Status: Active: Approved (STU)

Introduction

Describes the event of a patient consuming or otherwise being administered a medication. This may be as simple as swallowing a tablet or it may be a long running infusion. Related resources tie this event to the authorizing prescription, and the specific encounter between patient and health care practitioner.

Mandatory fields

The following fields are mandatory:

• status - Will generally be set to show that the administration has been completed. For some long running administrations such as infusions it is possible for an administration to be started but not completed or it may be paused while some other process is under way.

• medicationReference - Care connect have removed medication.codeableConcept in favour of referencing a medication resource, meaning that we have to model the medication resource. the reference.display field should be populated with the name of the medication which will be a DM&D description.

• subject – A reference to the patient who the request is for. To aid the data consumer, the display element should contain the patient’s name.

• effective – An important field to provide details of the time/time period during which the medication was administered.

Must Support fields

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

• category – We update the valueset used to populated this field, to include the additional code of “discharge”, which is present in R4. We also make this a required binding, as currently it is an example only.

• identifier – a Local Id should be provided, such that could be quoted if manually getting in touch to find out more

• context - This field is renamed to Encounter in R4. Here we limit the field to only allow references to an encounter resource. 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.

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 - Required to populate if known. The main purpose would be to provide details of a Practitioner who can give more information about the condition. Therefore it should not be populated with details of purely admin staff who may have keyed in the data. If the asserter is not populated then an unknown Practitioner should be assumed.

  A further consideration is the possibility of a Condition being asserted by a non-care-professional, for example the Patient themselves or a relative. FHIR caters for this possibiity by allowing the asserter to be a Patient or RelatedPerson, and this option is left open here.

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

• prescription - Link to the MedicationRequest that this MedicationAdministration is based on.

• reasonNotGiven - A set of codes indicating the reason why the administration was not performed.

• device - The device used in administering the medication to the patient. For example, a particular infusion pump.

• note - Extra information about the medication administration that is not conveyed by the other attributes.

• dosage - Details of how medication was taken, dosage information details e.g. dose (The amount of the medication given at one administration event.), rate (Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion), site, route, method (A coded value indicating the method by which the medication is intended to be or was introduced into or on the body(most commonly used for injections)) etc.

Discouraged or Removed fields

• definition – This field has been removed in R4 and we have done the same in our specification to keep it inline.

• partOf – It is not the intention to create a complex grouping or hierarchy of medication information, a simple flat structure is informative and preferred. Therefore,this fields have been removed.

• 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

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

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

This structure is derived from CareConnect-MedicationAdministration-1

Name	Flags	Card.	Type	Description & Constraints
MedicationAdministration		0..*	CareConnect-MedicationAdministration-1	Administration of medication to a patient
id	S	0..1	id	Logical id of this artifact
meta
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..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
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
system		1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
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
system		1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
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
definition		0..0
partOf		0..0
status	S	1..1	code	in-progress | on-hold | completed | entered-in-error | stopped | unknown
category	S	1..1	CodeableConcept	Type of medication usage Binding: InterweaveMedicationRequestCategory (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
medication[x]:medicationReference	S	1..1	Reference(CareConnect-Medication-1)	Reference to the medicatin resource
subject	S	1..1	Reference(CareConnectPatient1)	Who received medication
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
context	S	0..1	Reference(CareConnect-Encounter-1)	Encounter or Episode of Care administered as part of
supportingInformation		0..0
effective[x]	S	1..1	Period	Start and end time of administration
start	S	1..1	dateTime	Starting time with inclusive boundary
performer
actor	S	1..1	Reference(Device | CareConnectPatient1 | CareConnect-RelatedPerson-1 | CareConnect-Practitioner-1)	Individual who was performing
onBehalfOf		0..0
reasonNotGiven		0..*	CodeableConcept	Reason administration not performed. Binding: SNOMED CT Reason Medication Not Given Codes (preferred)
reasonCode		0..*	CodeableConcept	Reason administration performed Binding: Reason Medication Given Codes (preferred)
eventHistory		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
MedicationAdministration.category	required	InterweaveMedicationRequestCategory
MedicationAdministration.reasonNotGiven	preferred	SNOMED CT Reason Medication Not Given Codes
MedicationAdministration.reasonCode	preferred	Reason Medication Given Codes

Name	Flags	Card.	Type	Description & Constraints
MedicationAdministration	C	0..*	CareConnect-MedicationAdministration-1	Administration of medication to a patient
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..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
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: Common Tags (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: Common Tags (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://yhcr.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: Common Tags (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://yhcr.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: Common Languages (extensible): 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
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	in-progress | on-hold | completed | entered-in-error | stopped | unknown Binding: MedicationAdministrationStatus (required): A set of codes indicating the current status of a MedicationAdministration.
category	S	1..1	CodeableConcept	Type of medication usage Binding: InterweaveMedicationRequestCategory (required)
Slices for medication[x]	Σ	1..1	Reference()	What was administered Slice: Unordered, Closed by type:$this
medication[x]:medicationReference	SΣ	1..1	Reference(CareConnect-Medication-1)	Reference to the medicatin resource
subject	SΣ	1..1	Reference(CareConnectPatient1)	Who received medication
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
context	S	0..1	Reference(CareConnect-Encounter-1)	Encounter or Episode of Care administered as part of
effective[x]	SΣ	1..1	Period	Start and end time of administration
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
performer	Σ	0..*	BackboneElement	Who administered substance
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
actor	SΣ	1..1	Reference(Device | CareConnectPatient1 | CareConnect-RelatedPerson-1 | CareConnect-Practitioner-1)	Individual who was performing
notGiven	?!Σ	0..1	boolean	True if medication not administered
reasonNotGiven	C	0..*	CodeableConcept	Reason administration not performed. Binding: SNOMED CT Reason Medication Not Given Codes (preferred)
reasonCode	C	0..*	CodeableConcept	Reason administration performed Binding: Reason Medication Given Codes (preferred)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
MedicationAdministration.meta.security	extensible	All Security Labels
MedicationAdministration.meta.tag	example	Common Tags
MedicationAdministration.meta.tag:Source	example	Common Tags
MedicationAdministration.meta.tag:Provenance	example	Common Tags
MedicationAdministration.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
MedicationAdministration.status	required	MedicationAdministrationStatus
MedicationAdministration.category	required	InterweaveMedicationRequestCategory
MedicationAdministration.reasonNotGiven	preferred	SNOMED CT Reason Medication Not Given Codes
MedicationAdministration.reasonCode	preferred	Reason Medication Given Codes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-1	error	MedicationAdministration	If the resource is contained in another resource, it SHALL NOT contain any narrative : contained.text.empty()
dom-2	error	MedicationAdministration	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationAdministration	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource : contained.where(('#'+id in %resource.descendants().reference).not()).empty()
dom-4	error	MedicationAdministration	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()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())
mad-2	error	MedicationAdministration	Reason not given is only permitted if NotGiven is true : reasonNotGiven.empty() or notGiven = true
mad-3	error	MedicationAdministration	Reason given is only permitted if NotGiven is false : reasonCode.empty() or notGiven.empty() or notGiven = 'false'

Name	Flags	Card.	Type	Description & Constraints
MedicationAdministration	C	0..*	CareConnect-MedicationAdministration-1	Administration of medication to a patient
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	xml:id (or equivalent in JSON)
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.
profile	SΣ	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
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: Common Tags (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: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
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://yhcr.nhs.uk/Source
version	Σ	0..1	string	Version of the system - if relevant
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: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
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://yhcr.nhs.uk/Provenance
version	Σ	0..1	string	Version of the system - if relevant
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: Common Languages (extensible): 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
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	External identifier
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (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(CareConnect-Organization-1)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	in-progress | on-hold | completed | entered-in-error | stopped | unknown Binding: MedicationAdministrationStatus (required): A set of codes indicating the current status of a MedicationAdministration.
category	S	1..1	CodeableConcept	Type of medication usage Binding: InterweaveMedicationRequestCategory (required)
id		0..1	string	xml:id (or equivalent in JSON)
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	xml:id (or equivalent in JSON)
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
Slices for medication[x]	Σ	1..1	Reference()	What was administered Slice: Unordered, Closed by type:$this
medication[x]:medicationReference	SΣ	1..1	Reference(CareConnect-Medication-1)	Reference to the medicatin resource
subject	SΣ	1..1	Reference(CareConnectPatient1)	Who received medication
id		0..1	string	xml:id (or equivalent in JSON)
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)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
context	S	0..1	Reference(CareConnect-Encounter-1)	Encounter or Episode of Care administered as part of
effective[x]	SΣ	1..1	Period	Start and end time of administration
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
performer	Σ	0..*	BackboneElement	Who administered substance
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
actor	SΣ	1..1	Reference(Device | CareConnectPatient1 | CareConnect-RelatedPerson-1 | CareConnect-Practitioner-1)	Individual who was performing
notGiven	?!Σ	0..1	boolean	True if medication not administered
reasonNotGiven	C	0..*	CodeableConcept	Reason administration not performed. Binding: SNOMED CT Reason Medication Not Given Codes (preferred)
reasonCode	C	0..*	CodeableConcept	Reason administration performed Binding: Reason Medication Given Codes (preferred)
reasonReference		0..*	Reference(CareConnect-Condition-1 | CareConnect-Observation-1)	Condition or Observation that supports why the medication was administered
prescription		0..1	Reference(CareConnect-MedicationRequest-1)	Request administration performed against
device		0..*	Reference(Device)	Device used to administer
note		0..*	Annotation	Information about the administration
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
author[x]	Σ	0..1		Individual responsible for the annotation
authorString			string
authorReference			Reference(CareConnectPatient1 | CareConnect-RelatedPerson-1 | CareConnect-Practitioner-1)
time	Σ	0..1	dateTime	When the annotation was made
text		1..1	string	The annotation - text content
dosage	C	0..1	BackboneElement	Details of how medication was taken
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
text		0..1	string	Free text dosage instructions e.g. SIG
site		0..1	CodeableConcept	Body site administered to Binding: SNOMED CT Anatomical Structure for Administration Site Codes (example): A coded concept describing the site location the medicine enters into or onto the body.
route		0..1	CodeableConcept	Path of substance into body Binding: SNOMED CT Route Codes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:snomedCT	Σ	0..1	Coding	Code defined by a terminology system Binding: Care Connect Medication Dosage Route (example): A code from the SNOMED Clinical Terminology UK coding system that describes the e-Prescribing route of administration.
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
SnomedCTDescriptionId		0..1	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
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		0..1	CodeableConcept	How drug was administered Binding: SNOMED CT Administration Method Codes (example): A coded concept describing the technique by which the medicine is administered.
dose		0..1	SimpleQuantity	Amount of medication per dose
rate[x]		0..1		Dose quantity per unit of time
rateRatio			Ratio
rateQuantity			Quantity(SimpleQuantity)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
MedicationAdministration.meta.security	extensible	All Security Labels
MedicationAdministration.meta.tag	example	Common Tags
MedicationAdministration.meta.tag:Source	example	Common Tags
MedicationAdministration.meta.tag:Provenance	example	Common Tags
MedicationAdministration.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
MedicationAdministration.identifier.use	required	IdentifierUse
MedicationAdministration.identifier.type	extensible	Identifier Type Codes
MedicationAdministration.status	required	MedicationAdministrationStatus
MedicationAdministration.category	required	InterweaveMedicationRequestCategory
MedicationAdministration.reasonNotGiven	preferred	SNOMED CT Reason Medication Not Given Codes
MedicationAdministration.reasonCode	preferred	Reason Medication Given Codes
MedicationAdministration.dosage.site	example	SNOMED CT Anatomical Structure for Administration Site Codes
MedicationAdministration.dosage.route	example	SNOMED CT Route Codes
MedicationAdministration.dosage.route.coding:snomedCT	example	Care Connect Medication Dosage Route
MedicationAdministration.dosage.method	example	SNOMED CT Administration Method Codes

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())
mad-1	error	MedicationAdministration.dosage	SHALL have at least one of dosage.dose or dosage.rate[x] : dose.exists() or rate.exists()

Differential View

This structure is derived from CareConnect-MedicationAdministration-1

Name	Flags	Card.	Type	Description & Constraints
MedicationAdministration		0..*	CareConnect-MedicationAdministration-1	Administration of medication to a patient
id	S	0..1	id	Logical id of this artifact
meta
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..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
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
system		1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
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
system		1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
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
definition		0..0
partOf		0..0
status	S	1..1	code	in-progress | on-hold | completed | entered-in-error | stopped | unknown
category	S	1..1	CodeableConcept	Type of medication usage Binding: InterweaveMedicationRequestCategory (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
medication[x]:medicationReference	S	1..1	Reference(CareConnect-Medication-1)	Reference to the medicatin resource
subject	S	1..1	Reference(CareConnectPatient1)	Who received medication
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
context	S	0..1	Reference(CareConnect-Encounter-1)	Encounter or Episode of Care administered as part of
supportingInformation		0..0
effective[x]	S	1..1	Period	Start and end time of administration
start	S	1..1	dateTime	Starting time with inclusive boundary
performer
actor	S	1..1	Reference(Device | CareConnectPatient1 | CareConnect-RelatedPerson-1 | CareConnect-Practitioner-1)	Individual who was performing
onBehalfOf		0..0
reasonNotGiven		0..*	CodeableConcept	Reason administration not performed. Binding: SNOMED CT Reason Medication Not Given Codes (preferred)
reasonCode		0..*	CodeableConcept	Reason administration performed Binding: Reason Medication Given Codes (preferred)
eventHistory		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
MedicationAdministration.category	required	InterweaveMedicationRequestCategory
MedicationAdministration.reasonNotGiven	preferred	SNOMED CT Reason Medication Not Given Codes
MedicationAdministration.reasonCode	preferred	Reason Medication Given Codes

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
MedicationAdministration	C	0..*	CareConnect-MedicationAdministration-1	Administration of medication to a patient
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..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
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: Common Tags (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: Common Tags (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://yhcr.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: Common Tags (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://yhcr.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: Common Languages (extensible): 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
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	in-progress | on-hold | completed | entered-in-error | stopped | unknown Binding: MedicationAdministrationStatus (required): A set of codes indicating the current status of a MedicationAdministration.
category	S	1..1	CodeableConcept	Type of medication usage Binding: InterweaveMedicationRequestCategory (required)
Slices for medication[x]	Σ	1..1	Reference()	What was administered Slice: Unordered, Closed by type:$this
medication[x]:medicationReference	SΣ	1..1	Reference(CareConnect-Medication-1)	Reference to the medicatin resource
subject	SΣ	1..1	Reference(CareConnectPatient1)	Who received medication
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
context	S	0..1	Reference(CareConnect-Encounter-1)	Encounter or Episode of Care administered as part of
effective[x]	SΣ	1..1	Period	Start and end time of administration
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
performer	Σ	0..*	BackboneElement	Who administered substance
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
actor	SΣ	1..1	Reference(Device | CareConnectPatient1 | CareConnect-RelatedPerson-1 | CareConnect-Practitioner-1)	Individual who was performing
notGiven	?!Σ	0..1	boolean	True if medication not administered
reasonNotGiven	C	0..*	CodeableConcept	Reason administration not performed. Binding: SNOMED CT Reason Medication Not Given Codes (preferred)
reasonCode	C	0..*	CodeableConcept	Reason administration performed Binding: Reason Medication Given Codes (preferred)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
MedicationAdministration.meta.security	extensible	All Security Labels
MedicationAdministration.meta.tag	example	Common Tags
MedicationAdministration.meta.tag:Source	example	Common Tags
MedicationAdministration.meta.tag:Provenance	example	Common Tags
MedicationAdministration.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
MedicationAdministration.status	required	MedicationAdministrationStatus
MedicationAdministration.category	required	InterweaveMedicationRequestCategory
MedicationAdministration.reasonNotGiven	preferred	SNOMED CT Reason Medication Not Given Codes
MedicationAdministration.reasonCode	preferred	Reason Medication Given Codes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-1	error	MedicationAdministration	If the resource is contained in another resource, it SHALL NOT contain any narrative : contained.text.empty()
dom-2	error	MedicationAdministration	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationAdministration	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource : contained.where(('#'+id in %resource.descendants().reference).not()).empty()
dom-4	error	MedicationAdministration	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()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())
mad-2	error	MedicationAdministration	Reason not given is only permitted if NotGiven is true : reasonNotGiven.empty() or notGiven = true
mad-3	error	MedicationAdministration	Reason given is only permitted if NotGiven is false : reasonCode.empty() or notGiven.empty() or notGiven = 'false'

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
MedicationAdministration	C	0..*	CareConnect-MedicationAdministration-1	Administration of medication to a patient
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	xml:id (or equivalent in JSON)
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.
profile	SΣ	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
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: Common Tags (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: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
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://yhcr.nhs.uk/Source
version	Σ	0..1	string	Version of the system - if relevant
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: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
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://yhcr.nhs.uk/Provenance
version	Σ	0..1	string	Version of the system - if relevant
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: Common Languages (extensible): 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
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	External identifier
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (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(CareConnect-Organization-1)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	in-progress | on-hold | completed | entered-in-error | stopped | unknown Binding: MedicationAdministrationStatus (required): A set of codes indicating the current status of a MedicationAdministration.
category	S	1..1	CodeableConcept	Type of medication usage Binding: InterweaveMedicationRequestCategory (required)
id		0..1	string	xml:id (or equivalent in JSON)
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	xml:id (or equivalent in JSON)
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
Slices for medication[x]	Σ	1..1	Reference()	What was administered Slice: Unordered, Closed by type:$this
medication[x]:medicationReference	SΣ	1..1	Reference(CareConnect-Medication-1)	Reference to the medicatin resource
subject	SΣ	1..1	Reference(CareConnectPatient1)	Who received medication
id		0..1	string	xml:id (or equivalent in JSON)
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)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
context	S	0..1	Reference(CareConnect-Encounter-1)	Encounter or Episode of Care administered as part of
effective[x]	SΣ	1..1	Period	Start and end time of administration
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
performer	Σ	0..*	BackboneElement	Who administered substance
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
actor	SΣ	1..1	Reference(Device | CareConnectPatient1 | CareConnect-RelatedPerson-1 | CareConnect-Practitioner-1)	Individual who was performing
notGiven	?!Σ	0..1	boolean	True if medication not administered
reasonNotGiven	C	0..*	CodeableConcept	Reason administration not performed. Binding: SNOMED CT Reason Medication Not Given Codes (preferred)
reasonCode	C	0..*	CodeableConcept	Reason administration performed Binding: Reason Medication Given Codes (preferred)
reasonReference		0..*	Reference(CareConnect-Condition-1 | CareConnect-Observation-1)	Condition or Observation that supports why the medication was administered
prescription		0..1	Reference(CareConnect-MedicationRequest-1)	Request administration performed against
device		0..*	Reference(Device)	Device used to administer
note		0..*	Annotation	Information about the administration
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
author[x]	Σ	0..1		Individual responsible for the annotation
authorString			string
authorReference			Reference(CareConnectPatient1 | CareConnect-RelatedPerson-1 | CareConnect-Practitioner-1)
time	Σ	0..1	dateTime	When the annotation was made
text		1..1	string	The annotation - text content
dosage	C	0..1	BackboneElement	Details of how medication was taken
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
text		0..1	string	Free text dosage instructions e.g. SIG
site		0..1	CodeableConcept	Body site administered to Binding: SNOMED CT Anatomical Structure for Administration Site Codes (example): A coded concept describing the site location the medicine enters into or onto the body.
route		0..1	CodeableConcept	Path of substance into body Binding: SNOMED CT Route Codes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:snomedCT	Σ	0..1	Coding	Code defined by a terminology system Binding: Care Connect Medication Dosage Route (example): A code from the SNOMED Clinical Terminology UK coding system that describes the e-Prescribing route of administration.
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
SnomedCTDescriptionId		0..1	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
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		0..1	CodeableConcept	How drug was administered Binding: SNOMED CT Administration Method Codes (example): A coded concept describing the technique by which the medicine is administered.
dose		0..1	SimpleQuantity	Amount of medication per dose
rate[x]		0..1		Dose quantity per unit of time
rateRatio			Ratio
rateQuantity			Quantity(SimpleQuantity)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
MedicationAdministration.meta.security	extensible	All Security Labels
MedicationAdministration.meta.tag	example	Common Tags
MedicationAdministration.meta.tag:Source	example	Common Tags
MedicationAdministration.meta.tag:Provenance	example	Common Tags
MedicationAdministration.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
MedicationAdministration.identifier.use	required	IdentifierUse
MedicationAdministration.identifier.type	extensible	Identifier Type Codes
MedicationAdministration.status	required	MedicationAdministrationStatus
MedicationAdministration.category	required	InterweaveMedicationRequestCategory
MedicationAdministration.reasonNotGiven	preferred	SNOMED CT Reason Medication Not Given Codes
MedicationAdministration.reasonCode	preferred	Reason Medication Given Codes
MedicationAdministration.dosage.site	example	SNOMED CT Anatomical Structure for Administration Site Codes
MedicationAdministration.dosage.route	example	SNOMED CT Route Codes
MedicationAdministration.dosage.route.coding:snomedCT	example	Care Connect Medication Dosage Route
MedicationAdministration.dosage.method	example	SNOMED CT Administration Method Codes

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())
mad-1	error	MedicationAdministration.dosage	SHALL have at least one of dosage.dose or dosage.rate[x] : dose.exists() or rate.exists()

This structure is derived from CareConnect-MedicationAdministration-1

Summary

Mandatory: 5 elements (9 nested mandatory elements)
Must-Support: 18 elements
Fixed Value: 2 elements
Prohibited: 5 elements

Structures

This structure refers to these other structures:

• CareConnect-Medication-1 (https://fhir.hl7.org.uk/STU3/StructureDefinition/CareConnect-Medication-1)
• CareConnectPatient1 (https://fhir.hl7.org.uk/STU3/StructureDefinition/CareConnect-Patient-1)
• CareConnect-Encounter-1 (https://fhir.hl7.org.uk/STU3/StructureDefinition/CareConnect-Encounter-1)

Slices

This structure defines the following Slices:

• The element MedicationAdministration.meta.tag is sliced based on the value of value:system