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Pharmacy icon Work GroupMaturity Level: 3 Trial UseSecurity Category: Patient Compartments: Encounter, Patient, Practitioner

Detailed Descriptions for the elements in the MedicationRequest resource.

MedicationRequest
Element IdMedicationRequest
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.

Short DisplayOrdering of medication for patient or group
Cardinality0..*
TypeDomainResource
Alternate NamesPrescription; Order
Summaryfalse
MedicationRequest.identifier
Element IdMedicationRequest.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.

Short DisplayExternal ids for this request
NoteThis is a business identifier, not a resource identifier (see discussion)
Cardinality0..*
TypeIdentifier
Summaryfalse
Comments

This is a business identifier, not a resource identifier.

MedicationRequest.basedOn
Element IdMedicationRequest.basedOn
Definition

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

Short DisplayWhat request fulfills
Cardinality0..*
TypeReference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation)
Summarytrue
MedicationRequest.priorPrescription
Element IdMedicationRequest.priorPrescription
Definition

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

Short DisplayAn order/prescription that is being replaced
Cardinality0..1
TypeReference(MedicationRequest)
Summaryfalse
MedicationRequest.groupIdentifier
Element IdMedicationRequest.groupIdentifier
Definition

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

Short DisplayComposite request this is part of
Cardinality0..1
TypeIdentifier
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.

Summarytrue
MedicationRequest.status
Element IdMedicationRequest.status
Definition

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

Short Displayactive | on-hold | ended | stopped | completed | cancelled | entered-in-error | draft | unknown
Cardinality1..1
Terminology Bindingmedicationrequest Status (Required)
Typecode
Is Modifiertrue (Reason: 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)
Summarytrue
Comments

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

Clinical decision support systems should take the status into account when determining which medications to include in their algorithms.

MedicationRequest.statusReason
Element IdMedicationRequest.statusReason
Definition

Captures the reason for the current state of the MedicationRequest.

Short DisplayReason for current status
Cardinality0..1
Terminology BindingmedicationRequest Status Reason Codes (Example)
TypeCodeableConcept
Summaryfalse
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.

MedicationRequest.statusChanged
Element IdMedicationRequest.statusChanged
Definition

The date (and perhaps time) when the status was changed.

Short DisplayWhen the status was changed
Cardinality0..1
TypedateTime
Summaryfalse
MedicationRequest.intent
Element IdMedicationRequest.intent
Definition

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

Short Displayproposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
Cardinality1..1
Terminology BindingmedicationRequest Intent (Required)
Typecode
Is Modifiertrue (Reason: 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)
Summarytrue
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.

MedicationRequest.category
Element IdMedicationRequest.category
Definition

Indicates the grouping or category of medication request (for example, drug classification like ATC, where meds would be administered, legal category of the medication.).

Short DisplayGrouping or category of medication request
Cardinality0..*
Terminology BindingmedicationRequest Administration Location Codes (Example)
TypeCodeableConcept
Summaryfalse
Comments

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

MedicationRequest.priority
Element IdMedicationRequest.priority
Definition

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

Short Displayroutine | urgent | asap | stat
Cardinality0..1
Terminology BindingRequestPriority (Required)
Typecode
Summarytrue
MedicationRequest.doNotPerform
Element IdMedicationRequest.doNotPerform
Definition

If true, indicates that the provider is asking for the patient to either stop taking or to not start taking the specified medication. For example, the patient is taking an existing medication and the provider is changing their medication. They want to create two seperate requests: one to stop using the current medication and another to start the new medication.

Short DisplayTrue if patient is to stop taking or not to start taking the medication
Cardinality0..1
Typeboolean
Is Modifiertrue (Reason: 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))
Summarytrue
Comments

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

MedicationRequest.medication
Element IdMedicationRequest.medication
Definition

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

Short DisplayMedication to be taken
Cardinality1..1
Terminology BindingSNOMED CT Medication Codes (Example)
TypeCodeableReference(Medication)
Summarytrue
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.

MedicationRequest.subject
Element IdMedicationRequest.subject
Definition

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

Short DisplayWho or group medication request is for
Cardinality1..1
TypeReference(Patient | Group)
Summarytrue
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.

MedicationRequest.informationSource
Element IdMedicationRequest.informationSource
Definition

The person or organization who provided the information about this request, if the source is someone other than the requestor. This is often used when the MedicationRequest is reported by another person.

Short DisplayThe person or organization who provided the information about this request, if the source is someone other than the requestor
Cardinality0..*
TypeReference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization)
Summaryfalse
MedicationRequest.encounter
Element IdMedicationRequest.encounter
Definition

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

Short DisplayEncounter created as part of encounter/admission/stay
Cardinality0..1
TypeReference(Encounter)
Summaryfalse
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.

MedicationRequest.supportingInformation
Element IdMedicationRequest.supportingInformation
Definition

Information to support fulfilling (i.e. dispensing or administering) of the medication, for example, patient height and weight, a MedicationUsage for the patient).

Short DisplayInformation to support fulfilling of the medication
Cardinality0..*
TypeReference(Any)
Summaryfalse
Comments

This attribute can be used to reference a MedicationUsage about the patients' medication use.

MedicationRequest.authoredOn
Element IdMedicationRequest.authoredOn
Definition

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

Short DisplayWhen request was initially authored
Cardinality0..1
TypedateTime
Summarytrue
MedicationRequest.requester
Element IdMedicationRequest.requester
Definition

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

Short DisplayWho/What requested the Request
Cardinality0..1
TypeReference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)
Summarytrue
MedicationRequest.reported
Element IdMedicationRequest.reported
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.

Short DisplayReported rather than primary record
Cardinality0..1
Typeboolean
Summarytrue
Comments

If not populated, then assume that this is the original record and not reported

MedicationRequest.performerType
Element IdMedicationRequest.performerType
Definition

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

Short DisplayDesired kind of performer of the medication administration
Cardinality0..1
Terminology BindingMedication Intended Performer Role (Extensible)
TypeCodeableConcept
Summarytrue
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.

MedicationRequest.performer
Element IdMedicationRequest.performer
Definition

The specified desired performer of the medication treatment (e.g. the performer of the medication administration). For devices, this is the device that is intended to perform the administration of the medication. An IV Pump would be an example of a device that is performing the administration. Both the IV Pump and the practitioner that set the rate or bolus on the pump can be listed as performers.

Short DisplayIntended performer of administration
Cardinality0..*
TypeReference(Practitioner | PractitionerRole | Organization | Patient | DeviceDefinition | RelatedPerson | CareTeam | HealthcareService)
Summaryfalse
MedicationRequest.device
Element IdMedicationRequest.device
Definition

The intended type of device that is to be used for the administration of the medication (for example, PCA Pump).

Short DisplayIntended type of device for the administration
Cardinality0..1
TypeCodeableReference(DeviceDefinition)
Summaryfalse
MedicationRequest.recorder
Element IdMedicationRequest.recorder
Definition

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

Short DisplayPerson who entered the request
Cardinality0..1
TypeReference(Practitioner | PractitionerRole)
Summaryfalse
MedicationRequest.reason
Element IdMedicationRequest.reason
Definition

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

Short DisplayReason or indication for ordering or not ordering the medication
Cardinality0..*
Terminology BindingCondition/Problem/Diagnosis Codes (Example)
TypeCodeableReference(Condition | Observation)
Summaryfalse
Comments

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

MedicationRequest.courseOfTherapyType
Element IdMedicationRequest.courseOfTherapyType
Definition

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

Short DisplayOverall pattern of medication administration
Cardinality0..1
Terminology BindingmedicationRequest Course of Therapy Codes (Extensible)
TypeCodeableConcept
Summaryfalse
Comments

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

MedicationRequest.insurance
Element IdMedicationRequest.insurance
Definition

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

Short DisplayAssociated insurance coverage
Cardinality0..*
TypeReference(Coverage | ClaimResponse)
Summaryfalse
MedicationRequest.note
Element IdMedicationRequest.note
Definition

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

Short DisplayInformation about the prescription
Cardinality0..*
TypeAnnotation
Summaryfalse
MedicationRequest.dose
Element IdMedicationRequest.dose
Definition

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

Short DisplayHow the medication should be taken
Cardinality0..1
Summaryfalse
MedicationRequest.dose.renderedDosageInstruction
Element IdMedicationRequest.dose.renderedDosageInstruction
Definition

The full representation of the dose of the medication included in all dosage instructions. To be used when multiple dosage instructions are included to represent complex dosing such as increasing or tapering doses.

Short DisplayFull representation of the dosage instructions
Cardinality0..1
Typestring
Requirements

The content of the renderedDosageInstructions must not be different than the dose represented in the dosageInstruction content.

Summaryfalse
MedicationRequest.dose.effectiveDosePeriod
Element IdMedicationRequest.dose.effectiveDosePeriod
Definition

The period over which the medication is to be taken. Where there are multiple dosageInstruction lines (for example, tapering doses), this is the earliest date and the latest end date of the dosageInstructions.

Short DisplayPeriod over which the medication is to be taken
Cardinality0..1
TypePeriod
Summaryfalse
MedicationRequest.dose.dosageInstruction
Element IdMedicationRequest.dose.dosageInstruction
Definition

Specific instructions for how the medication is to be used by the patient.

Short DisplaySpecific instructions for how the medication should be taken
Cardinality0..*
TypeDosage
Summaryfalse
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. In general, each prescribed drug will be a separate Medication Request.

When drug orders are grouped together at the time of order entry, but each of the drugs can be manipulated independently e.g. changing the status of one order to "completed" or "cancelled", changing another order status to "on-hold", the method to "group" all of the medication requests together is to use MedicationRequest.groupIdentifier element. All of the orders grouped together in this manner will have the same groupIdentifier, and separately, each order in the group may have a unique identifier.

There are cases that require grouping of Medication orders together when it is necessary to specify optionality e.g. order two drugs at one time, but stating either of these drugs may be used to treat the patient. The use of a RequestOrchestration should be used as a parent for the Medication orders that require this type of grouping. An example when it may be necessary to group medication orders together is when you specify timing relationships e.g. order drug "xyz" with dose 123, then taper the same drug to a different dose after some interval of time precedence: e.g. give drug "abc" followed by drug "def" e.g. give drug 30 minutes before some procedure was performed more generically this supports - hierarchical groups of actions, where each specific action references the action to be performed (in terms of a Request resource), and each group describes additional behavior, relationships, and applicable conditions between the actions in the overall group. Note that one should NOT use the List or Composition resource to accomplish the above requirements. You may use List or Composition for other business requirements, but not to address the specific requirements of grouping medication orders.

MedicationRequest.dispenseRequest
Element IdMedicationRequest.dispenseRequest
Definition

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

Short DisplayMedication supply authorization
Cardinality0..1
Summaryfalse
MedicationRequest.dispenseRequest.initialFill
Element IdMedicationRequest.dispenseRequest.initialFill
Definition

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

Short DisplayFirst fill details
Cardinality0..1
Summaryfalse
Comments

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

MedicationRequest.dispenseRequest.initialFill.quantity
Element IdMedicationRequest.dispenseRequest.initialFill.quantity
Definition

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

Short DisplayFirst fill quantity
Cardinality0..1
TypeSimpleQuantity
Summaryfalse
MedicationRequest.dispenseRequest.initialFill.duration
Element IdMedicationRequest.dispenseRequest.initialFill.duration
Definition

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

Short DisplayFirst fill duration
Cardinality0..1
TypeDuration
Summaryfalse
MedicationRequest.dispenseRequest.dispenseInterval
Element IdMedicationRequest.dispenseRequest.dispenseInterval
Definition

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

Short DisplayMinimum period of time between dispenses
Cardinality0..1
TypeDuration
Summaryfalse
MedicationRequest.dispenseRequest.validityPeriod
Element IdMedicationRequest.dispenseRequest.validityPeriod
Definition

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

Short DisplayTime period supply is authorized for
Cardinality0..1
TypePeriod
Requirements

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

Summaryfalse
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.

MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
Element IdMedicationRequest.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.

Short DisplayNumber of refills authorized
Cardinality0..1
TypeunsignedInt
Summaryfalse
Comments

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

MedicationRequest.dispenseRequest.quantity
Element IdMedicationRequest.dispenseRequest.quantity
Definition

The amount that is to be dispensed for one fill.

Short DisplayAmount of medication to supply per dispense
Cardinality0..1
TypeSimpleQuantity
Summaryfalse
MedicationRequest.dispenseRequest.expectedSupplyDuration
Element IdMedicationRequest.dispenseRequest.expectedSupplyDuration
Definition

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

Short DisplayNumber of days supply per dispense
Cardinality0..1
TypeDuration
Summaryfalse
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.

MedicationRequest.dispenseRequest.dispenser
Element IdMedicationRequest.dispenseRequest.dispenser
Definition

Indicates the intended performing Organization that will dispense the medication as specified by the prescriber.

Short DisplayIntended performer of dispense
Cardinality0..1
TypeReference(Organization)
Summaryfalse
MedicationRequest.dispenseRequest.dispenserInstruction
Element IdMedicationRequest.dispenseRequest.dispenserInstruction
Definition

Provides additional information to the dispenser, for example, counselling to be provided to the patient.

Short DisplayAdditional information for the dispenser
Cardinality0..*
TypeAnnotation
Summaryfalse
MedicationRequest.dispenseRequest.doseAdministrationAid
Element IdMedicationRequest.dispenseRequest.doseAdministrationAid
Definition

Provides information about the type of adherence packaging to be supplied for the medication dispense.

Short DisplayType of adherence packaging to use for the dispense
Cardinality0..1
Terminology BindingMedication Dose Aids (Example)
TypeCodeableConcept
Summaryfalse
MedicationRequest.substitution
Element IdMedicationRequest.substitution
Definition

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

Short DisplayAny restrictions on medication substitution
Cardinality0..1
Summaryfalse
MedicationRequest.substitution.allowed[x]
Element IdMedicationRequest.substitution.allowed[x]
Definition

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

Short DisplayWhether substitution is allowed or not
Cardinality1..1
Terminology BindingActSubstanceAdminSubstitutionCode icon (Preferred)
Typeboolean|CodeableConcept
[x] NoteSee Choice of Datatypes for further information about how to use [x]
Summaryfalse
Comments

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

MedicationRequest.substitution.reason
Element IdMedicationRequest.substitution.reason
Definition

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

Short DisplayWhy should (not) substitution be made
Cardinality0..1
Terminology BindingSubstanceAdminSubstitutionReason icon (Example)
TypeCodeableConcept
Summaryfalse
MedicationRequest.eventHistory
Element IdMedicationRequest.eventHistory
Definition

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

Short DisplayA list of events of interest in the lifecycle
Cardinality0..*
TypeReference(Provenance)
Summaryfalse
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.).