Status: DRAFT: For Review

Introduction

This profile sets out the expectations for the interweave medication request resource. We use the madication structure definition as a base to this profile.

We use this resource to represent prescriptions of medication and repeat prescription schedules. Only prescriptions which have been issued should be shared. Issued is the point at when the prescription is either printed and signed, or passed on to the Electronic Prescription Service (EPS). The exception to this rule is repeat prescriptions, which are not themselves issued, but are authorised for instances of them to be issued.

Mandatory fields

The following fields are mandatory:

• status - Repeat prescriptions can have the statuses listed below. For all other prescription types, this should be defaulted to “complete”.

  • active – the repeat prescription is active
  • stopped – the repeat has been stopped, discontinued or cancelled.
  • complete – the repeat has ran its course

• courseOfTherapyType – This field records the type of prescription rather than having to derive this information from other fields. further details on how the codes should be used are outlined in the table below:

• intent – Only prescriptions which have been issued/authorised should be shared. When prescriptionType == “repeat” then intent == “plan” otherwise set to “order”. GPC use this field as part of a hierarchy implementation of prescriptions. It is felt that for the shared care record, having a linear list of prescriptions, and being able to identify which are ‘repeat prescriptions’ is enough and we do not want to create any complex linkages.

• category – Indicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)). We also make this a required binding.

• medication[x] - 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. If only a code is specified, then it needs to be a code for a specific product. In either case, the display field should be populated with the name of the medication which will be a DM&D description.

• subject – A reference to the representing the person (patient) to whom the medication will be given. To aid the data consumer, the display element should contain the patient’s name.

• authoredOn – This is the date/time that the medication was authorised/prescribed.

• dosageInstruction - Dosage instructions for the medication that indicates how the medication is to be used by the patient. The following sub-elements are mandatory.

  • dosageInstruction.text - Complete dosage instructions as text. The content of this attribute does not include the name or description of the medication. Additional information about administration or preparation of the medication should be included as text.

  • dosageInstruction.patientInstruction - Instructions in terms that are understood by the patient or consumer.

• substitution - 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. UK Core have mandated this field.

Must Support fields

In addition, the following fields are "Must Support" - i.e. they must be populated if relevant and known:

• repeatInformation – This is a useful extension which allows repeat information to be captured. It also include the date when the last repeat was issued. These fields should be populated when the prescription type is “repeat”.

• identifier – We keep this fields usage inline with GPC (GP Connect) specification as follows; If the EPS identifier is present, then the identifier.value is where the EPS Id SHOULD also be added. The codeSystem for this identifier is https://fhir.nhs.uk/Id/prescription-order-item-number and use should be set to “official”. This field may also be used to provide other types of unique business identifiers.

• statusReason – This should be populated when the status == “stopped” / "on-hold". along with the FHIR valueSet, We also add SNOMED concept, Drug therapy discontinued (274512008), which appears to be a good candidate to use here. We have set this as our “preferred” valueset – and will accept other code lists which have similar representations on a case by case basis.

• encounter - For a repeat prescriptions, this is the encounter where the repeat was authorised. For all others this is the encounter where the specific issue was authorised.

• requester - The individual or organization that initiated the request and has responsibility for its activation.

• reasonCode – A preferred list of SNOMED codes are used to populate this field which represent Condition/Problem/Diagnosis.

• note - Use this field for instructions to a third party e.g. “GP to Continue” noted on a prescription given to an outpatient.

• dispenseRequest – Hold suseful information on quantity and expected supply duration. We keep this sub-elements usage inline with GPC (GP Connect) specification

  • dispenseRequest.validityPeriod - This indicates the validity period of a prescription. It reflects the prescribers' perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The startDate of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an endDate is not specified then the Prescription is open-ended.

Optional fields

Other fields are optional and may be populated if known - on the understanding that not all data consumers will necessarily make use of them. Optional fields to note include:

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

• performerType - Indicates the type of performer of the administration of the medication. 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.

• recorder – This field is used to capture the person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order. In pharmacy systems, it is a legal requirement to capture this field, however we have left as optional, as no real-benefit was identified for use within the shared care record.

• reasonReference – Option to provide more detailed information via Observation and/or a condition resource which represent the reason for the medication request.

Discouraged or Removed fields

• priority – Removed, this field is more likely to be used in a prescribing system rather than the shared care record.

• supportingInformation – Removed. This field allows reference to any type of resource which is very open and may cause confusion to the consumer. GPC also do not use this field.

• instantiatesCanonical – Removed.

• instantiatesUri – Removed.

• basedOn and groupIdentifier – Both removed to avoid unnecessary hierarchy complexity, a simple list of prescriptions in date order will suffice.

• insurance - Removed.Not required for the shared care record.

• priorPrescription – Removed to avoid any unnecessary complexity.

• detectedIssue – Removed. Not required for the shared care record.

• eventHistory – Removed. Not required for the shared care record.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from UKCoreMedicationRequest

Name	Flags	Card.	Type	Description & Constraints
MedicationRequest			UKCoreMedicationRequest
id	S	0..1	id	Logical id of this artifact
meta
id		0..0
versionId	S	0..1	id	Version specific identifier
lastUpdated	S	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	S	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security		0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers
Slices for tag		0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:Source	S	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
id		0..0
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
version		0..0
code	S	1..1	code	The Data Provider Id of the system supplying the data
display	S	1..1	string	Name of the system supplying the data
tag:Provenance	S	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
id		0..0
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
version		0..0
code	S	1..1	code	The ODS Code of the organisation responsible for the data
display	S	1..1	string	Name of the organisation supplying the data
implicitRules		0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation)
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
Slices for extension				Content/Rules for all slices
extension:medicationRepeatInformation	S	0..1	ExtensionUKCoreMedicationRepeatInformation	Medication repeat information
Slices for extension				Content/Rules for all slices
extension:numberOfPrescriptionsIssued	S	0..1	Extension	Extension
extension:authorisationExpiryDate	S	0..1	Extension	Extension
LastIssuedDate	S	0..1	dateTime	Last issued date for repeat medication. URL: https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Extension-Interweave-MedicationLastIssuedDate
identifier
assigner		0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
statusReason	S	0..1	CodeableConcept	Reason for current status Binding: InterweaveMedicationRequestStatusReason (preferred)
category		1..1	CodeableConcept	Provides the business context for the relevant dispensing processes. Binding: UK Core Medication Request Category (required)
priority		0..0
doNotPerform		0..0
medication[x]		1..1	CodeableConcept, Reference(Medication)	Identifies the medication being requested. Binding: UK Core Medication Code (required)
subject		1..1	Reference(InterweavePatient)	Who the medication request is for.
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
encounter	S	0..1	Reference(InterweaveEncounter)	Encounter created as part of encounter/admission/stay
supportingInformation		0..0
authoredOn		1..1	dateTime	The date / time that the medication request was initially authored.
requester		0..1	Reference(InterweavePractitioner | InterweaveOrganization | InterweavePractitionerRole)	Who is requesting the medication.
performerType		0..1	CodeableConcept	Desired kind of performer of the medication administration Binding: ProcedurePerformerRoleCodes (preferred)
reasonCode	S	0..*	CodeableConcept	Reason or indication for ordering or not ordering the medication Binding: Condition/Problem/DiagnosisCodes (preferred)
instantiatesCanonical		0..0
instantiatesUri		0..0
basedOn		0..0
groupIdentifier		0..0
courseOfTherapyType	S	1..1	CodeableConcept	A course of therapy for a medication request Binding: InterweaveMedicationRequestCourseOfTherapyType (required)
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
insurance		0..0
note	S	0..*	Annotation	Extra information about the prescription that could not be conveyed by the other attributes.
dosageInstruction		1..1	Dosage	Dosage instructions for the medication.
text		1..1	string	Complete dosage instructions as text.
patientInstruction	S	1..1	string	Patient or consumer oriented instructions e.g. RHS of prescription label.
site
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
route
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
method
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
dispenseRequest
validityPeriod	S	1..1	Period	Time period supply is authorized for
expectedSupplyDuration	S	0..1	Duration	Number of days supply per dispense
value	S	0..1	decimal	The number of days supply.
unit	S	1..1	string	Unit representation Fixed Value: day
system	S	0..1	uri	System that defines coded unit form
code	S	1..1	code	Coded form of the unit Fixed Value: d
priorPrescription		0..0
detectedIssue		0..0
eventHistory		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
MedicationRequest.statusReason	preferred	InterweaveMedicationRequestStatusReason https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-MedicationRequestStatusReason from this IG
MedicationRequest.category	required	UKCoreMedicationRequestCategory https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationRequestCategory from this IG
MedicationRequest.medication[x]	required	UKCoreMedicationCode https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationCode from this IG
MedicationRequest.performerType	preferred	ProcedurePerformerRoleCodes http://hl7.org/fhir/ValueSet/performer-role from the FHIR Standard
MedicationRequest.reasonCode	preferred	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code from the FHIR Standard
MedicationRequest.courseOfTherapyType	required	InterweaveMedicationRequestCourseOfTherapyType https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-MedicationRequestCourseOfTherapyType from this IG

Name	Flags	Card.	Type	Description & Constraints
MedicationRequest		0..*	UKCoreMedicationRequest	Ordering of medication for patient or group
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
Slices for extension				Content/Rules for all slices
medicationRepeatInformation	S	0..1	(Complex)	Medication repeat information URL: https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation
Slices for extension				Content/Rules for all slices
extension:numberOfPrescriptionsIssued	S	0..1	Extension	Extension
extension		0..0
url		1..1	uri	"numberOfPrescriptionsIssued"
value[x]		1..1	unsignedInt	The specific number of times a repeat prescription has been issued
extension:authorisationExpiryDate	S	0..1	Extension	Extension
extension		0..0
url		1..1	uri	"authorisationExpiryDate"
value[x]		1..1	dateTime	Repeat prescription review date
LastIssuedDate	S	0..1	dateTime	Last issued date for repeat medication. URL: https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Extension-Interweave-MedicationLastIssuedDate
url		1..1	uri	"https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation"
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	S	0..*	Identifier	Allows the resource to be referenced within / by other resources.
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
assigner	Σ	0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	A code specifying the current state of the order. Binding: medicationrequest Status (required): A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.
statusReason	S	0..1	CodeableConcept	Reason for current status Binding: InterweaveMedicationRequestStatusReason (preferred)
intent	?!SΣ	1..1	code	Whether the request is a proposal, plan, or an original order. Binding: medicationRequest Intent (required): The kind of medication order.
category	S	1..1	CodeableConcept	Provides the business context for the relevant dispensing processes. Binding: UK Core Medication Request Category (required)
medication[x]	SΣ	1..1		Identifies the medication being requested. Binding: UK Core Medication Code (required)
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(Medication)
subject	SΣ	1..1	Reference(InterweavePatient)	Who the medication request is for.
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
encounter	S	0..1	Reference(InterweaveEncounter)	Encounter created as part of encounter/admission/stay
authoredOn	SΣ	1..1	dateTime	The date / time that the medication request was initially authored.
requester	SΣ	0..1	Reference(InterweavePractitioner | InterweaveOrganization | InterweavePractitionerRole)	Who is requesting the medication.
performerType	Σ	0..1	CodeableConcept	Desired kind of performer of the medication administration Binding: ProcedurePerformerRoleCodes (preferred)
reasonCode	S	0..*	CodeableConcept	Reason or indication for ordering or not ordering the medication Binding: Condition/Problem/DiagnosisCodes (preferred)
courseOfTherapyType	S	1..1	CodeableConcept	A course of therapy for a medication request Binding: InterweaveMedicationRequestCourseOfTherapyType (required)
note	S	0..*	Annotation	Extra information about the prescription that could not be conveyed by the other attributes.
dosageInstruction	S	1..1	Dosage	Dosage instructions for the medication.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
text	SΣ	1..1	string	Complete dosage instructions as text.
patientInstruction	SΣ	1..1	string	Patient or consumer oriented instructions e.g. RHS of prescription label.
timing	SΣ	0..1	Timing	When the medication should be administered.
doseAndRate	SΣ	0..*	Element	Dosage instructions for the requested medication.
dose[x]	SΣ	0..1		Quantity of requested medication to be administered.
doseRange			Range
doseQuantity			Quantity(SimpleQuantity)
rate[x]	SΣ	0..1		Rate at which the requested medication is to be administered.
rateRatio			Ratio
rateRange			Range
rateQuantity			Quantity(SimpleQuantity)
dispenseRequest	S	0..1	BackboneElement	Specific dispensing quantity instructions.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
validityPeriod	S	1..1	Period	Time period supply is authorized for
quantity	S	0..1	SimpleQuantity	>Amount of medication to supply per dispense.
expectedSupplyDuration	S	0..1	Duration	Number of days supply per dispense
value	SΣ	0..1	decimal	The number of days supply.
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	SΣ	1..1	string	Unit representation Fixed Value: day
system	SΣC	0..1	uri	System that defines coded unit form
code	SΣ	1..1	code	Coded form of the unit Fixed Value: d
substitution	S	1..1	BackboneElement	Any restrictions on medication substitution.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
allowed[x]		1..1		Whether substitution is allowed or not Binding: ActSubstanceAdminSubstitutionCode (example): Identifies the type of substitution allowed.
allowedBoolean			boolean
allowedCodeableConcept			CodeableConcept
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
MedicationRequest.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
MedicationRequest.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
MedicationRequest.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
MedicationRequest.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
MedicationRequest.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
MedicationRequest.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
MedicationRequest.status	required	medicationrequest Status http://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1 from the FHIR Standard
MedicationRequest.statusReason	preferred	InterweaveMedicationRequestStatusReason https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-MedicationRequestStatusReason from this IG
MedicationRequest.intent	required	medicationRequest Intent http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1 from the FHIR Standard
MedicationRequest.category	required	UKCoreMedicationRequestCategory https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationRequestCategory from this IG
MedicationRequest.medication[x]	required	UKCoreMedicationCode https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationCode from this IG
MedicationRequest.performerType	preferred	ProcedurePerformerRoleCodes http://hl7.org/fhir/ValueSet/performer-role from the FHIR Standard
MedicationRequest.reasonCode	preferred	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code from the FHIR Standard
MedicationRequest.courseOfTherapyType	required	InterweaveMedicationRequestCourseOfTherapyType https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-MedicationRequestCourseOfTherapyType from this IG
MedicationRequest.dispenseRequest.expectedSupplyDuration.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 from the FHIR Standard
MedicationRequest.substitution.allowed[x]	example	ActSubstanceAdminSubstitutionCode http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MedicationRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationRequest	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	error	MedicationRequest	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	error	MedicationRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MedicationRequest	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints
MedicationRequest		0..*	UKCoreMedicationRequest	Ordering of medication for patient or group
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
source	Σ	0..1	uri	Identifies where the resource comes from
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
medicationRepeatInformation	S	0..1	(Complex)	Medication repeat information URL: https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
extension:numberOfPrescriptionsIssued	S	0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"numberOfPrescriptionsIssued"
value[x]		1..1	unsignedInt	The specific number of times a repeat prescription has been issued
extension:authorisationExpiryDate	S	0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"authorisationExpiryDate"
value[x]		1..1	dateTime	Repeat prescription review date
LastIssuedDate	S	0..1	dateTime	Last issued date for repeat medication. URL: https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Extension-Interweave-MedicationLastIssuedDate
url		1..1	uri	"https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation"
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	S	0..*	Identifier	Allows the resource to be referenced within / by other resources.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	A code specifying the current state of the order. Binding: medicationrequest Status (required): A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.
statusReason	S	0..1	CodeableConcept	Reason for current status Binding: InterweaveMedicationRequestStatusReason (preferred)
intent	?!SΣ	1..1	code	Whether the request is a proposal, plan, or an original order. Binding: medicationRequest Intent (required): The kind of medication order.
category	S	1..1	CodeableConcept	Provides the business context for the relevant dispensing processes. Binding: UK Core Medication Request Category (required)
reported[x]	Σ	0..1		Reported rather than primary record
reportedBoolean			boolean
reportedReference			Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization)
medication[x]	SΣ	1..1		Identifies the medication being requested. Binding: UK Core Medication Code (required)
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(Medication)
subject	SΣ	1..1	Reference(InterweavePatient)	Who the medication request is for.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
encounter	S	0..1	Reference(InterweaveEncounter)	Encounter created as part of encounter/admission/stay
authoredOn	SΣ	1..1	dateTime	The date / time that the medication request was initially authored.
requester	SΣ	0..1	Reference(InterweavePractitioner | InterweaveOrganization | InterweavePractitionerRole)	Who is requesting the medication.
performer		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam)	Intended performer of administration
performerType	Σ	0..1	CodeableConcept	Desired kind of performer of the medication administration Binding: ProcedurePerformerRoleCodes (preferred)
recorder		0..1	Reference(Practitioner | PractitionerRole)	Person who entered the request
reasonCode	S	0..*	CodeableConcept	Reason or indication for ordering or not ordering the medication Binding: Condition/Problem/DiagnosisCodes (preferred)
reasonReference		0..*	Reference(Condition | Observation)	Condition or observation that supports why the prescription is being written
courseOfTherapyType	S	1..1	CodeableConcept	A course of therapy for a medication request Binding: InterweaveMedicationRequestCourseOfTherapyType (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
note	S	0..*	Annotation	Extra information about the prescription that could not be conveyed by the other attributes.
dosageInstruction	S	1..1	Dosage	Dosage instructions for the medication.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	0..1	integer	The order of the dosage instructions
text	SΣ	1..1	string	Complete dosage instructions as text.
additionalInstruction	Σ	0..*	CodeableConcept	Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
patientInstruction	SΣ	1..1	string	Patient or consumer oriented instructions e.g. RHS of prescription label.
timing	SΣ	0..1	Timing	When the medication should be administered.
asNeeded[x]	Σ	0..1		Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (preferred): 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.
asNeededBoolean			boolean
asNeededCodeableConcept			CodeableConcept
site	Σ	0..1	CodeableConcept	Body site to administer to Binding: UK Core Body Site (preferred)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
route	Σ	0..1	CodeableConcept	How drug should enter body Binding: UK Core Substance Or Product Administration Route (preferred)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
method	Σ	0..1	CodeableConcept	Technique for administering medication Binding: UK Core Medication Dosage Method (preferred)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
doseAndRate	SΣ	0..*	Element	Dosage instructions for the requested medication.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
type	Σ	0..1	CodeableConcept	The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
dose[x]	SΣ	0..1		Quantity of requested medication to be administered.
doseRange			Range
doseQuantity			Quantity(SimpleQuantity)
rate[x]	SΣ	0..1		Rate at which the requested medication is to be administered.
rateRatio			Ratio
rateRange			Range
rateQuantity			Quantity(SimpleQuantity)
maxDosePerPeriod	Σ	0..1	Ratio	Upper limit on medication per unit of time
maxDosePerAdministration	Σ	0..1	SimpleQuantity	Upper limit on medication per administration
maxDosePerLifetime	Σ	0..1	SimpleQuantity	Upper limit on medication per lifetime of the patient
dispenseRequest	S	0..1	BackboneElement	Specific dispensing quantity instructions.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
initialFill		0..1	BackboneElement	First fill details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
quantity		0..1	SimpleQuantity	First fill quantity
duration		0..1	Duration	First fill duration
dispenseInterval		0..1	Duration	Minimum period of time between dispenses
validityPeriod	S	1..1	Period	Time period supply is authorized for
numberOfRepeatsAllowed		0..1	unsignedInt	Number of refills authorized
quantity	S	0..1	SimpleQuantity	>Amount of medication to supply per dispense.
expectedSupplyDuration	S	0..1	Duration	Number of days supply per dispense
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	SΣ	0..1	decimal	The number of days supply.
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	SΣ	1..1	string	Unit representation Fixed Value: day
system	SΣC	0..1	uri	System that defines coded unit form
code	SΣ	1..1	code	Coded form of the unit Fixed Value: d
performer		0..1	Reference(Organization)	Intended dispenser
substitution	S	1..1	BackboneElement	Any restrictions on medication substitution.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
allowed[x]		1..1		Whether substitution is allowed or not Binding: ActSubstanceAdminSubstitutionCode (example): Identifies the type of substitution allowed.
allowedBoolean			boolean
allowedCodeableConcept			CodeableConcept
reason		0..1	CodeableConcept	Why should (not) substitution be made Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
MedicationRequest.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
MedicationRequest.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
MedicationRequest.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
MedicationRequest.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
MedicationRequest.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
MedicationRequest.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
MedicationRequest.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
MedicationRequest.status	required	medicationrequest Status http://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1 from the FHIR Standard
MedicationRequest.statusReason	preferred	InterweaveMedicationRequestStatusReason https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-MedicationRequestStatusReason from this IG
MedicationRequest.intent	required	medicationRequest Intent http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1 from the FHIR Standard
MedicationRequest.category	required	UKCoreMedicationRequestCategory https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationRequestCategory from this IG
MedicationRequest.medication[x]	required	UKCoreMedicationCode https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationCode from this IG
MedicationRequest.subject.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
MedicationRequest.performerType	preferred	ProcedurePerformerRoleCodes http://hl7.org/fhir/ValueSet/performer-role from the FHIR Standard
MedicationRequest.reasonCode	preferred	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code from the FHIR Standard
MedicationRequest.courseOfTherapyType	required	InterweaveMedicationRequestCourseOfTherapyType https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-MedicationRequestCourseOfTherapyType from this IG
MedicationRequest.dosageInstruction.additionalInstruction	example	SNOMEDCTAdditionalDosageInstructions http://hl7.org/fhir/ValueSet/additional-instruction-codes from the FHIR Standard
MedicationRequest.dosageInstruction.asNeeded[x]	preferred	SNOMEDCTMedicationAsNeededReasonCodes http://hl7.org/fhir/ValueSet/medication-as-needed-reason from the FHIR Standard
MedicationRequest.dosageInstruction.site	preferred	UKCoreBodySite https://fhir.hl7.org.uk/ValueSet/UKCore-BodySite from this IG
MedicationRequest.dosageInstruction.route	preferred	UKCoreSubstanceOrProductAdministrationRoute https://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute from this IG
MedicationRequest.dosageInstruction.method	preferred	UKCoreMedicationDosageMethod https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationDosageMethod from this IG
MedicationRequest.dosageInstruction.doseAndRate.type	example	DoseAndRateType http://hl7.org/fhir/ValueSet/dose-rate-type from the FHIR Standard
MedicationRequest.dispenseRequest.expectedSupplyDuration.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 from the FHIR Standard
MedicationRequest.substitution.allowed[x]	example	ActSubstanceAdminSubstitutionCode http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode
MedicationRequest.substitution.reason	example	SubstanceAdminSubstitutionReason http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MedicationRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationRequest	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	error	MedicationRequest	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	error	MedicationRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MedicationRequest	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from UKCoreMedicationRequest

Name	Flags	Card.	Type	Description & Constraints
MedicationRequest			UKCoreMedicationRequest
id	S	0..1	id	Logical id of this artifact
meta
id		0..0
versionId	S	0..1	id	Version specific identifier
lastUpdated	S	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	S	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security		0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers
Slices for tag		0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:Source	S	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
id		0..0
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
version		0..0
code	S	1..1	code	The Data Provider Id of the system supplying the data
display	S	1..1	string	Name of the system supplying the data
tag:Provenance	S	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
id		0..0
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
version		0..0
code	S	1..1	code	The ODS Code of the organisation responsible for the data
display	S	1..1	string	Name of the organisation supplying the data
implicitRules		0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation)
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
Slices for extension				Content/Rules for all slices
extension:medicationRepeatInformation	S	0..1	ExtensionUKCoreMedicationRepeatInformation	Medication repeat information
Slices for extension				Content/Rules for all slices
extension:numberOfPrescriptionsIssued	S	0..1	Extension	Extension
extension:authorisationExpiryDate	S	0..1	Extension	Extension
LastIssuedDate	S	0..1	dateTime	Last issued date for repeat medication. URL: https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Extension-Interweave-MedicationLastIssuedDate
identifier
assigner		0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
statusReason	S	0..1	CodeableConcept	Reason for current status Binding: InterweaveMedicationRequestStatusReason (preferred)
category		1..1	CodeableConcept	Provides the business context for the relevant dispensing processes. Binding: UK Core Medication Request Category (required)
priority		0..0
doNotPerform		0..0
medication[x]		1..1	CodeableConcept, Reference(Medication)	Identifies the medication being requested. Binding: UK Core Medication Code (required)
subject		1..1	Reference(InterweavePatient)	Who the medication request is for.
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
encounter	S	0..1	Reference(InterweaveEncounter)	Encounter created as part of encounter/admission/stay
supportingInformation		0..0
authoredOn		1..1	dateTime	The date / time that the medication request was initially authored.
requester		0..1	Reference(InterweavePractitioner | InterweaveOrganization | InterweavePractitionerRole)	Who is requesting the medication.
performerType		0..1	CodeableConcept	Desired kind of performer of the medication administration Binding: ProcedurePerformerRoleCodes (preferred)
reasonCode	S	0..*	CodeableConcept	Reason or indication for ordering or not ordering the medication Binding: Condition/Problem/DiagnosisCodes (preferred)
instantiatesCanonical		0..0
instantiatesUri		0..0
basedOn		0..0
groupIdentifier		0..0
courseOfTherapyType	S	1..1	CodeableConcept	A course of therapy for a medication request Binding: InterweaveMedicationRequestCourseOfTherapyType (required)
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
insurance		0..0
note	S	0..*	Annotation	Extra information about the prescription that could not be conveyed by the other attributes.
dosageInstruction		1..1	Dosage	Dosage instructions for the medication.
text		1..1	string	Complete dosage instructions as text.
patientInstruction	S	1..1	string	Patient or consumer oriented instructions e.g. RHS of prescription label.
site
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
route
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
method
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
dispenseRequest
validityPeriod	S	1..1	Period	Time period supply is authorized for
expectedSupplyDuration	S	0..1	Duration	Number of days supply per dispense
value	S	0..1	decimal	The number of days supply.
unit	S	1..1	string	Unit representation Fixed Value: day
system	S	0..1	uri	System that defines coded unit form
code	S	1..1	code	Coded form of the unit Fixed Value: d
priorPrescription		0..0
detectedIssue		0..0
eventHistory		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
MedicationRequest.statusReason	preferred	InterweaveMedicationRequestStatusReason https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-MedicationRequestStatusReason from this IG
MedicationRequest.category	required	UKCoreMedicationRequestCategory https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationRequestCategory from this IG
MedicationRequest.medication[x]	required	UKCoreMedicationCode https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationCode from this IG
MedicationRequest.performerType	preferred	ProcedurePerformerRoleCodes http://hl7.org/fhir/ValueSet/performer-role from the FHIR Standard
MedicationRequest.reasonCode	preferred	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code from the FHIR Standard
MedicationRequest.courseOfTherapyType	required	InterweaveMedicationRequestCourseOfTherapyType https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-MedicationRequestCourseOfTherapyType from this IG

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
MedicationRequest		0..*	UKCoreMedicationRequest	Ordering of medication for patient or group
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
Slices for extension				Content/Rules for all slices
medicationRepeatInformation	S	0..1	(Complex)	Medication repeat information URL: https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation
Slices for extension				Content/Rules for all slices
extension:numberOfPrescriptionsIssued	S	0..1	Extension	Extension
extension		0..0
url		1..1	uri	"numberOfPrescriptionsIssued"
value[x]		1..1	unsignedInt	The specific number of times a repeat prescription has been issued
extension:authorisationExpiryDate	S	0..1	Extension	Extension
extension		0..0
url		1..1	uri	"authorisationExpiryDate"
value[x]		1..1	dateTime	Repeat prescription review date
LastIssuedDate	S	0..1	dateTime	Last issued date for repeat medication. URL: https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Extension-Interweave-MedicationLastIssuedDate
url		1..1	uri	"https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation"
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	S	0..*	Identifier	Allows the resource to be referenced within / by other resources.
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
assigner	Σ	0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	A code specifying the current state of the order. Binding: medicationrequest Status (required): A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.
statusReason	S	0..1	CodeableConcept	Reason for current status Binding: InterweaveMedicationRequestStatusReason (preferred)
intent	?!SΣ	1..1	code	Whether the request is a proposal, plan, or an original order. Binding: medicationRequest Intent (required): The kind of medication order.
category	S	1..1	CodeableConcept	Provides the business context for the relevant dispensing processes. Binding: UK Core Medication Request Category (required)
medication[x]	SΣ	1..1		Identifies the medication being requested. Binding: UK Core Medication Code (required)
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(Medication)
subject	SΣ	1..1	Reference(InterweavePatient)	Who the medication request is for.
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
encounter	S	0..1	Reference(InterweaveEncounter)	Encounter created as part of encounter/admission/stay
authoredOn	SΣ	1..1	dateTime	The date / time that the medication request was initially authored.
requester	SΣ	0..1	Reference(InterweavePractitioner | InterweaveOrganization | InterweavePractitionerRole)	Who is requesting the medication.
performerType	Σ	0..1	CodeableConcept	Desired kind of performer of the medication administration Binding: ProcedurePerformerRoleCodes (preferred)
reasonCode	S	0..*	CodeableConcept	Reason or indication for ordering or not ordering the medication Binding: Condition/Problem/DiagnosisCodes (preferred)
courseOfTherapyType	S	1..1	CodeableConcept	A course of therapy for a medication request Binding: InterweaveMedicationRequestCourseOfTherapyType (required)
note	S	0..*	Annotation	Extra information about the prescription that could not be conveyed by the other attributes.
dosageInstruction	S	1..1	Dosage	Dosage instructions for the medication.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
text	SΣ	1..1	string	Complete dosage instructions as text.
patientInstruction	SΣ	1..1	string	Patient or consumer oriented instructions e.g. RHS of prescription label.
timing	SΣ	0..1	Timing	When the medication should be administered.
doseAndRate	SΣ	0..*	Element	Dosage instructions for the requested medication.
dose[x]	SΣ	0..1		Quantity of requested medication to be administered.
doseRange			Range
doseQuantity			Quantity(SimpleQuantity)
rate[x]	SΣ	0..1		Rate at which the requested medication is to be administered.
rateRatio			Ratio
rateRange			Range
rateQuantity			Quantity(SimpleQuantity)
dispenseRequest	S	0..1	BackboneElement	Specific dispensing quantity instructions.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
validityPeriod	S	1..1	Period	Time period supply is authorized for
quantity	S	0..1	SimpleQuantity	>Amount of medication to supply per dispense.
expectedSupplyDuration	S	0..1	Duration	Number of days supply per dispense
value	SΣ	0..1	decimal	The number of days supply.
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	SΣ	1..1	string	Unit representation Fixed Value: day
system	SΣC	0..1	uri	System that defines coded unit form
code	SΣ	1..1	code	Coded form of the unit Fixed Value: d
substitution	S	1..1	BackboneElement	Any restrictions on medication substitution.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
allowed[x]		1..1		Whether substitution is allowed or not Binding: ActSubstanceAdminSubstitutionCode (example): Identifies the type of substitution allowed.
allowedBoolean			boolean
allowedCodeableConcept			CodeableConcept
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
MedicationRequest.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
MedicationRequest.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
MedicationRequest.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
MedicationRequest.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
MedicationRequest.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
MedicationRequest.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
MedicationRequest.status	required	medicationrequest Status http://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1 from the FHIR Standard
MedicationRequest.statusReason	preferred	InterweaveMedicationRequestStatusReason https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-MedicationRequestStatusReason from this IG
MedicationRequest.intent	required	medicationRequest Intent http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1 from the FHIR Standard
MedicationRequest.category	required	UKCoreMedicationRequestCategory https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationRequestCategory from this IG
MedicationRequest.medication[x]	required	UKCoreMedicationCode https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationCode from this IG
MedicationRequest.performerType	preferred	ProcedurePerformerRoleCodes http://hl7.org/fhir/ValueSet/performer-role from the FHIR Standard
MedicationRequest.reasonCode	preferred	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code from the FHIR Standard
MedicationRequest.courseOfTherapyType	required	InterweaveMedicationRequestCourseOfTherapyType https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-MedicationRequestCourseOfTherapyType from this IG
MedicationRequest.dispenseRequest.expectedSupplyDuration.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 from the FHIR Standard
MedicationRequest.substitution.allowed[x]	example	ActSubstanceAdminSubstitutionCode http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MedicationRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationRequest	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	error	MedicationRequest	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	error	MedicationRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MedicationRequest	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
MedicationRequest		0..*	UKCoreMedicationRequest	Ordering of medication for patient or group
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
source	Σ	0..1	uri	Identifies where the resource comes from
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
medicationRepeatInformation	S	0..1	(Complex)	Medication repeat information URL: https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
extension:numberOfPrescriptionsIssued	S	0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"numberOfPrescriptionsIssued"
value[x]		1..1	unsignedInt	The specific number of times a repeat prescription has been issued
extension:authorisationExpiryDate	S	0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"authorisationExpiryDate"
value[x]		1..1	dateTime	Repeat prescription review date
LastIssuedDate	S	0..1	dateTime	Last issued date for repeat medication. URL: https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Extension-Interweave-MedicationLastIssuedDate
url		1..1	uri	"https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation"
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	S	0..*	Identifier	Allows the resource to be referenced within / by other resources.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	A code specifying the current state of the order. Binding: medicationrequest Status (required): A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.
statusReason	S	0..1	CodeableConcept	Reason for current status Binding: InterweaveMedicationRequestStatusReason (preferred)
intent	?!SΣ	1..1	code	Whether the request is a proposal, plan, or an original order. Binding: medicationRequest Intent (required): The kind of medication order.
category	S	1..1	CodeableConcept	Provides the business context for the relevant dispensing processes. Binding: UK Core Medication Request Category (required)
reported[x]	Σ	0..1		Reported rather than primary record
reportedBoolean			boolean
reportedReference			Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization)
medication[x]	SΣ	1..1		Identifies the medication being requested. Binding: UK Core Medication Code (required)
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(Medication)
subject	SΣ	1..1	Reference(InterweavePatient)	Who the medication request is for.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
encounter	S	0..1	Reference(InterweaveEncounter)	Encounter created as part of encounter/admission/stay
authoredOn	SΣ	1..1	dateTime	The date / time that the medication request was initially authored.
requester	SΣ	0..1	Reference(InterweavePractitioner | InterweaveOrganization | InterweavePractitionerRole)	Who is requesting the medication.
performer		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam)	Intended performer of administration
performerType	Σ	0..1	CodeableConcept	Desired kind of performer of the medication administration Binding: ProcedurePerformerRoleCodes (preferred)
recorder		0..1	Reference(Practitioner | PractitionerRole)	Person who entered the request
reasonCode	S	0..*	CodeableConcept	Reason or indication for ordering or not ordering the medication Binding: Condition/Problem/DiagnosisCodes (preferred)
reasonReference		0..*	Reference(Condition | Observation)	Condition or observation that supports why the prescription is being written
courseOfTherapyType	S	1..1	CodeableConcept	A course of therapy for a medication request Binding: InterweaveMedicationRequestCourseOfTherapyType (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
note	S	0..*	Annotation	Extra information about the prescription that could not be conveyed by the other attributes.
dosageInstruction	S	1..1	Dosage	Dosage instructions for the medication.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	0..1	integer	The order of the dosage instructions
text	SΣ	1..1	string	Complete dosage instructions as text.
additionalInstruction	Σ	0..*	CodeableConcept	Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
patientInstruction	SΣ	1..1	string	Patient or consumer oriented instructions e.g. RHS of prescription label.
timing	SΣ	0..1	Timing	When the medication should be administered.
asNeeded[x]	Σ	0..1		Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (preferred): 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.
asNeededBoolean			boolean
asNeededCodeableConcept			CodeableConcept
site	Σ	0..1	CodeableConcept	Body site to administer to Binding: UK Core Body Site (preferred)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
route	Σ	0..1	CodeableConcept	How drug should enter body Binding: UK Core Substance Or Product Administration Route (preferred)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
method	Σ	0..1	CodeableConcept	Technique for administering medication Binding: UK Core Medication Dosage Method (preferred)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
doseAndRate	SΣ	0..*	Element	Dosage instructions for the requested medication.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
type	Σ	0..1	CodeableConcept	The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
dose[x]	SΣ	0..1		Quantity of requested medication to be administered.
doseRange			Range
doseQuantity			Quantity(SimpleQuantity)
rate[x]	SΣ	0..1		Rate at which the requested medication is to be administered.
rateRatio			Ratio
rateRange			Range
rateQuantity			Quantity(SimpleQuantity)
maxDosePerPeriod	Σ	0..1	Ratio	Upper limit on medication per unit of time
maxDosePerAdministration	Σ	0..1	SimpleQuantity	Upper limit on medication per administration
maxDosePerLifetime	Σ	0..1	SimpleQuantity	Upper limit on medication per lifetime of the patient
dispenseRequest	S	0..1	BackboneElement	Specific dispensing quantity instructions.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
initialFill		0..1	BackboneElement	First fill details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
quantity		0..1	SimpleQuantity	First fill quantity
duration		0..1	Duration	First fill duration
dispenseInterval		0..1	Duration	Minimum period of time between dispenses
validityPeriod	S	1..1	Period	Time period supply is authorized for
numberOfRepeatsAllowed		0..1	unsignedInt	Number of refills authorized
quantity	S	0..1	SimpleQuantity	>Amount of medication to supply per dispense.
expectedSupplyDuration	S	0..1	Duration	Number of days supply per dispense
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	SΣ	0..1	decimal	The number of days supply.
comparator	?!Σ	0..1	code	< | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	SΣ	1..1	string	Unit representation Fixed Value: day
system	SΣC	0..1	uri	System that defines coded unit form
code	SΣ	1..1	code	Coded form of the unit Fixed Value: d
performer		0..1	Reference(Organization)	Intended dispenser
substitution	S	1..1	BackboneElement	Any restrictions on medication substitution.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
allowed[x]		1..1		Whether substitution is allowed or not Binding: ActSubstanceAdminSubstitutionCode (example): Identifies the type of substitution allowed.
allowedBoolean			boolean
allowedCodeableConcept			CodeableConcept
reason		0..1	CodeableConcept	Why should (not) substitution be made Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
MedicationRequest.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
MedicationRequest.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
MedicationRequest.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
MedicationRequest.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
MedicationRequest.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
MedicationRequest.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
MedicationRequest.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
MedicationRequest.status	required	medicationrequest Status http://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1 from the FHIR Standard
MedicationRequest.statusReason	preferred	InterweaveMedicationRequestStatusReason https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-MedicationRequestStatusReason from this IG
MedicationRequest.intent	required	medicationRequest Intent http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1 from the FHIR Standard
MedicationRequest.category	required	UKCoreMedicationRequestCategory https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationRequestCategory from this IG
MedicationRequest.medication[x]	required	UKCoreMedicationCode https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationCode from this IG
MedicationRequest.subject.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
MedicationRequest.performerType	preferred	ProcedurePerformerRoleCodes http://hl7.org/fhir/ValueSet/performer-role from the FHIR Standard
MedicationRequest.reasonCode	preferred	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code from the FHIR Standard
MedicationRequest.courseOfTherapyType	required	InterweaveMedicationRequestCourseOfTherapyType https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-MedicationRequestCourseOfTherapyType from this IG
MedicationRequest.dosageInstruction.additionalInstruction	example	SNOMEDCTAdditionalDosageInstructions http://hl7.org/fhir/ValueSet/additional-instruction-codes from the FHIR Standard
MedicationRequest.dosageInstruction.asNeeded[x]	preferred	SNOMEDCTMedicationAsNeededReasonCodes http://hl7.org/fhir/ValueSet/medication-as-needed-reason from the FHIR Standard
MedicationRequest.dosageInstruction.site	preferred	UKCoreBodySite https://fhir.hl7.org.uk/ValueSet/UKCore-BodySite from this IG
MedicationRequest.dosageInstruction.route	preferred	UKCoreSubstanceOrProductAdministrationRoute https://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute from this IG
MedicationRequest.dosageInstruction.method	preferred	UKCoreMedicationDosageMethod https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationDosageMethod from this IG
MedicationRequest.dosageInstruction.doseAndRate.type	example	DoseAndRateType http://hl7.org/fhir/ValueSet/dose-rate-type from the FHIR Standard
MedicationRequest.dispenseRequest.expectedSupplyDuration.comparator	required	QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 from the FHIR Standard
MedicationRequest.substitution.allowed[x]	example	ActSubstanceAdminSubstitutionCode http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode
MedicationRequest.substitution.reason	example	SubstanceAdminSubstitutionReason http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MedicationRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationRequest	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	error	MedicationRequest	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	error	MedicationRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MedicationRequest	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from UKCoreMedicationRequest

Summary

Mandatory: 8 elements(21 nested mandatory elements)
Must-Support: 26 elements
Fixed: 4 elements
Prohibited: 16 elements

Structures

This structure refers to these other structures:

• InterweaveOrganization (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Organization)
• InterweavePatient (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Patient)
• InterweaveEncounter (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Encounter)
• InterweavePractitioner (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Practitioner)
• InterweavePractitionerRole (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-PractitionerRole)

Extensions

This structure refers to these extensions:

• https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Extension-Interweave-MedicationLastIssuedDate

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of MedicationRequest.meta.tag