Interweave Implementation Guide
0.1.0 - ci-build

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Resource Profile: InterweaveMedicationRequest - Detailed Descriptions

Active as of 2024-06-10

Definitions for the Interweave-MedicationRequest resource profile.

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

1. MedicationRequest
2. MedicationRequest.id
Must Supporttrue
3. MedicationRequest.meta
Control0..?
4. MedicationRequest.meta.versionId
Control0..?
Must Supporttrue
5. MedicationRequest.meta.lastUpdated
Control0..?
Must Supporttrue
6. MedicationRequest.meta.profile
Control0..?
Must Supporttrue
7. MedicationRequest.meta.security
Control0..?
8. MedicationRequest.meta.tag
Control0..?
SlicingThis element introduces a set of slices on MedicationRequest.meta.tag. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
9. MedicationRequest.meta.tag:Source
SliceNameSource
Control0..1
Must Supporttrue
10. MedicationRequest.meta.tag:Source.system
Control1..?
Fixed Valuehttps://yhcr.nhs.uk/Source
11. MedicationRequest.meta.tag:Source.code
Control1..?
Must Supporttrue
12. MedicationRequest.meta.tag:Source.display
Control1..?
Must Supporttrue
13. MedicationRequest.meta.tag:Provenance
SliceNameProvenance
Control0..1
Must Supporttrue
14. MedicationRequest.meta.tag:Provenance.system
Control1..?
Fixed Valuehttps://yhcr.nhs.uk/Provenance
15. MedicationRequest.meta.tag:Provenance.code
Control1..?
Must Supporttrue
16. MedicationRequest.meta.tag:Provenance.display
Control1..?
Must Supporttrue
17. MedicationRequest.implicitRules
18. MedicationRequest.language
19. MedicationRequest.text
20. MedicationRequest.extension
Control10..*
21. MedicationRequest.extension:repeatInformation
SliceNamerepeatInformation
Must Supporttrue
22. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsAllowed
SliceNamenumberOfRepeatPrescriptionsAllowed
Control0..?
Must Supporttrue
23. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsIssued
SliceNamenumberOfRepeatPrescriptionsIssued
Control0..?
Must Supporttrue
24. MedicationRequest.extension:repeatInformation.extension:authorisationExpiryDate
SliceNameauthorisationExpiryDate
Control0..?
Must Supporttrue
25. MedicationRequest.extension:repeatInformation.extension:LastIssuedDate
SliceNameLastIssuedDate
Control0..1
TypeExtension(ExtensionInterweaveMedicationLastIssuedDate1) (Extension Type: dateTime)
Must Supporttrue
26. MedicationRequest.extension:statusReason
SliceNamestatusReason
Must Supporttrue
27. MedicationRequest.extension:statusReason.extension
Control2..?
28. MedicationRequest.extension:statusReason.extension:statusReason
SliceNamestatusReason
Control0..?
Must Supporttrue
29. MedicationRequest.extension:statusReason.extension:statusChangeDate
SliceNamestatusChangeDate
Control1..?
Must Supporttrue
30. MedicationRequest.extension:prescriptionType
SliceNameprescriptionType
Control10..1
Must Supporttrue
31. MedicationRequest.definition
Control0..0*
32. MedicationRequest.basedOn
Control0..0*
33. MedicationRequest.groupIdentifier
Control0..01
34. MedicationRequest.status
Control10..1
Must Supporttrue
35. MedicationRequest.intent
Must Supporttrue
36. MedicationRequest.category
Control10..1
BindingThe codes SHALL be taken from InterweaveMedicationRequestCategoryThe codes SHOULD be taken from MedicationRequestCategory
Must Supporttrue
37. MedicationRequest.category.coding
Control0..?
38. MedicationRequest.category.coding.system
Control1..?
39. MedicationRequest.category.coding.code
Control1..?
40. MedicationRequest.category.coding.display
Control1..?
41. MedicationRequest.priority
Control0..01
42. MedicationRequest.medication[x]
[x] NoteSee Choice of Data Types for further information about how to use [x]
SlicingThis element introduces a set of slices on MedicationRequest.medication[x]. The slices are and OpenClosed, and can be differentiated using the following discriminators:
  • @
43. MedicationRequest.medication[x]:medicationReference
SliceNamemedicationReference
TypeReference(CareConnect-Medication-1)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
44. MedicationRequest.subject
TypeReference(CareConnectPatient1|Group)
Must Supporttrue
45. MedicationRequest.subject.reference
Control1..?
46. MedicationRequest.subject.identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..?
47. MedicationRequest.subject.display
Control1..?
48. MedicationRequest.context
TypeReference(CareConnect-Encounter-1|EpisodeOfCare)
Must Supporttrue
49. MedicationRequest.supportingInformation
Control0..0*
50. MedicationRequest.authoredOn
Control10..1
Must Supporttrue
51. MedicationRequest.requester
Control0..?
52. MedicationRequest.requester.agent
TypeReference(CareConnect-Practitioner-1|CareConnect-Organization-1|RelatedPerson|Device|CareConnectPatient1)
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
53. MedicationRequest.requester.onBehalfOf
Control0..01
54. MedicationRequest.reasonCode
BindingThe codes SHOULD be taken from Condition/Problem/Diagnosis CodesFor example codes, see Condition/Problem/Diagnosis Codes
Must Supporttrue
55. MedicationRequest.note
Must Supporttrue
56. MedicationRequest.dosageInstruction
Control10..1*
Must Supporttrue
57. MedicationRequest.dosageInstruction.text
Control10..1
Must Supporttrue
58. MedicationRequest.dosageInstruction.patientInstruction
Control10..1
Must Supporttrue
59. MedicationRequest.dispenseRequest
Control0..?
60. MedicationRequest.dispenseRequest.validityPeriod
61. MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
Control0..01
62. MedicationRequest.dispenseRequest.quantity
Must Supporttrue
63. MedicationRequest.dispenseRequest.quantity.extension:quantityText
SliceNamequantityText
Must Supporttrue
64. MedicationRequest.dispenseRequest.expectedSupplyDuration
Must Supporttrue
65. MedicationRequest.dispenseRequest.expectedSupplyDuration.value
Must Supporttrue
66. MedicationRequest.dispenseRequest.expectedSupplyDuration.unit
Control10..1
Must Supporttrue
Fixed Valueday
67. MedicationRequest.dispenseRequest.expectedSupplyDuration.system
Must Supporttrue
68. MedicationRequest.dispenseRequest.expectedSupplyDuration.code
Must Supporttrue
Fixed Valued
69. MedicationRequest.substitution
Control0..01
70. MedicationRequest.priorPrescription
Control0..01
71. MedicationRequest.detectedIssue
Control0..0*
72. MedicationRequest.eventHistory
Control0..0*

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

1. MedicationRequest
Definition

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

Control0..*
Alternate NamesPrescription, Order
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())
2. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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 MedicationRequest.meta.tag. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
9. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.implicitRules
Definition

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

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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.extension
Definition

An Extension

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.

Control10..*
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 MedicationRequest.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
21. MedicationRequest.extension:repeatInformation
SliceNamerepeatInformation
Definition

Medication repeat information.

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..1* This element is affected by the following invariants: ele-1
TypeExtension(Extension-CareConnect-MedicationRepeatInformation-1) (Complex Extension)
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
22. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsAllowed
SliceNamenumberOfRepeatPrescriptionsAllowed
Definition

An Extension

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..1*
TypeExtension
Must Supporttrue
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.

23. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsAllowed.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Control1..1
Typeuri
XML RepresentationIn the XML format, this property is represented as an attribute.
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed ValuenumberOfRepeatPrescriptionsAllowed
24. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsAllowed.value[x]
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control10..1
TypeChoice of: unsignedInt, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, time, Timing, decimal, CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
SlicingThis element introduces a set of slices on MedicationRequest.extension.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
25. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsAllowed.value[x]:valueUnsignedInt
SliceNamevalueUnsignedInt
Definition

Number of issues authorised.

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control10..1
TypeChoice of: unsignedInt, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, time, Timing, decimal, CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
26. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsIssued
SliceNamenumberOfRepeatPrescriptionsIssued
Definition

An Extension

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..1*
TypeExtension
Must Supporttrue
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.

27. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsIssued.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Control1..1
Typeuri
XML RepresentationIn the XML format, this property is represented as an attribute.
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed ValuenumberOfRepeatPrescriptionsIssued
28. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsIssued.value[x]
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control0..1
TypeChoice of: unsignedInt, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, time, Timing, decimal, CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
SlicingThis element introduces a set of slices on MedicationRequest.extension.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
29. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsIssued.value[x]:valueUnsignedInt
SliceNamevalueUnsignedInt
Definition

Number of issues issued.

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control0..1
TypeChoice of: unsignedInt, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, time, Timing, decimal, CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
30. MedicationRequest.extension:repeatInformation.extension:authorisationExpiryDate
SliceNameauthorisationExpiryDate
Definition

An Extension

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..1*
TypeExtension
Must Supporttrue
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.

31. MedicationRequest.extension:repeatInformation.extension:authorisationExpiryDate.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Control1..1
Typeuri
XML RepresentationIn the XML format, this property is represented as an attribute.
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed ValueauthorisationExpiryDate
32. MedicationRequest.extension:repeatInformation.extension:authorisationExpiryDate.value[x]
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control0..1
TypeChoice of: dateTime, date, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
SlicingThis element introduces a set of slices on MedicationRequest.extension.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
33. MedicationRequest.extension:repeatInformation.extension:authorisationExpiryDate.value[x]:valueDateTime
SliceNamevalueDateTime
Definition

Repeat review date.

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control0..1
TypeChoice of: dateTime, date, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
34. MedicationRequest.extension:repeatInformation.extension:LastIssuedDate
SliceNameLastIssuedDate
Definition

Last issued date for repeat medication.

Control0..1
TypeExtension(ExtensionInterweaveMedicationLastIssuedDate1) (Extension Type: dateTime)
Must Supporttrue
35. MedicationRequest.extension:repeatInformation.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Control1..1
Typeuri
XML RepresentationIn the XML format, this property is represented as an attribute.
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Valuehttps://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-MedicationRepeatInformation-1
36. MedicationRequest.extension:repeatInformation.value[x]
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control0..01
TypeChoice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta
[x] NoteSee Choice of Data Types for further information about how to use [x]
37. MedicationRequest.extension:statusReason
SliceNamestatusReason
Definition

To record the reason the medication (plan or order) was stopped and the date this occurred.

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..1* This element is affected by the following invariants: ele-1
TypeExtension(Extension-CareConnect-MedicationStatusReason-1) (Complex Extension)
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
38. MedicationRequest.extension:statusReason.extension
Definition

An Extension

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.

Control20..*
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 MedicationRequest.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
39. MedicationRequest.extension:statusReason.extension:statusReason
SliceNamestatusReason
Definition

An Extension

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.

Control10..1*
TypeExtension
Must Supporttrue
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.

40. MedicationRequest.extension:statusReason.extension:statusReason.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Control1..1
Typeuri
XML RepresentationIn the XML format, this property is represented as an attribute.
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed ValuestatusReason
41. MedicationRequest.extension:statusReason.extension:statusReason.value[x]
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control0..1
TypeChoice of: CodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
[x] NoteSee Choice of Data Types for further information about how to use [x]
SlicingThis element introduces a set of slices on MedicationRequest.extension.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
42. MedicationRequest.extension:statusReason.extension:statusReason.value[x]:valueCodeableConcept
SliceNamevalueCodeableConcept
Definition

To record the reason the medication (plan or order) was stopped.

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control0..1
TypeChoice of: CodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
[x] NoteSee Choice of Data Types for further information about how to use [x]
43. MedicationRequest.extension:statusReason.extension:statusChangeDate
SliceNamestatusChangeDate
Definition

An Extension

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.

Control10..1*
TypeExtension
Must Supporttrue
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.

44. MedicationRequest.extension:statusReason.extension:statusChangeDate.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Control1..1
Typeuri
XML RepresentationIn the XML format, this property is represented as an attribute.
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed ValuestatusChangeDate
45. MedicationRequest.extension:statusReason.extension:statusChangeDate.value[x]
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control0..1
TypeChoice of: dateTime, date, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
SlicingThis element introduces a set of slices on MedicationRequest.extension.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
46. MedicationRequest.extension:statusReason.extension:statusChangeDate.value[x]:valueDateTime
SliceNamevalueDateTime
Definition

To record the date this occurred.

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control0..1
TypeChoice of: dateTime, date, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
47. MedicationRequest.extension:statusReason.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Control1..1
Typeuri
XML RepresentationIn the XML format, this property is represented as an attribute.
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Valuehttps://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-MedicationStatusReason-1
48. MedicationRequest.extension:statusReason.value[x]
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control0..01
TypeChoice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta
[x] NoteSee Choice of Data Types for further information about how to use [x]
49. MedicationRequest.extension:prescriptionType
SliceNameprescriptionType
Definition

To record the type of prescription.

Control1..1 This element is affected by the following invariants: ele-1
TypeExtension(Extension-CareConnect-PrescriptionType-1) (Extension Type: CodeableConcept)
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
50. MedicationRequest.modifierExtension
Definition

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

51. MedicationRequest.definition
Definition

Protocol or definition followed by this request.

Control0..0*
TypeReference(ActivityDefinition|PlanDefinition)
Summarytrue
52. MedicationRequest.basedOn
Definition

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

Control0..0*
TypeReference(CarePlan|ProcedureRequest|ReferralRequest|CareConnect-MedicationRequest-1|MedicationRequest)
Summarytrue
53. MedicationRequest.groupIdentifier
Definition

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

Control0..01
TypeIdentifier
Summarytrue
Requirements

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

54. MedicationRequest.status
Definition

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

Control10..1
BindingThe codes SHALL be taken from MedicationRequestStatus

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

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.

55. MedicationRequest.intent
Definition

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

Control1..1
BindingThe codes SHALL be taken from MedicationRequestIntent

The kind of medication order

Typecode
Is Modifiertrue
Must Supporttrue
Summarytrue
Comments

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

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

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

56. MedicationRequest.category
Definition

Indicates the type of medication order 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 MedicationRequestCategory
TypeCodeableConcept
Must Supporttrue
57. MedicationRequest.priority
Definition

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

Control0..01
BindingThe codes SHALL be taken from MedicationRequestPriority

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

Typecode
Summarytrue
58. MedicationRequest.medication[x]
Definition

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

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 or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource. .

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

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

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 or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource. .

60. MedicationRequest.subject
Definition

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

Control1..1
TypeReference(CareConnectPatient1|Patient|Group)
Must Supporttrue
Summarytrue
Comments

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

61. MedicationRequest.subject.reference
Definition

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

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.

62. MedicationRequest.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.

63. MedicationRequest.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.

64. MedicationRequest.context
Definition

A link to an encounter, or episode of care, that identifies the particular occurrence or set occurrences of contact between patient and health care provider.

Control0..1
TypeReference(CareConnect-Encounter-1|Encounter|EpisodeOfCare)
Must Supporttrue
Comments

SubstanceAdministration->component->EncounterEvent.

65. MedicationRequest.supportingInformation
Definition

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

Control0..0*
TypeReference(Resource)
66. MedicationRequest.authoredOn
Definition

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

Control10..1
TypedateTime
Must Supporttrue
Summarytrue
67. MedicationRequest.requester
Definition

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

Control0..1
TypeBackboneElement
Summarytrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
mps-1: onBehalfOf can only be specified if agent is practitioner or device (: (agent.resolve().empty()) or (agent.resolve() is Device) or (agent.resolve() is Practitioner) or onBehalfOf.exists().not())
68. MedicationRequest.requester.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.

69. MedicationRequest.requester.agent
Definition

The healthcare professional responsible for authorizing the initial prescription.

Control1..1
TypeReference(CareConnect-Practitioner-1|CareConnect-Organization-1|Practitioner|Organization|Patient|RelatedPerson|Device)
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summarytrue
Comments

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

70. MedicationRequest.requester.onBehalfOf
Definition

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

Control0..01 This element is affected by the following invariants: mps-1
TypeReference(CareConnect-Organization-1|Organization)
Summarytrue
Requirements

Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when authoring the request.

71. MedicationRequest.reasonCode
Definition

The reason or the indication for ordering the medication.

Control0..*
BindingThe codes SHOULD be taken from Condition/Problem/Diagnosis CodesFor example codes, see Condition/Problem/Diagnosis Codes
TypeCodeableConcept
Must Supporttrue
Comments

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

72. MedicationRequest.note
Definition

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

Control0..*
TypeAnnotation
Must Supporttrue
73. MedicationRequest.note.text
Definition

The text of the annotation.

Control1..1
Typestring
74. MedicationRequest.dosageInstruction
Definition

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

Control10..1*
TypeDosage
Must Supporttrue
Comments

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

75. MedicationRequest.dosageInstruction.text
Definition

Free text dosage instructions e.g. SIG.

Control10..1
Typestring
Must Supporttrue
Summarytrue
Requirements

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

76. MedicationRequest.dosageInstruction.patientInstruction
Definition

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

Control10..1
Typestring
Must Supporttrue
Summarytrue
77. MedicationRequest.dispenseRequest
Definition

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

Control0..1
TypeBackboneElement
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
78. MedicationRequest.dispenseRequest.modifierExtension
Definition

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

79. MedicationRequest.dispenseRequest.validityPeriod
Definition

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

Control0..1
TypePeriod
Requirements

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

Comments

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

80. MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
Definition

An integer indicating the number of times, in addition to the original dispense, (aka refills or repeats) that the patient can receive the prescribed medication. Usage Notes: This integer does not include the original order dispense. This means that if an order indicates dispense 30 tablets plus "3 repeats", then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets.

Control0..01
TypepositiveInt
Comments

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

81. MedicationRequest.dispenseRequest.quantity
Definition

The amount that is to be dispensed for one fill.

Control0..1
TypeQuantity(SimpleQuantity)
Must Supporttrue
82. MedicationRequest.dispenseRequest.quantity.extension:quantityText
SliceNamequantityText
Definition

Quantity representation.

Control0..1
TypeExtension(Extension-CareConnect-MedicationQuantityText-1) (Extension Type: string)
Must Supporttrue
83. MedicationRequest.dispenseRequest.quantity.comparator
Definition

Not allowed to be used in this context

How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

Control0..01
BindingThe codes SHALL be taken from QuantityComparator

How the Quantity should be understood and represented.

Typecode
Is Modifiertrue
Summarytrue
Requirements

Need a framework for handling measures where the value is <5ug /L or >400mg/L due to the limitations of measuring methodology.

Comments

This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value.

Meaning if MissingIf there is no comparator, then there is no modification of the value
84. MedicationRequest.dispenseRequest.expectedSupplyDuration
Definition

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

Control0..1
TypeDuration
Must Supporttrue
Comments

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

85. MedicationRequest.dispenseRequest.expectedSupplyDuration.value
Definition

The value of the measured amount. The value includes an implicit precision in the presentation of the value.

Control10..1
Typedecimal
Must Supporttrue
Summarytrue
Requirements

Precision is handled implicitly in almost all cases of measurement.

Comments

The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

86. MedicationRequest.dispenseRequest.expectedSupplyDuration.comparator
Definition

How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

Control0..1
BindingThe codes SHALL be taken from QuantityComparator

How the Quantity should be understood and represented.

Typecode
Is Modifiertrue
Summarytrue
Requirements

Need a framework for handling measures where the value is <5ug /L or >400mg/L due to the limitations of measuring methodology.

Comments

This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value.

Meaning if MissingIf there is no comparator, then there is no modification of the value
87. MedicationRequest.dispenseRequest.expectedSupplyDuration.unit
Definition

A human-readable form of the unit.

Control10..1
Typestring
Must Supporttrue
Summarytrue
Requirements

There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

Fixed Valueday
88. MedicationRequest.dispenseRequest.expectedSupplyDuration.system
Definition

The identification of the system that provides the coded form of the unit.

Control10..1 This element is affected by the following invariants: qty-3
Typeuri
Must Supporttrue
Summarytrue
Requirements

Need to know the system that defines the coded form of the unit.

Fixed Valuehttp://unitsofmeasure.org
89. MedicationRequest.dispenseRequest.expectedSupplyDuration.code
Definition

A computer processable form of the unit in some unit representation system.

Control10..1
BindingThe codes SHALL be taken from UnitsOfTimeFor codes, see (unbound) A unit of time (units from UCUM)
Typecode
Must Supporttrue
Summarytrue
Requirements

Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

Comments

The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

Fixed Valued
90. MedicationRequest.substitution
Definition

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

Control0..01
TypeBackboneElement
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
91. MedicationRequest.priorPrescription
Definition

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

Control0..01
TypeReference(CareConnect-MedicationRequest-1|MedicationRequest)
92. MedicationRequest.detectedIssue
Definition

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

Control0..0*
TypeReference(DetectedIssue)
Alternate NamesContraindication, Drug Utilization Review (DUR), Alert
93. MedicationRequest.eventHistory
Definition

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

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. MedicationRequest
Definition

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

Control0..*
Alternate NamesPrescription, Order
2. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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 MedicationRequest.meta.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
6. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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 MedicationRequest.meta.tag. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
11. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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 MedicationRequest.meta.tag.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
14. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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 MedicationRequest.meta.tag.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
22. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.implicitRules
Definition

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

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. MedicationRequest.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. MedicationRequest.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. MedicationRequest.contained
Definition

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

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. MedicationRequest.extension
Definition

An Extension

Control1..*
TypeExtension
SlicingThis element introduces a set of slices on MedicationRequest.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
32. MedicationRequest.extension:repeatInformation
SliceNamerepeatInformation
Definition

Medication repeat information.

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(Extension-CareConnect-MedicationRepeatInformation-1) (Complex Extension)
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
33. MedicationRequest.extension:repeatInformation.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.
34. MedicationRequest.extension:repeatInformation.extension
Definition

An Extension

Control0..*
TypeExtension
SlicingThis element introduces a set of slices on MedicationRequest.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
35. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsAllowed
SliceNamenumberOfRepeatPrescriptionsAllowed
Definition

An Extension

Control0..1
TypeExtension
Must Supporttrue
36. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsAllowed.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.
37. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsAllowed.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 MedicationRequest.extension.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
38. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsAllowed.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Control1..1
Typeuri
XML RepresentationIn the XML format, this property is represented as an attribute.
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed ValuenumberOfRepeatPrescriptionsAllowed
39. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsAllowed.value[x]
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control1..1
TypeunsignedInt
[x] NoteSee Choice of Data Types for further information about how to use [x]
SlicingThis element introduces a set of slices on MedicationRequest.extension.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
40. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsAllowed.value[x]:valueUnsignedInt
SliceNamevalueUnsignedInt
Definition

Number of issues authorised.

Control1..1
TypeunsignedInt
[x] NoteSee Choice of Data Types for further information about how to use [x]
41. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsIssued
SliceNamenumberOfRepeatPrescriptionsIssued
Definition

An Extension

Control0..1
TypeExtension
Must Supporttrue
42. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsIssued.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.
43. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsIssued.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 MedicationRequest.extension.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
44. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsIssued.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Control1..1
Typeuri
XML RepresentationIn the XML format, this property is represented as an attribute.
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed ValuenumberOfRepeatPrescriptionsIssued
45. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsIssued.value[x]
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control0..1
TypeunsignedInt
[x] NoteSee Choice of Data Types for further information about how to use [x]
SlicingThis element introduces a set of slices on MedicationRequest.extension.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
46. MedicationRequest.extension:repeatInformation.extension:numberOfRepeatPrescriptionsIssued.value[x]:valueUnsignedInt
SliceNamevalueUnsignedInt
Definition

Number of issues issued.

Control0..1
TypeunsignedInt
[x] NoteSee Choice of Data Types for further information about how to use [x]
47. MedicationRequest.extension:repeatInformation.extension:authorisationExpiryDate
SliceNameauthorisationExpiryDate
Definition

An Extension

Control0..1
TypeExtension
Must Supporttrue
48. MedicationRequest.extension:repeatInformation.extension:authorisationExpiryDate.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.
49. MedicationRequest.extension:repeatInformation.extension:authorisationExpiryDate.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 MedicationRequest.extension.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
50. MedicationRequest.extension:repeatInformation.extension:authorisationExpiryDate.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Control1..1
Typeuri
XML RepresentationIn the XML format, this property is represented as an attribute.
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed ValueauthorisationExpiryDate
51. MedicationRequest.extension:repeatInformation.extension:authorisationExpiryDate.value[x]
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control0..1
TypedateTime
[x] NoteSee Choice of Data Types for further information about how to use [x]
SlicingThis element introduces a set of slices on MedicationRequest.extension.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
52. MedicationRequest.extension:repeatInformation.extension:authorisationExpiryDate.value[x]:valueDateTime
SliceNamevalueDateTime
Definition

Repeat review date.

Control0..1
TypedateTime
[x] NoteSee Choice of Data Types for further information about how to use [x]
53. MedicationRequest.extension:repeatInformation.extension:LastIssuedDate
SliceNameLastIssuedDate
Definition

Last issued date for repeat medication.

Control0..1
TypeExtension(ExtensionInterweaveMedicationLastIssuedDate1) (Extension Type: dateTime)
Must Supporttrue
54. MedicationRequest.extension:repeatInformation.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Control1..1
Typeuri
XML RepresentationIn the XML format, this property is represented as an attribute.
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Valuehttps://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-MedicationRepeatInformation-1
55. MedicationRequest.extension:repeatInformation.value[x]
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control0..0
TypeChoice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta
[x] NoteSee Choice of Data Types for further information about how to use [x]
56. MedicationRequest.extension:statusReason
SliceNamestatusReason
Definition

To record the reason the medication (plan or order) was stopped and the date this occurred.

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(Extension-CareConnect-MedicationStatusReason-1) (Complex Extension)
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
57. MedicationRequest.extension:statusReason.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.
58. MedicationRequest.extension:statusReason.extension
Definition

An Extension

Control2..*
TypeExtension
SlicingThis element introduces a set of slices on MedicationRequest.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
59. MedicationRequest.extension:statusReason.extension:statusReason
SliceNamestatusReason
Definition

An Extension

Control1..1
TypeExtension
Must Supporttrue
60. MedicationRequest.extension:statusReason.extension:statusReason.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. MedicationRequest.extension:statusReason.extension:statusReason.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 MedicationRequest.extension.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
62. MedicationRequest.extension:statusReason.extension:statusReason.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Control1..1
Typeuri
XML RepresentationIn the XML format, this property is represented as an attribute.
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed ValuestatusReason
63. MedicationRequest.extension:statusReason.extension:statusReason.value[x]
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control0..1
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
SlicingThis element introduces a set of slices on MedicationRequest.extension.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
64. MedicationRequest.extension:statusReason.extension:statusReason.value[x]:valueCodeableConcept
SliceNamevalueCodeableConcept
Definition

To record the reason the medication (plan or order) was stopped.

Control0..1
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
65. MedicationRequest.extension:statusReason.extension:statusChangeDate
SliceNamestatusChangeDate
Definition

An Extension

Control1..1
TypeExtension
Must Supporttrue
66. MedicationRequest.extension:statusReason.extension:statusChangeDate.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.
67. MedicationRequest.extension:statusReason.extension:statusChangeDate.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 MedicationRequest.extension.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
68. MedicationRequest.extension:statusReason.extension:statusChangeDate.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Control1..1
Typeuri
XML RepresentationIn the XML format, this property is represented as an attribute.
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed ValuestatusChangeDate
69. MedicationRequest.extension:statusReason.extension:statusChangeDate.value[x]
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control0..1
TypedateTime
[x] NoteSee Choice of Data Types for further information about how to use [x]
SlicingThis element introduces a set of slices on MedicationRequest.extension.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
70. MedicationRequest.extension:statusReason.extension:statusChangeDate.value[x]:valueDateTime
SliceNamevalueDateTime
Definition

To record the date this occurred.

Control0..1
TypedateTime
[x] NoteSee Choice of Data Types for further information about how to use [x]
71. MedicationRequest.extension:statusReason.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Control1..1
Typeuri
XML RepresentationIn the XML format, this property is represented as an attribute.
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Valuehttps://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-MedicationStatusReason-1
72. MedicationRequest.extension:statusReason.value[x]
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control0..0
TypeChoice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta
[x] NoteSee Choice of Data Types for further information about how to use [x]
73. MedicationRequest.extension:prescriptionType
SliceNameprescriptionType
Definition

To record the type of prescription.

Control1..1 This element is affected by the following invariants: ele-1
TypeExtension(Extension-CareConnect-PrescriptionType-1) (Extension Type: CodeableConcept)
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
74. MedicationRequest.modifierExtension
Definition

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

75. MedicationRequest.identifier
Definition

This records identifiers associated with this medication request that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. For example a re-imbursement system might issue its own id for each prescription that is created. This is particularly important where FHIR only provides part of an entire workflow process where records must be tracked through an entire system.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
76. MedicationRequest.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.
77. MedicationRequest.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 MedicationRequest.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
78. MedicationRequest.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.

79. MedicationRequest.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.

80. MedicationRequest.identifier.system
Definition

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

Control1..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
81. MedicationRequest.identifier.value
Definition

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

Control1..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
82. MedicationRequest.identifier.period
Definition

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

Control0..1
TypePeriod
Summarytrue
83. MedicationRequest.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.

84. MedicationRequest.definition
Definition

Protocol or definition followed by this request.

Control0..0
TypeReference(ActivityDefinition|PlanDefinition)
Summarytrue
85. MedicationRequest.basedOn
Definition

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

Control0..0
TypeReference(CarePlan|ProcedureRequest|ReferralRequest|CareConnect-MedicationRequest-1)
Summarytrue
86. MedicationRequest.groupIdentifier
Definition

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

Control0..0
TypeIdentifier
Summarytrue
Requirements

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

87. MedicationRequest.status
Definition

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

Control1..1
BindingThe codes SHALL be taken from MedicationRequestStatus A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescriptio
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.

88. MedicationRequest.intent
Definition

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

Control1..1
BindingThe codes SHALL be taken from MedicationRequestIntent The kind of medication orde
Typecode
Is Modifiertrue
Must Supporttrue
Summarytrue
Comments

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

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

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

89. MedicationRequest.category
Definition

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

Control1..1
BindingThe codes SHALL be taken from InterweaveMedicationRequestCategory
TypeCodeableConcept
Must Supporttrue
90. MedicationRequest.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.
91. MedicationRequest.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 MedicationRequest.category.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
92. MedicationRequest.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.

93. MedicationRequest.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.
94. MedicationRequest.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 MedicationRequest.category.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
95. MedicationRequest.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.

96. MedicationRequest.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.

97. MedicationRequest.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.

98. MedicationRequest.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.

99. MedicationRequest.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.

100. MedicationRequest.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.

101. MedicationRequest.priority
Definition

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

Control0..0
BindingThe codes SHALL be taken from MedicationRequestPriority Identifies the level of importance to be assigned to actioning the reques
Typecode
Summarytrue
102. MedicationRequest.medication[x]
Definition

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

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 or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource. .

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

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

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 or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource. .

104. MedicationRequest.subject
Definition

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

Control1..1
TypeReference(CareConnectPatient1)
Must Supporttrue
Summarytrue
Comments

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

105. MedicationRequest.subject.id
Definition

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

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
106. MedicationRequest.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 MedicationRequest.subject.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
107. MedicationRequest.subject.reference
Definition

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

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.

108. MedicationRequest.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.

109. MedicationRequest.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.

110. MedicationRequest.context
Definition

A link to an encounter, or episode of care, that identifies the particular occurrence or set occurrences of contact between patient and health care provider.

Control0..1
TypeReference(CareConnect-Encounter-1)
Must Supporttrue
Comments

SubstanceAdministration->component->EncounterEvent.

111. MedicationRequest.supportingInformation
Definition

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

Control0..0
TypeReference(Resource)
112. MedicationRequest.authoredOn
Definition

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

Control1..1
TypedateTime
Must Supporttrue
Summarytrue
113. MedicationRequest.requester
Definition

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

Control0..1
TypeBackboneElement
Summarytrue
114. MedicationRequest.requester.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.
115. MedicationRequest.requester.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.

116. MedicationRequest.requester.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.

117. MedicationRequest.requester.agent
Definition

The healthcare professional responsible for authorizing the initial prescription.

Control1..1
TypeReference(CareConnect-Practitioner-1|CareConnect-Organization-1)
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summarytrue
Comments

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

118. MedicationRequest.requester.onBehalfOf
Definition

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

Control0..0 This element is affected by the following invariants: mps-1
TypeReference(CareConnect-Organization-1)
Summarytrue
Requirements

Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when authoring the request.

119. MedicationRequest.recorder
Definition

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

Control0..1
TypeReference(CareConnect-Practitioner-1)
120. MedicationRequest.reasonCode
Definition

The reason or the indication for ordering the medication.

Control0..*
BindingThe codes SHOULD be taken from Condition/Problem/Diagnosis Codes
TypeCodeableConcept
Must Supporttrue
Comments

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

121. MedicationRequest.reasonReference
Definition

Condition or observation that supports why the medication was ordered.

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

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

122. MedicationRequest.note
Definition

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

Control0..*
TypeAnnotation
Must Supporttrue
123. MedicationRequest.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.
124. MedicationRequest.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 MedicationRequest.note.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
125. MedicationRequest.note.author[x]
Definition

The individual responsible for making the annotation.

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

Indicates when this particular annotation was made.

Control0..1
TypedateTime
Summarytrue
127. MedicationRequest.note.text
Definition

The text of the annotation.

Control1..1
Typestring
128. MedicationRequest.dosageInstruction
Definition

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

Control1..1
TypeDosage
Must Supporttrue
Comments

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

129. MedicationRequest.dosageInstruction.id
Definition

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

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
130. MedicationRequest.dosageInstruction.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 MedicationRequest.dosageInstruction.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
131. MedicationRequest.dosageInstruction.sequence
Definition

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

Control0..1
Typeinteger
Summarytrue
Requirements

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

132. MedicationRequest.dosageInstruction.text
Definition

Free text dosage instructions e.g. SIG.

Control1..1
Typestring
Must Supporttrue
Summarytrue
Requirements

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

133. MedicationRequest.dosageInstruction.additionalInstruction
Definition

Supplemental instruction - e.g. "with meals".

Control0..*
BindingFor example codes, see SNOMED CT Additional Dosage Instructions A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery"
TypeCodeableConcept
Summarytrue
Requirements

Additional instruction such as "Swallow with plenty of water" which may or may not be coded.

134. MedicationRequest.dosageInstruction.additionalInstruction.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.
135. MedicationRequest.dosageInstruction.additionalInstruction.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 MedicationRequest.dosageInstruction.additionalInstruction.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
136. MedicationRequest.dosageInstruction.additionalInstruction.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 MedicationRequest.dosageInstruction.additionalInstruction.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
137. MedicationRequest.dosageInstruction.additionalInstruction.coding:snomedCT
SliceNamesnomedCT
Definition

A reference to a code defined by a terminology system.

Control0..1
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.

138. MedicationRequest.dosageInstruction.additionalInstruction.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.
139. MedicationRequest.dosageInstruction.additionalInstruction.coding:snomedCT.extension
Definition

An Extension

Control0..*
TypeExtension
SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.additionalInstruction.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
140. MedicationRequest.dosageInstruction.additionalInstruction.coding:snomedCT.extension:snomedCTDescriptionID
SliceNamesnomedCTDescriptionID
Definition

The SNOMED CT Description ID for the display.

Control0..*
TypeExtension(Extension-coding-sctdescid) (Complex Extension)
141. MedicationRequest.dosageInstruction.additionalInstruction.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
142. MedicationRequest.dosageInstruction.additionalInstruction.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.

143. MedicationRequest.dosageInstruction.additionalInstruction.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.

144. MedicationRequest.dosageInstruction.additionalInstruction.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.

145. MedicationRequest.dosageInstruction.additionalInstruction.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.

146. MedicationRequest.dosageInstruction.additionalInstruction.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.

147. MedicationRequest.dosageInstruction.patientInstruction
Definition

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

Control1..1
Typestring
Must Supporttrue
Summarytrue
148. MedicationRequest.dosageInstruction.timing
Definition

When medication should be administered.

Control0..1
TypeTiming
Summarytrue
Requirements

The timing schedule for giving the medication to the patient. The Schedule data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

Comments

This attribute may not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.

149. MedicationRequest.dosageInstruction.asNeeded[x]
Definition

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

Control0..1
BindingFor example codes, see SNOMED CT Medication As Needed Reason Codes A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc
TypeChoice of: boolean, CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
Comments

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

150. MedicationRequest.dosageInstruction.site
Definition

Body site to administer to.

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
Summarytrue
Requirements

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

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.

151. MedicationRequest.dosageInstruction.route
Definition

How drug should enter body.

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
Summarytrue
Requirements

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

152. MedicationRequest.dosageInstruction.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.
153. MedicationRequest.dosageInstruction.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 MedicationRequest.dosageInstruction.route.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
154. MedicationRequest.dosageInstruction.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 MedicationRequest.dosageInstruction.route.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
155. MedicationRequest.dosageInstruction.route.coding:snomedCT
SliceNamesnomedCT
Definition

A reference to a code defined by a terminology system.

Control0..1
BindingThe codes SHOULD be taken from 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.

156. MedicationRequest.dosageInstruction.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.
157. MedicationRequest.dosageInstruction.route.coding:snomedCT.extension
Definition

An Extension

Control0..*
TypeExtension
SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.route.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
158. MedicationRequest.dosageInstruction.route.coding:snomedCT.extension:snomedCTDescriptionID
SliceNamesnomedCTDescriptionID
Definition

The SNOMED CT Description ID for the display.

Control0..*
TypeExtension(Extension-coding-sctdescid) (Complex Extension)
159. MedicationRequest.dosageInstruction.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
160. MedicationRequest.dosageInstruction.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.

161. MedicationRequest.dosageInstruction.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.

162. MedicationRequest.dosageInstruction.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.

163. MedicationRequest.dosageInstruction.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.

164. MedicationRequest.dosageInstruction.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.

165. MedicationRequest.dosageInstruction.method
Definition

Technique for administering medication.

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

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

Comments

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

166. MedicationRequest.dosageInstruction.dose[x]
Definition

Amount of medication per dose.

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

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

Comments

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

167. MedicationRequest.dosageInstruction.maxDosePerPeriod
Definition

Upper limit on medication per unit of time.

Control0..1
TypeRatio
Summarytrue
Requirements

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

Comments

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

168. MedicationRequest.dosageInstruction.maxDosePerAdministration
Definition

Upper limit on medication per administration.

Control0..1
TypeQuantity(SimpleQuantity)
Summarytrue
Requirements

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

Comments

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

169. MedicationRequest.dosageInstruction.maxDosePerLifetime
Definition

Upper limit on medication per lifetime of the patient.

Control0..1
TypeQuantity(SimpleQuantity)
Summarytrue
Requirements

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

170. MedicationRequest.dosageInstruction.rate[x]
Definition

Amount of medication per unit of time.

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

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

Comments

It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.

171. MedicationRequest.dispenseRequest
Definition

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

Control0..1
TypeBackboneElement
172. MedicationRequest.dispenseRequest.id
Definition

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

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
173. MedicationRequest.dispenseRequest.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.

174. MedicationRequest.dispenseRequest.modifierExtension
Definition

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

175. MedicationRequest.dispenseRequest.validityPeriod
Definition

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

Control0..1
TypePeriod
Requirements

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

Comments

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

176. MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
Definition

An integer indicating the number of times, in addition to the original dispense, (aka refills or repeats) that the patient can receive the prescribed medication. Usage Notes: This integer does not include the original order dispense. This means that if an order indicates dispense 30 tablets plus "3 repeats", then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets.

Control0..0
TypepositiveInt
Comments

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

177. MedicationRequest.dispenseRequest.quantity
Definition

The amount that is to be dispensed for one fill.

Control0..1
TypeQuantity(SimpleQuantity)
Must Supporttrue
178. MedicationRequest.dispenseRequest.quantity.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.
179. MedicationRequest.dispenseRequest.quantity.extension
Definition

An Extension

Control0..*
TypeExtension
SlicingThis element introduces a set of slices on MedicationRequest.dispenseRequest.quantity.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
180. MedicationRequest.dispenseRequest.quantity.extension:quantityText
SliceNamequantityText
Definition

Quantity representation.

Control0..1
TypeExtension(Extension-CareConnect-MedicationQuantityText-1) (Extension Type: string)
Must Supporttrue
181. MedicationRequest.dispenseRequest.quantity.value
Definition

The value of the measured amount. The value includes an implicit precision in the presentation of the value.

Control0..1
Typedecimal
Summarytrue
Requirements

Precision is handled implicitly in almost all cases of measurement.

Comments

The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

182. MedicationRequest.dispenseRequest.quantity.comparator
Definition

Not allowed to be used in this context

Control0..0
BindingThe codes SHALL be taken from QuantityComparator How the Quantity should be understood and represented
Typecode
Is Modifiertrue
Summarytrue
Requirements

Need a framework for handling measures where the value is <5ug /L or >400mg/L due to the limitations of measuring methodology.

Comments

This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value.

Meaning if MissingIf there is no comparator, then there is no modification of the value
183. MedicationRequest.dispenseRequest.quantity.unit
Definition

A human-readable form of the unit.

Control0..1
Typestring
Summarytrue
Requirements

There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

184. MedicationRequest.dispenseRequest.quantity.system
Definition

The identification of the system that provides the coded form of the unit.

Control0..1 This element is affected by the following invariants: qty-3
Typeuri
Summarytrue
Requirements

Need to know the system that defines the coded form of the unit.

185. MedicationRequest.dispenseRequest.quantity.code
Definition

A computer processable form of the unit in some unit representation system.

Control0..1
Typecode
Summarytrue
Requirements

Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

Comments

The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

186. MedicationRequest.dispenseRequest.expectedSupplyDuration
Definition

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

Control0..1
TypeDuration
Must Supporttrue
Comments

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

187. MedicationRequest.dispenseRequest.expectedSupplyDuration.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.
188. MedicationRequest.dispenseRequest.expectedSupplyDuration.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 MedicationRequest.dispenseRequest.expectedSupplyDuration.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
189. MedicationRequest.dispenseRequest.expectedSupplyDuration.value
Definition

The value of the measured amount. The value includes an implicit precision in the presentation of the value.

Control1..1
Typedecimal
Must Supporttrue
Summarytrue
Requirements

Precision is handled implicitly in almost all cases of measurement.

Comments

The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

190. MedicationRequest.dispenseRequest.expectedSupplyDuration.comparator
Definition

How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

Control0..1
BindingThe codes SHALL be taken from QuantityComparator How the Quantity should be understood and represented
Typecode
Is Modifiertrue
Summarytrue
Requirements

Need a framework for handling measures where the value is <5ug /L or >400mg/L due to the limitations of measuring methodology.

Comments

This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value.

Meaning if MissingIf there is no comparator, then there is no modification of the value
191. MedicationRequest.dispenseRequest.expectedSupplyDuration.unit
Definition

A human-readable form of the unit.

Control1..1
Typestring
Must Supporttrue
Summarytrue
Requirements

There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

Fixed Valueday
192. MedicationRequest.dispenseRequest.expectedSupplyDuration.system
Definition

The identification of the system that provides the coded form of the unit.

Control1..1 This element is affected by the following invariants: qty-3
Typeuri
Must Supporttrue
Summarytrue
Requirements

Need to know the system that defines the coded form of the unit.

Fixed Valuehttp://unitsofmeasure.org
193. MedicationRequest.dispenseRequest.expectedSupplyDuration.code
Definition

A computer processable form of the unit in some unit representation system.

Control1..1
BindingThe codes SHALL be taken from UnitsOfTime A unit of time (units from UCUM)
Typecode
Must Supporttrue
Summarytrue
Requirements

Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

Comments

The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

Fixed Valued
194. MedicationRequest.dispenseRequest.performer
Definition

Indicates the intended dispensing Organization specified by the prescriber.

Control0..1
TypeReference(CareConnect-Organization-1)
195. MedicationRequest.substitution
Definition

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

Control0..0
TypeBackboneElement
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
196. MedicationRequest.priorPrescription
Definition

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

Control0..0
TypeReference(CareConnect-MedicationRequest-1)
197. MedicationRequest.detectedIssue
Definition

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

Control0..0
TypeReference(DetectedIssue)
Alternate NamesContraindication, Drug Utilization Review (DUR), Alert
198. MedicationRequest.eventHistory
Definition

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

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.).