Interweave Implementation Guide
0.1.0 - ci-build

Interweave Implementation Guide - Local Development build (v0.1.0). See the Directory of published versions

Resource Profile: InterweaveMedicationAdministration - Detailed Descriptions

Active as of 2024-06-10

Definitions for the Interweave-MedicationAdministration resource profile.

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

1. MedicationAdministration
2. MedicationAdministration.id
Must Supporttrue
3. MedicationAdministration.meta
Control0..?
4. MedicationAdministration.meta.versionId
Control0..?
Must Supporttrue
5. MedicationAdministration.meta.lastUpdated
Control0..?
Must Supporttrue
6. MedicationAdministration.meta.profile
Control0..?
Must Supporttrue
7. MedicationAdministration.meta.security
Control0..?
8. MedicationAdministration.meta.tag
Control0..?
SlicingThis element introduces a set of slices on MedicationAdministration.meta.tag. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
9. MedicationAdministration.meta.tag:Source
SliceNameSource
Control0..1
Must Supporttrue
10. MedicationAdministration.meta.tag:Source.system
Control1..?
Fixed Valuehttps://yhcr.nhs.uk/Source
11. MedicationAdministration.meta.tag:Source.code
Control1..?
Must Supporttrue
12. MedicationAdministration.meta.tag:Source.display
Control1..?
Must Supporttrue
13. MedicationAdministration.meta.tag:Provenance
SliceNameProvenance
Control0..1
Must Supporttrue
14. MedicationAdministration.meta.tag:Provenance.system
Control1..?
Fixed Valuehttps://yhcr.nhs.uk/Provenance
15. MedicationAdministration.meta.tag:Provenance.code
Control1..?
Must Supporttrue
16. MedicationAdministration.meta.tag:Provenance.display
Control1..?
Must Supporttrue
17. MedicationAdministration.implicitRules
18. MedicationAdministration.language
19. MedicationAdministration.text
20. MedicationAdministration.definition
Control0..0*
21. MedicationAdministration.partOf
Control0..0*
22. MedicationAdministration.status
Must Supporttrue
23. MedicationAdministration.category
Control10..1
BindingThe codes SHALL be taken from InterweaveMedicationRequestCategoryThe codes SHOULD be taken from MedicationAdministrationCategory
Must Supporttrue
24. MedicationAdministration.category.coding
Control0..?
25. MedicationAdministration.category.coding.system
Control1..?
26. MedicationAdministration.category.coding.code
Control1..?
27. MedicationAdministration.category.coding.display
Control1..?
28. MedicationAdministration.medication[x]:medicationReference
SliceNamemedicationReference
TypeReference(CareConnect-Medication-1|Medication)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
29. MedicationAdministration.subject
TypeReference(CareConnectPatient1|Group)
Must Supporttrue
30. MedicationAdministration.subject.reference
Control1..?
31. MedicationAdministration.subject.identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..?
32. MedicationAdministration.subject.display
Control1..?
33. MedicationAdministration.context
TypeReference(CareConnect-Encounter-1|CareConnect-EpisodeOfCare-1)
Must Supporttrue
34. MedicationAdministration.supportingInformation
Control0..0*
35. MedicationAdministration.effective[x]
TypeChoice of: , dateTime
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
36. MedicationAdministration.effective[x].start
Control1..?
Must Supporttrue
37. MedicationAdministration.performer
Control0..?
38. MedicationAdministration.performer.actor
Must Supporttrue
39. MedicationAdministration.performer.onBehalfOf
Control0..01
40. MedicationAdministration.reasonNotGiven
BindingThe codes SHOULD be taken from SNOMED CT Reason Medication Not Given CodesFor example codes, see SNOMED CT Reason Medication Not Given Codes
41. MedicationAdministration.reasonCode
BindingThe codes SHOULD be taken from Reason Medication Given CodesFor example codes, see Reason Medication Given Codes
42. MedicationAdministration.eventHistory
Control0..0*

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

1. MedicationAdministration
Definition

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.

Control0..*
Comments

The WG will be updating the MedicationAdministration resource to adjust each affected resource to align with the workflow pattern (see workflow.html).

InvariantsDefined on this element
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (: contained.text.empty())
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (: contained.where(('#'+id in %resource.descendants().reference).not()).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
mad-2: Reason not given is only permitted if NotGiven is true (: reasonNotGiven.empty() or notGiven = true)
mad-3: Reason given is only permitted if NotGiven is false (: reasonCode.empty() or notGiven.empty() or notGiven = 'false')
2. MedicationAdministration.id
Definition

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

Control0..1
Typeid
Must Supporttrue
Summarytrue
Comments

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

3. MedicationAdministration.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

Control0..1
TypeMeta
Summarytrue
4. MedicationAdministration.meta.versionId
Definition

The version specific identifier, as it appears in the version portion of the URL. This values changes when the resource is created, updated, or deleted.

Control0..1
Typeid
Must Supporttrue
Summarytrue
Comments

The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

5. MedicationAdministration.meta.lastUpdated
Definition

When the resource last changed - e.g. when the version changed.

Control0..1
Typeinstant
Must Supporttrue
Summarytrue
Comments

This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant.

6. MedicationAdministration.meta.profile
Definition

A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

Control0..*
Typeuri
Must Supporttrue
Summarytrue
Comments

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

7. MedicationAdministration.meta.security
Definition

Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

Control0..*
BindingThe codes SHALL be taken from All Security Labels; other codes may be used where these codes are not suitable

Security Labels from the Healthcare Privacy and Security Classification System.

TypeCoding
Summarytrue
Comments

The security labels can be updated without changing the stated version of the resource The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

8. MedicationAdministration.meta.tag
Definition

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

Control0..*
BindingFor example codes, see Common Tags

Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"

TypeCoding
Summarytrue
Comments

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

SlicingThis element introduces a set of slices on MedicationAdministration.meta.tag. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
9. MedicationAdministration.meta.tag:Source
SliceNameSource
Definition

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

Control0..1*
BindingFor example codes, see Common Tags

Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"

TypeCoding
Must Supporttrue
Summarytrue
Comments

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

10. MedicationAdministration.meta.tag:Source.system
Definition

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

Control10..1
Typeuri
Summarytrue
Requirements

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

Comments

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

Fixed Valuehttps://yhcr.nhs.uk/Source
11. MedicationAdministration.meta.tag:Source.code
Definition

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

Control10..1
Typecode
Must Supporttrue
Summarytrue
Requirements

Need to refer to a particular code in the system.

12. MedicationAdministration.meta.tag:Source.display
Definition

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

Control10..1
Typestring
Must Supporttrue
Summarytrue
Requirements

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

13. MedicationAdministration.meta.tag:Provenance
SliceNameProvenance
Definition

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

Control0..1*
BindingFor example codes, see Common Tags

Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"

TypeCoding
Must Supporttrue
Summarytrue
Comments

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

14. MedicationAdministration.meta.tag:Provenance.system
Definition

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

Control10..1
Typeuri
Summarytrue
Requirements

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

Comments

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

Fixed Valuehttps://yhcr.nhs.uk/Provenance
15. MedicationAdministration.meta.tag:Provenance.code
Definition

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

Control10..1
Typecode
Must Supporttrue
Summarytrue
Requirements

Need to refer to a particular code in the system.

16. MedicationAdministration.meta.tag:Provenance.display
Definition

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

Control10..1
Typestring
Must Supporttrue
Summarytrue
Requirements

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

17. MedicationAdministration.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Control0..1
Typeuri
Is Modifiertrue
Summarytrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

18. MedicationAdministration.language
Definition

The base language in which the resource is written.

Control0..1
BindingThe codes SHALL be taken from Common Languages; other codes may be used where these codes are not suitable

A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
Typecode
Comments

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

19. MedicationAdministration.text
Definition

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Control0..1 This element is affected by the following invariants: dom-1
TypeNarrative
Alternate Namesnarrative, html, xhtml, display
Comments

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

20. MedicationAdministration.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content
Comments

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

21. MedicationAdministration.definition
Definition

A protocol, guideline, orderset or other definition that was adhered to in whole or in part by this event.

Control0..0*
TypeReference(PlanDefinition|ActivityDefinition)
Summarytrue
22. MedicationAdministration.partOf
Definition

A larger event of which this particular event is a component or step.

Control0..0*
TypeReference(CareConnect-Procedure-1|CareConnect-MedicationAdministration-1|MedicationAdministration|Procedure)
Summarytrue
23. MedicationAdministration.status
Definition

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.

Control1..1
BindingThe codes SHALL be taken from MedicationAdministrationStatus

A set of codes indicating the current status of a MedicationAdministration.

Typecode
Is Modifiertrue
Must Supporttrue
Summarytrue
Comments

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

24. MedicationAdministration.category
Definition

Indicates the type of medication administration and where the medication is expected to be consumed or administered.

Control10..1
BindingThe codes SHALL be taken from InterweaveMedicationRequestCategoryThe codes SHOULD be taken from MedicationAdministrationCategory
TypeCodeableConcept
Must Supporttrue
25. MedicationAdministration.medication[x]
Definition

Identifies the medication that was administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.

Control1..1
TypeChoice of: Reference(Medication), CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
Comments

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

SlicingThis element introduces a set of slices on MedicationAdministration.medication[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
26. MedicationAdministration.medication[x]:medicationReference
SliceNamemedicationReference
Definition

Identifies the medication that was administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.

Control1..1
TypeChoice of: Reference(CareConnect-Medication-1|Medication), CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Summarytrue
Comments

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

27. MedicationAdministration.subject
Definition

The person or animal or group receiving the medication.

Control1..1
TypeReference(CareConnectPatient1|Patient|Group)
Must Supporttrue
Summarytrue
28. MedicationAdministration.subject.reference
Definition

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

Control10..1 This element is affected by the following invariants: ref-1
Typestring
Summarytrue
Comments

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

29. MedicationAdministration.subject.identifier
Definition

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

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
TypeIdentifier
Summarytrue
Comments

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

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

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

30. MedicationAdministration.subject.display
Definition

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

Control10..1
Typestring
Summarytrue
Comments

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

31. MedicationAdministration.context
Definition

The visit, admission or other contact between patient and health care provider the medication administration was performed as part of.

Control0..1
TypeReference(CareConnect-Encounter-1|Encounter|EpisodeOfCare)
Must Supporttrue
32. MedicationAdministration.supportingInformation
Definition

Additional information (for example, patient height and weight) that supports the administration of the medication.

Control0..0*
TypeReference(Resource)
33. MedicationAdministration.effective[x]
Definition

A specific date/time or interval of time during which the administration took place (or did not take place, when the 'notGiven' attribute is true). For many administrations, such as swallowing a tablet the use of dateTime is more appropriate.

Control1..1
TypeChoice of: Period, dateTime
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Summarytrue
34. MedicationAdministration.effective[x].start
Definition

The start of the period. The boundary is inclusive.

Control10..1 This element is affected by the following invariants: per-1
TypedateTime
Must Supporttrue
Summarytrue
Comments

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

35. MedicationAdministration.performer
Definition

The individual who was responsible for giving the medication to the patient.

Control0..*
TypeBackboneElement
Summarytrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
36. MedicationAdministration.performer.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Summarytrue
Alternate Namesextensions, user content, modifiers
Comments

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

37. MedicationAdministration.performer.actor
Definition

The device, practitioner, etc. who performed the action.

Control1..1
TypeReference(Device|CareConnectPatient1|CareConnect-RelatedPerson-1|CareConnect-Practitioner-1|Practitioner|Patient|RelatedPerson)
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summarytrue
38. MedicationAdministration.performer.onBehalfOf
Definition

The organization the device or practitioner was acting on behalf of.

Control0..01
TypeReference(CareConnect-Organization-1|Organization)
39. MedicationAdministration.notGiven
Definition

Set this to true if the record is saying that the medication was NOT administered.

Control0..1
Typeboolean
Is Modifiertrue
Summarytrue
Comments

This element is labeled as a modifier because it indicates that a administration didn't happen.

Meaning if MissingIf this is missing, then the medication was administered
40. MedicationAdministration.reasonNotGiven
Definition

A code indicating why the administration was not performed.

Control0..* This element is affected by the following invariants: mad-2
BindingThe codes SHOULD be taken from SNOMED CT Reason Medication Not Given CodesFor example codes, see SNOMED CT Reason Medication Not Given Codes
TypeCodeableConcept
41. MedicationAdministration.reasonCode
Definition

A code indicating why the medication was given.

Control0..* This element is affected by the following invariants: mad-3
BindingThe codes SHOULD be taken from Reason Medication Given CodesFor example codes, see Reason Medication Given Codes
TypeCodeableConcept
42. MedicationAdministration.eventHistory
Definition

A summary of the events of interest that have occurred, such as when the administration was verified.

Control0..0*
TypeReference(Provenance)
Comments

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

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

1. MedicationAdministration
Definition

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.

Control0..*
Comments

The WG will be updating the MedicationAdministration resource to adjust each affected resource to align with the workflow pattern (see workflow.html).

2. MedicationAdministration.id
Definition

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

Control0..1
Typeid
Must Supporttrue
Summarytrue
Comments

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

3. MedicationAdministration.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

Control0..1
TypeMeta
Summarytrue
4. MedicationAdministration.meta.id
Definition

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

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
5. MedicationAdministration.meta.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

SlicingThis element introduces a set of slices on MedicationAdministration.meta.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
6. MedicationAdministration.meta.versionId
Definition

The version specific identifier, as it appears in the version portion of the URL. This values changes when the resource is created, updated, or deleted.

Control0..1
Typeid
Must Supporttrue
Summarytrue
Comments

The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

7. MedicationAdministration.meta.lastUpdated
Definition

When the resource last changed - e.g. when the version changed.

Control0..1
Typeinstant
Must Supporttrue
Summarytrue
Comments

This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant.

8. MedicationAdministration.meta.profile
Definition

A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

Control0..*
Typeuri
Must Supporttrue
Summarytrue
Comments

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

9. MedicationAdministration.meta.security
Definition

Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

Control0..*
BindingThe codes SHALL be taken from All Security Labels; other codes may be used where these codes are not suitable Security Labels from the Healthcare Privacy and Security Classification System
TypeCoding
Summarytrue
Comments

The security labels can be updated without changing the stated version of the resource The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

10. MedicationAdministration.meta.tag
Definition

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

Control0..*
BindingFor example codes, see Common Tags Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones
TypeCoding
Summarytrue
Comments

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

SlicingThis element introduces a set of slices on MedicationAdministration.meta.tag. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
11. MedicationAdministration.meta.tag:Source
SliceNameSource
Definition

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

Control0..1
BindingFor example codes, see Common Tags Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones
TypeCoding
Must Supporttrue
Summarytrue
Comments

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

12. MedicationAdministration.meta.tag:Source.id
Definition

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

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
13. MedicationAdministration.meta.tag:Source.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

SlicingThis element introduces a set of slices on MedicationAdministration.meta.tag.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
14. MedicationAdministration.meta.tag:Source.system
Definition

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

Control1..1
Typeuri
Summarytrue
Requirements

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

Comments

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

Fixed Valuehttps://yhcr.nhs.uk/Source
15. MedicationAdministration.meta.tag:Source.version
Definition

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

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Summarytrue
Comments

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

16. MedicationAdministration.meta.tag:Source.code
Definition

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

Control1..1
Typecode
Must Supporttrue
Summarytrue
Requirements

Need to refer to a particular code in the system.

17. MedicationAdministration.meta.tag:Source.display
Definition

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

Control1..1
Typestring
Must Supporttrue
Summarytrue
Requirements

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

18. MedicationAdministration.meta.tag:Source.userSelected
Definition

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

Control0..1
Typeboolean
Summarytrue
Requirements

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

Comments

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

19. MedicationAdministration.meta.tag:Provenance
SliceNameProvenance
Definition

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

Control0..1
BindingFor example codes, see Common Tags Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones
TypeCoding
Must Supporttrue
Summarytrue
Comments

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

20. MedicationAdministration.meta.tag:Provenance.id
Definition

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

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
21. MedicationAdministration.meta.tag:Provenance.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

SlicingThis element introduces a set of slices on MedicationAdministration.meta.tag.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
22. MedicationAdministration.meta.tag:Provenance.system
Definition

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

Control1..1
Typeuri
Summarytrue
Requirements

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

Comments

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

Fixed Valuehttps://yhcr.nhs.uk/Provenance
23. MedicationAdministration.meta.tag:Provenance.version
Definition

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

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Summarytrue
Comments

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

24. MedicationAdministration.meta.tag:Provenance.code
Definition

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

Control1..1
Typecode
Must Supporttrue
Summarytrue
Requirements

Need to refer to a particular code in the system.

25. MedicationAdministration.meta.tag:Provenance.display
Definition

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

Control1..1
Typestring
Must Supporttrue
Summarytrue
Requirements

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

26. MedicationAdministration.meta.tag:Provenance.userSelected
Definition

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

Control0..1
Typeboolean
Summarytrue
Requirements

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

Comments

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

27. MedicationAdministration.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Control0..1
Typeuri
Is Modifiertrue
Summarytrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

28. MedicationAdministration.language
Definition

The base language in which the resource is written.

Control0..1
BindingThe codes SHALL be taken from Common Languages; other codes may be used where these codes are not suitable A human language
Additional BindingsPurpose
AllLanguagesMax Binding
Typecode
Comments

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

29. MedicationAdministration.text
Definition

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Control0..1 This element is affected by the following invariants: dom-1
TypeNarrative
Alternate Namesnarrative, html, xhtml, display
Comments

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

30. MedicationAdministration.contained
Definition

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

Control0..*
TypeResource
Alternate Namesinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

31. MedicationAdministration.extension
Definition

May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

32. MedicationAdministration.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content
Comments

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

33. MedicationAdministration.identifier
Definition

External identifier - FHIR will generate its own internal identifiers (probably URLs) which do not need to be explicitly managed by the resource. The identifier here is one that would be used by another non-FHIR system - for example an automated medication pump would provide a record each time it operated; an administration while the patient was off the ward might be made with a different system and entered after the event. Particularly important if these records have to be updated.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
34. MedicationAdministration.identifier.id
Definition

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

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
35. MedicationAdministration.identifier.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

SlicingThis element introduces a set of slices on MedicationAdministration.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
36. MedicationAdministration.identifier.use
Definition

The purpose of this identifier.

Control0..1
BindingThe codes SHALL be taken from IdentifierUse Identifies the purpose for this identifier, if known
Typecode
Is Modifiertrue
Summarytrue
Requirements

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

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

37. MedicationAdministration.identifier.type
Definition

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

Control0..1
BindingThe codes SHALL be taken from Identifier Type Codes; other codes may be used where these codes are not suitable A coded type for an identifier that can be used to determine which identifier to use for a specific purpose
TypeCodeableConcept
Summarytrue
Requirements

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

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage.

Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

38. MedicationAdministration.identifier.system
Definition

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

Control0..1
Typeuri
Summarytrue
Requirements

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

Example
General:http://www.acme.com/identifiers/patient
39. MedicationAdministration.identifier.value
Definition

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

Control0..1
Typestring
Summarytrue
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.

Example
General:123456
40. MedicationAdministration.identifier.period
Definition

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

Control0..1
TypePeriod
Summarytrue
41. MedicationAdministration.identifier.assigner
Definition

Organization that issued/manages the identifier.

Control0..1
TypeReference(CareConnect-Organization-1)
Summarytrue
Comments

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

42. MedicationAdministration.definition
Definition

A protocol, guideline, orderset or other definition that was adhered to in whole or in part by this event.

Control0..0
TypeReference(PlanDefinition|ActivityDefinition)
Summarytrue
43. MedicationAdministration.partOf
Definition

A larger event of which this particular event is a component or step.

Control0..0
TypeReference(CareConnect-Procedure-1|CareConnect-MedicationAdministration-1)
Summarytrue
44. MedicationAdministration.status
Definition

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.

Control1..1
BindingThe codes SHALL be taken from MedicationAdministrationStatus A set of codes indicating the current status of a MedicationAdministration
Typecode
Is Modifiertrue
Must Supporttrue
Summarytrue
Comments

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

45. MedicationAdministration.category
Definition

Indicates the type of medication administration and where the medication is expected to be consumed or administered.

Control1..1
BindingThe codes SHALL be taken from InterweaveMedicationRequestCategory
TypeCodeableConcept
Must Supporttrue
46. MedicationAdministration.category.id
Definition

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

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
47. MedicationAdministration.category.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

SlicingThis element introduces a set of slices on MedicationAdministration.category.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
48. MedicationAdministration.category.coding
Definition

A reference to a code defined by a terminology system.

Control0..*
TypeCoding
Summarytrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

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

49. MedicationAdministration.category.coding.id
Definition

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

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
50. MedicationAdministration.category.coding.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

SlicingThis element introduces a set of slices on MedicationAdministration.category.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
51. MedicationAdministration.category.coding.system
Definition

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

Control1..1
Typeuri
Summarytrue
Requirements

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

Comments

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

52. MedicationAdministration.category.coding.version
Definition

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

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Summarytrue
Comments

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

53. MedicationAdministration.category.coding.code
Definition

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

Control1..1
Typecode
Summarytrue
Requirements

Need to refer to a particular code in the system.

54. MedicationAdministration.category.coding.display
Definition

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

Control1..1
Typestring
Summarytrue
Requirements

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

55. MedicationAdministration.category.coding.userSelected
Definition

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

Control0..1
Typeboolean
Summarytrue
Requirements

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

Comments

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

56. MedicationAdministration.category.text
Definition

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

Control0..1
Typestring
Summarytrue
Requirements

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

Comments

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

57. MedicationAdministration.medication[x]
Definition

Identifies the medication that was administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.

Control1..1
TypeReference
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
Comments

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

SlicingThis element introduces a set of slices on MedicationAdministration.medication[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
58. MedicationAdministration.medication[x]:medicationReference
SliceNamemedicationReference
Definition

Identifies the medication that was administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.

Control1..1
TypeReference(CareConnect-Medication-1)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Summarytrue
Comments

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

59. MedicationAdministration.subject
Definition

The person or animal or group receiving the medication.

Control1..1
TypeReference(CareConnectPatient1)
Must Supporttrue
Summarytrue
60. MedicationAdministration.subject.id
Definition

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

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
61. MedicationAdministration.subject.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

SlicingThis element introduces a set of slices on MedicationAdministration.subject.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
62. MedicationAdministration.subject.reference
Definition

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

Control1..1 This element is affected by the following invariants: ref-1
Typestring
Summarytrue
Comments

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

63. MedicationAdministration.subject.identifier
Definition

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

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
TypeIdentifier
Summarytrue
Comments

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

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

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

64. MedicationAdministration.subject.display
Definition

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

Control1..1
Typestring
Summarytrue
Comments

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

65. MedicationAdministration.context
Definition

The visit, admission or other contact between patient and health care provider the medication administration was performed as part of.

Control0..1
TypeReference(CareConnect-Encounter-1)
Must Supporttrue
66. MedicationAdministration.supportingInformation
Definition

Additional information (for example, patient height and weight) that supports the administration of the medication.

Control0..0
TypeReference(Resource)
67. MedicationAdministration.effective[x]
Definition

A specific date/time or interval of time during which the administration took place (or did not take place, when the 'notGiven' attribute is true). For many administrations, such as swallowing a tablet the use of dateTime is more appropriate.

Control1..1
TypePeriod
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Summarytrue
68. MedicationAdministration.effective[x].id
Definition

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

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
69. MedicationAdministration.effective[x].extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

SlicingThis element introduces a set of slices on MedicationAdministration.effective[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
70. MedicationAdministration.effective[x].start
Definition

The start of the period. The boundary is inclusive.

Control1..1 This element is affected by the following invariants: per-1
TypedateTime
Must Supporttrue
Summarytrue
Comments

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

71. MedicationAdministration.effective[x].end
Definition

The end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

Control0..1 This element is affected by the following invariants: per-1
TypedateTime
Summarytrue
Comments

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

Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
72. MedicationAdministration.performer
Definition

The individual who was responsible for giving the medication to the patient.

Control0..*
TypeBackboneElement
Summarytrue
73. MedicationAdministration.performer.id
Definition

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

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
74. MedicationAdministration.performer.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

75. MedicationAdministration.performer.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Summarytrue
Alternate Namesextensions, user content, modifiers
Comments

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

76. MedicationAdministration.performer.actor
Definition

The device, practitioner, etc. who performed the action.

Control1..1
TypeReference(Device|CareConnectPatient1|CareConnect-RelatedPerson-1|CareConnect-Practitioner-1)
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summarytrue
77. MedicationAdministration.performer.onBehalfOf
Definition

The organization the device or practitioner was acting on behalf of.

Control0..0
TypeReference(CareConnect-Organization-1)
78. MedicationAdministration.notGiven
Definition

Set this to true if the record is saying that the medication was NOT administered.

Control0..1
Typeboolean
Is Modifiertrue
Summarytrue
Comments

This element is labeled as a modifier because it indicates that a administration didn't happen.

Meaning if MissingIf this is missing, then the medication was administered
79. MedicationAdministration.reasonNotGiven
Definition

A code indicating why the administration was not performed.

Control0..* This element is affected by the following invariants: mad-2
BindingThe codes SHOULD be taken from SNOMED CT Reason Medication Not Given Codes
TypeCodeableConcept
80. MedicationAdministration.reasonCode
Definition

A code indicating why the medication was given.

Control0..* This element is affected by the following invariants: mad-3
BindingThe codes SHOULD be taken from Reason Medication Given Codes
TypeCodeableConcept
81. MedicationAdministration.reasonReference
Definition

Condition or observation that supports why the medication was administered.

Control0..*
TypeReference(CareConnect-Condition-1|CareConnect-Observation-1)
Comments

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

82. MedicationAdministration.prescription
Definition

The original request, instruction or authority to perform the administration.

Control0..1
TypeReference(CareConnect-MedicationRequest-1)
83. MedicationAdministration.device
Definition

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

Control0..*
TypeReference(Device)
84. MedicationAdministration.note
Definition

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

Control0..*
TypeAnnotation
85. MedicationAdministration.note.id
Definition

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

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
86. MedicationAdministration.note.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

SlicingThis element introduces a set of slices on MedicationAdministration.note.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
87. MedicationAdministration.note.author[x]
Definition

The individual responsible for making the annotation.

Control0..1
TypeChoice of: string, Reference(CareConnectPatient1|CareConnect-RelatedPerson-1|CareConnect-Practitioner-1)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
88. MedicationAdministration.note.time
Definition

Indicates when this particular annotation was made.

Control0..1
TypedateTime
Summarytrue
89. MedicationAdministration.note.text
Definition

The text of the annotation.

Control1..1
Typestring
90. MedicationAdministration.dosage
Definition

Describes the medication dosage information details e.g. dose, rate, site, route, etc.

Control0..1
TypeBackboneElement
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
mad-1: SHALL have at least one of dosage.dose or dosage.rate[x] (: dose.exists() or rate.exists())
91. MedicationAdministration.dosage.id
Definition

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

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
92. MedicationAdministration.dosage.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

93. MedicationAdministration.dosage.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Summarytrue
Alternate Namesextensions, user content, modifiers
Comments

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

94. MedicationAdministration.dosage.text
Definition

Free text dosage can be used for cases where the dosage administered is too complex to code. When coded dosage is present, the free text dosage may still be present for display to humans.

The dosage instructions should reflect the dosage of the medication that was administered.

Control0..1
Typestring
95. MedicationAdministration.dosage.site
Definition

A coded specification of the anatomic site where the medication first entered the body. For example, "left arm".

Control0..1
BindingFor example codes, see SNOMED CT Anatomical Structure for Administration Site Codes A coded concept describing the site location the medicine enters into or onto the body
TypeCodeableConcept
Comments

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

96. MedicationAdministration.dosage.route
Definition

A code specifying the route or physiological path of administration of a therapeutic agent into or onto the patient. For example, topical, intravenous, etc.

Control0..1
BindingFor example codes, see SNOMED CT Route Codes A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject
TypeCodeableConcept
97. MedicationAdministration.dosage.route.id
Definition

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

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
98. MedicationAdministration.dosage.route.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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

SlicingThis element introduces a set of slices on MedicationAdministration.dosage.route.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
99. MedicationAdministration.dosage.route.coding
Definition

A reference to a code defined by a terminology system.

Control0..*
TypeCoding
Summarytrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

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

SlicingThis element introduces a set of slices on MedicationAdministration.dosage.route.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
100. MedicationAdministration.dosage.route.coding:snomedCT
SliceNamesnomedCT
Definition

A reference to a code defined by a terminology system.

Control0..1
BindingFor example codes, see Care Connect Medication Dosage Route A code from the SNOMED Clinical Terminology UK coding system that describes the e-Prescribing route of administration
TypeCoding
Summarytrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

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

101. MedicationAdministration.dosage.route.coding:snomedCT.id
Definition

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

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
102. MedicationAdministration.dosage.route.coding:snomedCT.extension
Definition

An Extension

Control0..*
TypeExtension
SlicingThis element introduces a set of slices on MedicationAdministration.dosage.route.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
103. MedicationAdministration.dosage.route.coding:snomedCT.extension:SnomedCTDescriptionId
SliceNameSnomedCTDescriptionId
Definition

The SNOMED CT Description ID for the display.

Control0..1
TypeExtension(Extension-coding-sctdescid) (Complex Extension)
104. MedicationAdministration.dosage.route.coding:snomedCT.system
Definition

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

Control1..1
Typeuri
Summarytrue
Requirements

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

Comments

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

Fixed Valuehttp://snomed.info/sct
105. MedicationAdministration.dosage.route.coding:snomedCT.version
Definition

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

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Summarytrue
Comments

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

106. MedicationAdministration.dosage.route.coding:snomedCT.code
Definition

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

Control1..1
Typecode
Summarytrue
Requirements

Need to refer to a particular code in the system.

107. MedicationAdministration.dosage.route.coding:snomedCT.display
Definition

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

Control1..1
Typestring
Summarytrue
Requirements

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

108. MedicationAdministration.dosage.route.coding:snomedCT.userSelected
Definition

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

Control0..1
Typeboolean
Summarytrue
Requirements

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

Comments

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

109. MedicationAdministration.dosage.route.text
Definition

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

Control0..1
Typestring
Summarytrue
Requirements

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

Comments

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

110. MedicationAdministration.dosage.method
Definition

A coded value indicating the method by which the medication is intended to be or was introduced into or on the body. This attribute will most often NOT be populated. It is most commonly used for injections. For example, Slow Push, Deep IV.

Control0..1
BindingFor example codes, see SNOMED CT Administration Method Codes A coded concept describing the technique by which the medicine is administered
TypeCodeableConcept
Comments

One of the reasons this attribute is not used often, is that the method is often pre-coordinated with the route and/or form of administration. This means the codes used in route or form may pre-coordinate the method in the route code or the form code. The implementation decision about what coding system to use for route or form code will determine how frequently the method code will be populated e.g. if route or form code pre-coordinate method code, then this attribute will not be populated often; if there is no pre-coordination then method code may be used frequently.

111. MedicationAdministration.dosage.dose
Definition

The amount of the medication given at one administration event. Use this value when the administration is essentially an instantaneous event such as a swallowing a tablet or giving an injection.

Control0..1
TypeQuantity(SimpleQuantity)
Comments

If the administration is not instantaneous (rate is present), this can be specified to convey the total amount administered over period of time of a single administration.

112. MedicationAdministration.dosage.rate[x]
Definition

Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours.

Control0..1
TypeChoice of: Ratio, Quantity(SimpleQuantity)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

If the rate changes over time, and you want to capture this in MedicationAdministration, then each change should be captured as a distinct MedicationAdministration, with a specific MedicationAdministration.dosage.rate, and the date time when the rate change occurred. Typically, the MedicationAdministration.dosage.rate element is not used to convey an average rate.

113. MedicationAdministration.eventHistory
Definition

A summary of the events of interest that have occurred, such as when the administration was verified.

Control0..0
TypeReference(Provenance)
Comments

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