

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

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

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          136. MedicationRequest.dosageInstruction.additionalInstruction
                          Definition

                          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").

                          ShortSupplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
                          Comments

                          Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.

                          Control0..*
                          BindingFor example codes, see SNOMEDCTAdditionalDosageInstructions
                          (example to http://hl7.org/fhir/ValueSet/additional-instruction-codes)

                          A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

                          TypeCodeableConcept
                          Is Modifierfalse
                          Summarytrue
                          Requirements

                          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.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          138. MedicationRequest.dosageInstruction.patientInstruction
                          Definition

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

                          ShortPatient or consumer oriented instructions
                          Control0..1
                          Typestring
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          140. MedicationRequest.dosageInstruction.timing
                          Definition

                          When medication should be administered.

                          ShortWhen medication should be administered
                          Comments

                          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.

                          Control0..1
                          TypeTiming
                          Is Modifierfalse
                          Must Supporttrue
                          Summarytrue
                          Requirements

                          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.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          MedicationRequest-DosageInstruction-1: If the Repeat Frequency does not exist then the Timing Code SHALL be present. (repeat.frequency.exists().not() implies code.exists())
                          142. MedicationRequest.dosageInstruction.timing.id
                          Definition

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

                          ShortUnique id for inter-element referencing
                          Control0..1
                          Typestring
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          144. MedicationRequest.dosageInstruction.timing.extension
                          Definition

                          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 manageable, 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.

                          ShortAdditional content defined by implementations
                          Comments

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

                          Control0..*
                          TypeExtension
                          Is Modifierfalse
                          Summaryfalse
                          Alternate Namesextensions, user content
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.timing.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 146. MedicationRequest.dosageInstruction.timing.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 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 manageable, 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).

                            ShortExtensions that cannot be ignored even if unrecognized
                            Comments

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

                            Control0..*
                            TypeExtension
                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                            Summarytrue
                            Requirements

                            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.

                            Alternate Namesextensions, user content, modifiers
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            148. MedicationRequest.dosageInstruction.timing.event
                            Definition

                            Identifies specific times when the event occurs.

                            ShortWhen the event occurs
                            Control0..*
                            TypedateTime
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            In a Medication Administration Record, for instance, you need to take a general specification, and turn it into a precise specification.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            150. MedicationRequest.dosageInstruction.timing.repeat
                            Definition

                            A set of rules that describe when the event is scheduled.

                            ShortWhen the event is to occur
                            Control0..1
                            TypeElement
                            Is Modifierfalse
                            Summarytrue
                            Requirements

                            Many timing schedules are determined by regular repetitions.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            tim-1: if there's a duration, there needs to be duration units (duration.empty() or durationUnit.exists())
                            tim-2: if there's a period, there needs to be period units (period.empty() or periodUnit.exists())
                            tim-4: duration SHALL be a non-negative value (duration.exists() implies duration >= 0)
                            tim-5: period SHALL be a non-negative value (period.exists() implies period >= 0)
                            tim-6: If there's a periodMax, there must be a period (periodMax.empty() or period.exists())
                            tim-7: If there's a durationMax, there must be a duration (durationMax.empty() or duration.exists())
                            tim-8: If there's a countMax, there must be a count (countMax.empty() or count.exists())
                            tim-9: If there's an offset, there must be a when (and not C, CM, CD, CV) (offset.empty() or (when.exists() and ((when in ('C' | 'CM' | 'CD' | 'CV')).not())))
                            tim-10: If there's a timeOfDay, there cannot be a when, or vice versa (timeOfDay.empty() or when.empty())
                            152. MedicationRequest.dosageInstruction.timing.repeat.id
                            Definition

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

                            ShortUnique id for inter-element referencing
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            154. MedicationRequest.dosageInstruction.timing.repeat.extension
                            Definition

                            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 manageable, 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.

                            ShortAdditional content defined by implementations
                            Comments

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

                            Control0..*
                            TypeExtension
                            Is Modifierfalse
                            Summaryfalse
                            Alternate Namesextensions, user content
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.timing.repeat.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 156. MedicationRequest.dosageInstruction.timing.repeat.bounds[x]
                              Definition

                              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.

                              ShortLength/Range of lengths, or (Start and/or end) limits
                              Control0..1
                              TypeChoice of: Duration, Range, Period
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              158. MedicationRequest.dosageInstruction.timing.repeat.count
                              Definition

                              A total count of the desired number of repetitions across the duration of the entire timing specification. If countMax is present, this element indicates the lower bound of the allowed range of count values.

                              ShortNumber of times to repeat
                              Comments

                              If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.

                              Control1..1
                              TypepositiveInt
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Requirements

                              Repetitions may be limited by end time or total occurrences.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              160. MedicationRequest.dosageInstruction.timing.repeat.countMax
                              Definition

                              If present, indicates that the count is a range - so to perform the action between [count] and [countMax] times.

                              ShortMaximum number of times to repeat
                              Control0..1
                              TypepositiveInt
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              162. MedicationRequest.dosageInstruction.timing.repeat.duration
                              Definition

                              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.

                              ShortHow long when it happens
                              Comments

                              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).

                              Control1..1
                              Typedecimal
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Requirements

                              Some activities are not instantaneous and need to be maintained for a period of time.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              164. MedicationRequest.dosageInstruction.timing.repeat.durationMax
                              Definition

                              If present, indicates that the duration is a range - so to perform the action between [duration] and [durationMax] time length.

                              ShortHow long when it happens (Max)
                              Comments

                              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).

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

                              Some activities are not instantaneous and need to be maintained for a period of time.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              166. MedicationRequest.dosageInstruction.timing.repeat.durationUnit
                              Definition

                              The units of time for the duration, in UCUM units.

                              Shorts | min | h | d | wk | mo | a - unit of time (UCUM)
                              Control1..1
                              BindingThe codes SHALL be taken from UnitsOfTime
                              (required to http://hl7.org/fhir/ValueSet/units-of-time|4.0.1)

                              A unit of time (units from UCUM).

                              Typecode
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              168. MedicationRequest.dosageInstruction.timing.repeat.frequency
                              Definition

                              reason(s) why this should be supported.

                              ShortEvent occurs frequency times per period
                              Control0..1
                              TypepositiveInt
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              Summarytrue
                              Meaning if MissingIf no frequency is stated, the assumption is that the event occurs once per period, but systems SHOULD always be specific about this
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              170. MedicationRequest.dosageInstruction.timing.repeat.frequencyMax
                              Definition

                              If present, indicates that the frequency is a range - so to repeat between [frequency] and [frequencyMax] times within the period or period range.

                              ShortEvent occurs up to frequencyMax times per period
                              Control0..1
                              TypepositiveInt
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              172. MedicationRequest.dosageInstruction.timing.repeat.period
                              Definition

                              reason(s) why this should be supported.

                              ShortEvent occurs frequency times per period
                              Control0..1
                              Typedecimal
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              174. MedicationRequest.dosageInstruction.timing.repeat.periodMax
                              Definition

                              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.

                              ShortUpper limit of period (3-4 hours)
                              Control0..1
                              Typedecimal
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              176. MedicationRequest.dosageInstruction.timing.repeat.periodUnit
                              Definition

                              reason(s) why this should be supported.

                              Shorts | min | h | d | wk | mo | a - unit of time (UCUM)
                              Control0..1
                              BindingThe codes SHALL be taken from UnitsOfTime
                              (required to http://hl7.org/fhir/ValueSet/units-of-time|4.0.1)

                              A unit of time (units from UCUM).

                              Typecode
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              178. MedicationRequest.dosageInstruction.timing.repeat.dayOfWeek
                              Definition

                              If one or more days of week is provided, then the action happens only on the specified day(s).

                              Shortmon | tue | wed | thu | fri | sat | sun
                              Comments

                              If no days are specified, the action is assumed to happen every day as otherwise specified. The elements frequency and period cannot be used as well as dayOfWeek.

                              Control0..*
                              BindingThe codes SHALL be taken from DaysOfWeek
                              (required to http://hl7.org/fhir/ValueSet/days-of-week|4.0.1)
                              Typecode
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              180. MedicationRequest.dosageInstruction.timing.repeat.timeOfDay
                              Definition

                              Specified time of day for action to take place.

                              ShortTime of day for action
                              Comments

                              When time of day is specified, it is inferred that the action happens every day (as filtered by dayofWeek) on the specified times. The elements when, frequency and period cannot be used as well as timeOfDay.

                              Control0..*
                              Typetime
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              182. MedicationRequest.dosageInstruction.timing.repeat.when
                              Definition

                              An approximate time period during the day, potentially linked to an event of daily living that indicates when the action should occur.

                              ShortCode for time period of occurrence
                              Comments

                              When more than one event is listed, the event is tied to the union of the specified events.

                              Control0..*
                              BindingThe codes SHALL be taken from EventTiming
                              (required to http://hl7.org/fhir/ValueSet/event-timing|4.0.1)

                              Real world event relating to the schedule.

                              Typecode
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Requirements

                              Timings are frequently determined by occurrences such as waking, eating and sleep.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              184. MedicationRequest.dosageInstruction.timing.repeat.offset
                              Definition

                              The number of minutes from the event. If the event code does not indicate whether the minutes is before or after the event, then the offset is assumed to be after the event.

                              ShortMinutes from event (before or after)
                              Control0..1
                              TypeunsignedInt
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              186. MedicationRequest.dosageInstruction.timing.code
                              Definition

                              reason(s) why this should be supported.

                              ShortBID | TID | QID | AM | PM | QD | QOD | +
                              Comments

                              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).

                              Control0..1
                              BindingThe codes SHOULD be taken from Drug Frequency Codes
                              (preferred to http://fhir.health.gov.lk/ips/ValueSet/vs-drug-frequency)
                              TypeCodeableConcept
                              Is Modifierfalse
                              Must Supporttrue
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              188. MedicationRequest.dosageInstruction.asNeeded[x]
                              Definition

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

                              ShortTake "as needed" (for x)
                              Comments

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

                              Control0..1
                              BindingFor example codes, see SNOMEDCTMedicationAsNeededReasonCodes
                              (example to http://hl7.org/fhir/ValueSet/medication-as-needed-reason)

                              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.

                              TypeChoice of: boolean, CodeableConcept
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              190. MedicationRequest.dosageInstruction.site
                              Definition

                              Body site to administer to.

                              ShortBody site to administer to
                              Comments

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

                              Control0..1
                              BindingFor example codes, see SNOMEDCTAnatomicalStructureForAdministrationSiteCodes
                              (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.

                              TypeCodeableConcept
                              Is Modifierfalse
                              Summarytrue
                              Requirements

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

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              192. MedicationRequest.dosageInstruction.route
                              Definition

                              A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.

                              ShortConcept - reference to a terminology or just text
                              Comments

                              Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

                              Control0..1
                              This element is affected by the following invariants: ele-1
                              BindingThe codes SHOULD be taken from Medicine Route of Administration - IPS
                              (preferred to http://hl7.org/fhir/uv/ips/ValueSet/medicine-route-of-administration)

                              EDQM Standards Terms

                              TypeCodeableConcept(Codeable Concept (IPS))
                              Is Modifierfalse
                              Requirements

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

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              194. MedicationRequest.dosageInstruction.method
                              Definition

                              Technique for administering medication.

                              ShortTechnique for administering medication
                              Comments

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

                              Control0..1
                              BindingFor example codes, see SNOMEDCTAdministrationMethodCodes
                              (example to http://hl7.org/fhir/ValueSet/administration-method-codes)

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

                              TypeCodeableConcept
                              Is Modifierfalse
                              Summarytrue
                              Requirements

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

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              196. MedicationRequest.dosageInstruction.doseAndRate
                              Definition

                              The amount of medication administered.

                              ShortAmount of medication administered
                              Control0..*
                              TypeElement
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              198. MedicationRequest.dosageInstruction.doseAndRate.id
                              Definition

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

                              ShortUnique id for inter-element referencing
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              200. MedicationRequest.dosageInstruction.doseAndRate.extension
                              Definition

                              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 manageable, 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.

                              ShortAdditional content defined by implementations
                              Comments

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

                              Control0..*
                              TypeExtension
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesextensions, user content
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.doseAndRate.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 202. MedicationRequest.dosageInstruction.doseAndRate.type
                                Definition

                                The kind of dose or rate specified, for example, ordered or calculated.

                                ShortThe kind of dose or rate specified
                                Control0..1
                                BindingFor example codes, see DoseAndRateType
                                (example to http://hl7.org/fhir/ValueSet/dose-rate-type)

                                The kind of dose or rate specified.

                                TypeCodeableConcept
                                Is Modifierfalse
                                Summarytrue
                                Requirements

                                If the type is not populated, assume to be "ordered".

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                204. MedicationRequest.dosageInstruction.doseAndRate.dose[x]
                                Definition

                                Amount of medication per dose.

                                ShortAmount of medication per dose
                                Comments

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

                                Control1..1
                                TypeQuantity(SimpleQuantity)
                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                Is Modifierfalse
                                Summarytrue
                                Requirements

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

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.doseAndRate.dose[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                • type @ $this
                                • 206. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity
                                  Slice NamedoseQuantity
                                  Definition

                                  The comparator is not used on a SimpleQuantity

                                  ShortA 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.

                                  Control1..1
                                  This element is affected by the following invariants: ele-1
                                  TypeQuantity(SimpleQuantity)
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Is Modifierfalse
                                  Requirements

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

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (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())
                                  208. MedicationRequest.dosageInstruction.doseAndRate.rate[x]
                                  Definition

                                  Amount of medication per unit of time.

                                  ShortAmount of medication per unit of time
                                  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.

                                  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 grammer 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.

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

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

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  210. MedicationRequest.dosageInstruction.maxDosePerPeriod
                                  Definition

                                  Upper limit on medication per unit of time.

                                  ShortUpper limit on medication per unit of time
                                  Comments

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

                                  Control0..1
                                  TypeRatio
                                  Is Modifierfalse
                                  Summarytrue
                                  Requirements

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

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  212. MedicationRequest.dosageInstruction.maxDosePerAdministration
                                  Definition

                                  Upper limit on medication per administration.

                                  ShortUpper limit on medication per administration
                                  Comments

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

                                  Control0..1
                                  TypeQuantity(SimpleQuantity)
                                  Is Modifierfalse
                                  Summarytrue
                                  Requirements

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

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  214. MedicationRequest.dosageInstruction.maxDosePerLifetime
                                  Definition

                                  Upper limit on medication per lifetime of the patient.

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

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

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  216. MedicationRequest.dispenseRequest
                                  Definition

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

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

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

                                  ShortUnique id for inter-element referencing
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  220. MedicationRequest.dispenseRequest.extension
                                  Definition

                                  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 manageable, 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.

                                  ShortAdditional content defined by implementations
                                  Comments

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

                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  Alternate Namesextensions, user content
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  222. MedicationRequest.dispenseRequest.modifierExtension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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 manageable, 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).

                                  ShortExtensions that cannot be ignored even if unrecognized
                                  Comments

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

                                  Control0..*
                                  TypeExtension
                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                  Summarytrue
                                  Requirements

                                  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.

                                  Alternate Namesextensions, user content, modifiers
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  224. MedicationRequest.dispenseRequest.initialFill
                                  Definition

                                  Indicates the quantity or duration for the first dispense of the medication.

                                  ShortFirst fill details
                                  Comments

                                  If populating this element, either the quantity or the duration must be included.

                                  Control0..1
                                  TypeBackboneElement
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  226. MedicationRequest.dispenseRequest.initialFill.id
                                  Definition

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

                                  ShortUnique id for inter-element referencing
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  228. MedicationRequest.dispenseRequest.initialFill.extension
                                  Definition

                                  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 manageable, 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.

                                  ShortAdditional content defined by implementations
                                  Comments

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

                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  Alternate Namesextensions, user content
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  230. MedicationRequest.dispenseRequest.initialFill.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 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 manageable, 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).

                                  ShortExtensions that cannot be ignored even if unrecognized
                                  Comments

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

                                  Control0..*
                                  TypeExtension
                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                  Summarytrue
                                  Requirements

                                  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.

                                  Alternate Namesextensions, user content, modifiers
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  232. MedicationRequest.dispenseRequest.initialFill.quantity
                                  Definition

                                  The amount or quantity to provide as part of the first dispense.

                                  ShortFirst fill quantity
                                  Control0..1
                                  TypeQuantity(SimpleQuantity)
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  234. MedicationRequest.dispenseRequest.initialFill.duration
                                  Definition

                                  The length of time that the first dispense is expected to last.

                                  ShortFirst fill duration
                                  Control0..1
                                  TypeDuration
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  236. MedicationRequest.dispenseRequest.dispenseInterval
                                  Definition

                                  The minimum period of time that must occur between dispenses of the medication.

                                  ShortMinimum period of time between dispenses
                                  Control0..1
                                  TypeDuration
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  238. MedicationRequest.dispenseRequest.validityPeriod
                                  Definition

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

                                  ShortTime period supply is authorized for
                                  Comments

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

                                  Control0..1
                                  TypePeriod
                                  Is Modifierfalse
                                  Summaryfalse
                                  Requirements

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

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  240. MedicationRequest.dispenseRequest.validityPeriod.id
                                  Definition

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

                                  ShortUnique id for inter-element referencing
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  242. MedicationRequest.dispenseRequest.validityPeriod.extension
                                  Definition

                                  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 manageable, 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.

                                  ShortAdditional content defined by implementations
                                  Comments

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

                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  Alternate Namesextensions, user content
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  SlicingThis element introduces a set of slices on MedicationRequest.dispenseRequest.validityPeriod.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 244. MedicationRequest.dispenseRequest.validityPeriod.extension:data-absent-reason
                                    Slice Namedata-absent-reason
                                    Definition

                                    Provides a reason why the validityPeriod is missing.

                                    ShortvalidityPeriod absence reason
                                    Control0..1
                                    TypeExtension(Data Absent Reason) (Extension Type: code)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    246. MedicationRequest.dispenseRequest.validityPeriod.start
                                    Definition

                                    The start of the period. The boundary is inclusive.

                                    ShortStarting time with inclusive boundary
                                    Comments

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

                                    Control0..1
                                    This element is affected by the following invariants: per-1
                                    TypedateTime
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    248. MedicationRequest.dispenseRequest.validityPeriod.end
                                    Definition

                                    The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

                                    ShortEnd time with inclusive boundary, if not ongoing
                                    Comments

                                    The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.

                                    Control0..1
                                    This element is affected by the following invariants: per-1
                                    TypedateTime
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    250. 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. A prescriber may explicitly say that zero refills are permitted after the initial dispense.

                                    ShortNumber of refills authorized
                                    Comments

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

                                    Control0..1
                                    TypeunsignedInt
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    252. MedicationRequest.dispenseRequest.quantity
                                    Definition

                                    reason(s) why this should be supported.

                                    ShortAmount of medication to supply per dispense
                                    Control0..1
                                    TypeQuantity(SimpleQuantity)
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    254. MedicationRequest.dispenseRequest.expectedSupplyDuration
                                    Definition

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

                                    ShortNumber of days supply per dispense
                                    Comments

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

                                    Control0..1
                                    TypeDuration
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    256. MedicationRequest.dispenseRequest.performer
                                    Definition

                                    Indicates the intended dispensing Organization specified by the prescriber.

                                    ShortIntended dispenser
                                    Control0..1
                                    TypeReference(Organization)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    258. MedicationRequest.substitution
                                    Definition

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

                                    ShortAny restrictions on medication substitution
                                    Control0..1
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    260. 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.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    262. MedicationRequest.substitution.extension
                                    Definition

                                    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 manageable, 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.

                                    ShortAdditional content defined by implementations
                                    Comments

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

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    264. 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 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 manageable, 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).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

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

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    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.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    266. MedicationRequest.substitution.allowed[x]
                                    Definition

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

                                    ShortWhether substitution is allowed or not
                                    Comments

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

                                    Control1..1
                                    BindingFor example codes, see ActSubstanceAdminSubstitutionCode
                                    (example to http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode)

                                    Identifies the type of substitution allowed.

                                    TypeChoice of: boolean, CodeableConcept
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    268. MedicationRequest.substitution.reason
                                    Definition

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

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

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

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    270. MedicationRequest.priorPrescription
                                    Definition

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

                                    ShortAn order/prescription that is being replaced
                                    Control0..1
                                    TypeReference(MedicationRequest)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    272. MedicationRequest.detectedIssue
                                    Definition

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

                                    ShortClinical Issue with action
                                    Comments

                                    This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.

                                    Control0..*
                                    TypeReference(DetectedIssue)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate NamesContraindication, Drug Utilization Review (DUR), Alert
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    274. MedicationRequest.eventHistory
                                    Definition

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

                                    ShortA list of events of interest in the lifecycle
                                    Comments

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

                                    Control0..*
                                    TypeReference(Provenance)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))