Generated Narrative: StructureDefinition ISiKMedikationsInformation Name Flags Card. Type Description & Constraints MedicationStatement 0..* MedicationStatement Record of medication being taken by a patient #xD; id S 0..1 id serverseitige, interne ID des Datensatzes #xD; meta #xD; versionId 0..1 id Eindeutiger Name der serverseitigen Version des Datensatzes #xD; lastUpdated 0..1 instant Zeitpunkt der letzten Änderung #xD; implicitRules 0..0 Verweis auf die Regeln, nach denen die Ressource erstellt wurde #xD; Slices for extension S 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:acceptedRisk S 0..1 (Complex) akzeptiertes (in Kauf genommenes) Risiko URL: https://gematik.de/fhir/isik/StructureDefinition/ExtensionISiKAcceptedRisk #xD; value[x] S 1..1 string Value of extension #xD; extension:medikationsart S 0..1 (Complex) Therapieart der Medikation URL: https://gematik.de/fhir/isik/StructureDefinition/ExtensionISiKMedikationsart #xD; value[x] #xD; system S 1..1 uri Identity of the terminology system #xD; code S 1..1 code Symbol in syntax defined by the system #xD; display S 0..1 string Representation defined by the system #xD; extension:selbstmedikation S 0..1 (Complex) Selbstmedikation URL: https://gematik.de/fhir/isik/StructureDefinition/ExtensionISiKSelbstmedikation #xD; value[x] S 1..1 boolean Value of extension #xD; extension:behandlungsziel S 0..1 (Complex) Behandlungsziel (textuell) URL: https://gematik.de/fhir/isik/StructureDefinition/ExtensionISiKBehandlungsziel #xD; value[x] S 1..1 string Value of extension #xD; extension:medicationStatementReplaces S 0..1 (Complex) Welche Medikationsinformation wird ersetzt? URL: https://gematik.de/fhir/isik/StructureDefinition/ExtensionISiKMedicationStatementReplaces #xD; value[x] S 1..1 Reference(MedicationStatement) Value of extension #xD; reference S 1..1 string Literal reference, Relative, internal or absolute URL #xD; partOf 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Observation) Referenz auf andere Objekte, deren Bestandteil diese MedikationsInformation ist #xD; status S 1..1 code Status der Medikationsinformation #xD; Slices for medication[x] S 1..1 CodeableConcept, Reference(Medication) Angabe des Medikaments Slice: Unordered, Open by type:$this #xD; medication[x]:medicationCodeableConcept S 0..1 CodeableConcept Medikament in codierter Form oder ggf. als Freitext #xD; Slices for coding S 0..* Coding Code defined by a terminology system Slice: Unordered, Open by pattern:$this #xD; coding:PZN S 0..* ISiKPZNCoding Code defined by a terminology system Required Pattern: At least the following #xD; coding:ATC-DE S 0..* ISiKATCCoding Code defined by a terminology system Required Pattern: At least the following #xD; coding:SCT S 0..1 ISiKSnomedCTCoding Code defined by a terminology system Required Pattern: At least the following #xD; text S 0..1 string Plain text representation of the concept #xD; medication[x]:medicationReference S 0..1 Reference(Medication) Referenz auf das Medikament (Medication-Ressource) #xD; reference S 1..1 string Literal reference, Relative, internal or absolute URL #xD; subject S 1..1 Reference(Patient) Referenz auf den Patienten #xD; reference S 1..1 string Patienten-Link #xD; context S 0..1 Reference(Encounter | EpisodeOfCare) Referenz auf den Abteilungskontakt #xD; reference S 1..1 string Literal reference, Relative, internal or absolute URL #xD; Slices for effective[x] S 1..1 dateTime, Period Zeitpunkt oder Zeitraum, für den die MedikationsInformation gilt Slice: Unordered, Open by type:$this #xD; effective[x]:effectiveDateTime S 0..1 dateTime Zeitpunkt (Datum oder Datum + Uhrzeit) #xD; effective[x]:effectivePeriod S 0..1 Period Zeitraum #xD; start S 0..1 dateTime Starting time with inclusive boundary #xD; end S 0..1 dateTime End time with inclusive boundary, if not ongoing #xD; dateAsserted S 0..1 dateTime Datum der Feststellung/des Bekanntwerdens der MedikationsInformation #xD; reasonCode S 0..* CodeableConcept Grund der Medikation (codiert) #xD; coding S 0..* Coding Code defined by a terminology system #xD; system S 1..1 uri Identity of the terminology system #xD; code S 1..1 code Symbol in syntax defined by the system #xD; display S 0..1 string Representation defined by the system #xD; text S 0..1 string Plain text representation of the concept #xD; reasonReference S 0..* Reference(Condition | Observation | DiagnosticReport) Grund der Medikation (Referenz) #xD; reference S 1..1 string Literal reference, Relative, internal or absolute URL #xD; note S 0..* Annotation Zusätzliche Anmerkungen zur Medikation #xD; text S 1..1 markdown Freitext-Notiz #xD; dosage S 0..* ?pkp-2? Dosierungsangaben #xD; text 0..1 string Free text dosage instructions e.g. SIG #xD; patientInstruction S 0..1 string besondere Anweisungen für den Patienten #xD; timing #xD; event S 0..* dateTime fester Zeitpunkt #xD; repeat 0..1 Element Wiederholungs-Angaben #xD; Slices for bounds[x] Content/Rules for all slices #xD; bounds[x]:boundsDuration 0..1 Duration Begrenzung der Dauer Required Pattern: At least the following #xD; value 1..1 decimal Numerical value (with implicit precision) #xD; system 1..1 uri System that defines coded unit form Fixed Value: http://unitsofmeasure.org #xD; code 1..1 code Coded form of the unit #xD; bounds[x]:boundsRange S 0..1 Range Bereich für die Begrenzung #xD; low S 0..1 SimpleQuantity(4.0.1) Low limit Required Pattern: At least the following #xD; value S 1..1 decimal Numerical value (with implicit precision) #xD; unit S 0..1 string Unit representation #xD; system S 1..1 uri System that defines coded unit form Fixed Value: http://unitsofmeasure.org #xD; code S 1..1 code Coded form of the unit #xD; high S 0..1 SimpleQuantity(4.0.1) High limit Required Pattern: At least the following #xD; value S 1..1 decimal Numerical value (with implicit precision) #xD; unit S 0..1 string Unit representation #xD; system S 1..1 uri System that defines coded unit form Fixed Value: http://unitsofmeasure.org #xD; code S 1..1 code Coded form of the unit #xD; bounds[x]:boundsPeriod S 0..1 Period begrenzender Zeitraum #xD; start S 0..1 dateTime Starting time with inclusive boundary #xD; end S 0..1 dateTime End time with inclusive boundary, if not ongoing #xD; count S 0..1 positiveInt Anzahl Wiederholungen #xD; countMax S 0..1 positiveInt maximale Anzahl Wiederholungen #xD; duration S 0..1 decimal Dauer der Verabreichung #xD; durationMax S 0..1 decimal maximale Dauer der Verabreichung #xD; durationUnit S 0..1 code Einheit der Dauer #xD; frequency 0..1 positiveInt Frequenz (Anzahl der Gaben pro Periode) #xD; frequencyMax S 0..1 positiveInt maximale Frequenz #xD; period 0..1 decimal Zeitperiode zur Frequenz #xD; periodMax S 0..1 decimal maximale Zeitperiode zur Frequenz #xD; periodUnit 0..1 code Einheit der Zeitperiode #xD; dayOfWeek 0..* code Wochentag #xD; timeOfDay 0..* time Tageszeit #xD; when 0..* code Tageszeitpunkt codiert #xD; offset S 0..1 unsignedInt zeitlicher Abstand der Gabe zum beschriebenen Zeitpunkt #xD; Slices for asNeeded[x] 0..1 boolean, CodeableConcept Take "as needed" (for x) Slice: Unordered, Open by type:$this #xD; asNeeded[x]:asNeededBoolean S 0..1 boolean Bedarfsmedikation #xD; site S 0..1 CodeableConcept Körperstelle der Verabreichung #xD; Slices for coding S 0..* Coding Code defined by a terminology system Slice: Unordered, Open by pattern:$this #xD; coding:SNOMED-CT S 0..1 ISiKSnomedCTCoding Code defined by a terminology system Required Pattern: At least the following #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://snomed.info/sct #xD; text S 0..1 string Plain text representation of the concept #xD; route S 0..1 CodeableConcept Route #xD; Slices for coding S 0..* Coding Code defined by a terminology system Slice: Unordered, Open by pattern:$this #xD; coding:EDQM S 0..1 ISiKCoding Code defined by a terminology system Binding: Medicine EDQM Route of Administration - IPS (required) Required Pattern: At least the following #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://standardterms.edqm.eu #xD; coding:SNOMED-CT S 0..1 ISiKSnomedCTCoding Code defined by a terminology system Binding: SctRouteOfAdministration (required) Required Pattern: At least the following #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://snomed.info/sct #xD; text S 0..1 string Plain text representation of the concept #xD; doseAndRate #xD; Slices for dose[x] Content/Rules for all slices #xD; dose[x]:doseQuantity 0..1 SimpleQuantity Dosis #xD; value S 0..1 decimal Dosiswert #xD; unit S 0..1 string Menschenlesbare Dosis-Einheit #xD; system S 0..1 uri CodeSystem der Dosisangabe #xD; code S 0..1 code Code der Dosisangabe #xD; dose[x]:doseRange S 0..1 Range Dosisbereich #xD; low S 0..1 MedicationQuantityDoseForm Low limit #xD; high S 0..1 MedicationQuantityDoseForm High limit #xD; Slices for rate[x] 0..1 Ratio, Range, SimpleQuantity(4.0.1) Amount of medication per unit of time Slice: Unordered, Open by type:$this #xD; rate[x]:rateRatio S 0..1 Ratio Raten-Verhältnis #xD; numerator S 1..1 MedicationQuantityDoseForm Numerator value #xD; denominator S 1..1 MedicationQuantity Denominator value #xD; rate[x]:rateRange S 0..1 Range Raten-Bereich #xD; low S 0..1 MedicationQuantityDoseForm Low limit #xD; high S 0..1 MedicationQuantityDoseForm High limit #xD; rate[x]:rateQuantity S 0..1 MedicationQuantity Rate #xD; maxDosePerPeriod S 0..1 Ratio Maximaldosis (Zähler) pro Zeitraum (Nenner) #xD; numerator S 0..1 MedicationQuantityDoseForm Numerator value #xD; denominator S 0..1 MedicationQuantity Denominator value #xD; maxDosePerAdministration S 0..1 MedicationQuantityDoseForm Maximaldosis pro Verabreichung #xD; Documentation for this format
Dieses Profil ermöglicht die Abbildung von Informationen zur Medikation eines Patienten in ISiK Szenarien. Hinweis zur Auswahl des Profils: In Abgrenzung zu ISiKMedikationsVerabreichung (MedicationAdministration) wird mittels des vorliegenden Profils die Verabreichung eines Medikaments an einen Patienten mit einer lediglich Datums-genauen Angabe abgebildet (einschließlich Granularität Jahr, Monat oder Tag für .effectiveDateTime oder .effectivePeriod auf Datums-Ebene gemäß der [FHIR-Core Vorgabe](https://hl7.org/fhir/R4/datatypes.html#dateTime)). Zur sekunden-genauen Angabe der Verabreichung eines Medikaments (im Sinne einer medizinischen Verabreichungsdokumentation durch medizinisches Personal) an einen Patienten SOLL das Profil ISiKMedikationsVerabreichung (MedicationAdministration) verwendet werden. Siehe entsprechende Profilseite für weitere Begründung. **Hinweis zur Pausierung einer Medikation (Best-Practice):** Für die Abbildung der Pausierung einer Medikation wird empfohlen, **mehrere `MedicationStatement`-Ressourcen** zu verwenden, anstatt eine bestehende zu überschreiben. Dies bringt folgende Vorteile: - **Korrekte Statusabbildung:** Das `status`-Feld muss stets aktuell gepflegt werden, um den momentanen Zustand der Medikation systemweit sichtbar und durchsuchbar zu halten. - **Effiziente Abfragen über REST API:** In Kombination mit `effective[x]` ermöglicht das `status`-Feld die gezielte Abfrage aller aktuell gültigen Medikationseinträge über die REST API. Wird stattdessen nur das `dosage`-Element verändert, ist keine zuverlässige Filterung möglich – alle `MedicationStatements` müssten abgerufen und manuell analysiert werden. - **Erhalt von Verlaufsinformationen:** Wenn z.B. auch ein `statusReason` (z.B. „pausiert wegen Nebenwirkungen“) dokumentiert wird, ginge diese Information bei einem Update der bestehenden Ressource verloren, sobald die Medikation fortgesetzt wird. Durch neue `MedicationStatement`-Einträge bleibt die Verlaufshistorie erhalten. *(Dieser Anwendungsfall ist aktuell nicht gefordert, aber zukünftig denkbar.)*
Record of medication being taken by a patient
A record of a medication that is being consumed by a patient. A MedicationStatement may indicate that the patient may be taking the medication now or has taken the medication in the past or will be taking the medication in the future. The source of this information can be the patient, significant other (such as a family member or spouse), or a clinician. A common scenario where this information is captured is during the history taking process during a patient visit or stay. The medication information may come from sources such as the patient's memory, from a prescription bottle, or from a list of medications the patient, clinician or other party maintains. The primary difference between a medication statement and a medication administration is that the medication administration has complete administration information and is based on actual administration information from the person who administered the medication. A medication statement is often, if not always, less specific. There is no required date/time when the medication was administered, in fact we only know that a source has reported the patient is taking this medication, where details such as time, quantity, or rate or even medication product may be incomplete or missing or less precise. As stated earlier, the medication statement information may come from the patient's memory, from a prescription bottle or from a list of medications the patient, clinician or other party maintains. Medication administration is more formal and is not missing detailed information.
When interpreting a medicationStatement, the value of the status and NotTaken needed to be considered: MedicationStatement.status + MedicationStatement.wasNotTaken Status=Active + NotTaken=T = Not currently taking Status=Completed + NotTaken=T = Not taken in the past Status=Intended + NotTaken=T = No intention of taking Status=Active + NotTaken=F = Taking, but not as prescribed Status=Active + NotTaken=F = Taking Status=Intended +NotTaken= F = Will be taking (not started) Status=Completed + NotTaken=F = Taken in past Status=In Error + NotTaken=N/A = In Error.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
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()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
serverseitige, interne ID des Datensatzes
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
**bedingtes Pflichtfeld/bedingtes MS:** Alle von einem Server bereitgestellten Ressourcen MÜSSEN über eine `id` verfügen. Von Clients erzeugte Ressourcen, die im Kontext einer CREATE-Interaktion übermittelt werden, MÜSSEN NICHT über eine `id`verfügen.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
Eindeutiger Name der serverseitigen Version des Datensatzes
The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.
Alle von einem Server bereitgestellten Ressourcen SOLLEN über eine `versionID` verfügen. Von Clients erzeugte Ressourcen, die im Kontext einer CREATE-Interaktion übermittelt werden, MÜSSEN NICHT über eine `versionID`verfügen.
When the resource last changed - e.g. when the version changed.
Alle von einem Server bereitgestellten Ressourcen SOLLEN über ein `lastUpdate` verfügen. Von Clients erzeugte Ressourcen, die im Kontext einer CREATE-Interaktion übermittelt werden, MÜSSEN NICHT über ein `lastUpdate`verfügen.
Identifies where the resource comes from
A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](http://hl7.org/fhir/R4/provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.
In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
Profiles this resource claims to conform to
A list of profiles (references to [StructureDefinition](http://hl7.org/fhir/R4/structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](http://hl7.org/fhir/R4/structuredefinition-definitions.html#StructureDefinition.url).
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.
Security Labels applied to this resource
Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.
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.
Security Labels from the Healthcare Privacy and Security Classification System.
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.
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.
Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
Verweis auf die Regeln, nach denen die Ressource erstellt wurde
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Begründung Constraint: In ISiK existiert kein Use-Case für dieses Element. Da es sich um ein Modifying Element handelt, wird es daher ausgeschlossen. Darüber hinaus werden die Regeln als URI vorgehalten. Dies führt dazu, dass sich hinter der URI eine beliebige Menge an Regeln befinden kann; wodurch nicht sichergestellt werden kann, dass alle Clients die Regeln korrekt interpretieren können.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
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).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource and can 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.
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 information is added later.
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.
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
akzeptiertes (in Kauf genommenes) Risiko
Begründung des Must-Support: Folgeinformation der AMTS-Bewertung, sollte auch an nachfolgende Behandelnde übermittelbar sein Hinweis: Hier kann ein im Rahmen der Medikation festgestelltes, aber in Kauf genommenes Risiko dokumentiert werden, speziell auch die Begründung und ggf. erforderliche Begleitmaßnahmen.
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
Source of the definition for the extension code - a logical name or a URL.
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.
Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R4/extensibility.html) for a list).
Begründung des Must-Support: von der Fachseite gewünschte Angabe Hinweis: Angabe Akut- oder Dauermedikation.
The identification of the code system that defines the meaning of the symbol in the code.
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 reference to some definition that establishes the system clearly and unambiguously.
Need to be unambiguous about the source of the definition of the symbol.
fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
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.
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.
fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
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).
Need to refer to a particular code in the system.
fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
A representation of the meaning of the code in the system, following the rules of the system.
Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
C*E.2 - but note this is not well followed
fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
If this coding was chosen directly by the user
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
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.
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.
fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
Begründung des Must-Support: von der Fachseite gewünschte Angabe Hinweis: Flag zur Selbstmedikation.
Begründung des Must-Support: von der Fachseite gewünschte Angabe Hinweis: Freitext-Beschreibung des Behandlungsziels.
Welche Medikationsinformation wird ersetzt?
Begründung des Must-Support: historische Nachvollziehbarkeit Hinweis: Welche Medikationsinformation wird ersetzt?
Literal reference, Relative, internal or absolute URL
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.
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.
Type the reference refers to (e.g. "Patient")
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Aa resource (or, for logical models, the URI of the logical model).
Logical reference, when literal reference is not known
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents 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.
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. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Plain text narrative that identifies the resource in addition to the resource reference.
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.
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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Identifiers associated with this Medication Statement that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.
This is a business identifier, not a resource identifier.
A plan, proposal or order that is fulfilled in whole or in part by this event.
Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.
.outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]
Referenz auf andere Objekte, deren Bestandteil diese MedikationsInformation ist
A larger event of which this particular event is a component or step.
Begründung des Must-Support: Abbildung der Zusammenhänge
This should not be used when indicating which resource a MedicationStatement has been derived from. If that is the use case, then MedicationStatement.derivedFrom should be used.
.outboundRelationship[typeCode=COMP]/target[classCode=SPLY or SBADM or PROC or OBS,moodCode=EVN]
A code representing the patient or other source's judgment about the state of the medication used that this statement is about. Generally, this will be active or completed.
Begründung des Must-Support: Erforderliche Angabe im FHIR-Standard
This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
A coded concept indicating the current status of a MedicationStatement.
Captures the reason for the current state of the MedicationStatement.
This is generally only used for "exception" statuses such as "not-taken", "on-hold", "cancelled" or "entered-in-error". The reason for performing the event at all is captured in reasonCode, not here.
A coded concept indicating the reason for the status of the statement.
.inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde
Indicates where the medication is expected to be consumed or administered.
A coded concept identifying where the medication included in the MedicationStatement is expected to be consumed or administered.
.inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication usage"].value
Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.
Begründung des Must-Support: Basisinformation. Siehe Slicing-Definition zur Wahlmöglichkeit zwischen codierter Angabe und Referenz auf Medication-Ressource.
A coded concept identifying the substance or product being taken.
.participation[typeCode=CSM].role[classCode=ADMM or MANU]
Medikament in codierter Form oder ggf. als Freitext
Begründung des Must-Support: Basisinformation Hinweis: kann verwendet werden, wenn keine detaillierten Informationen zum Medikament (z.B. Rezepturen) existieren.
A reference to a code defined by a terminology system.
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.
Allows for alternative encodings within a code system, and translations to other code systems.
fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
Mehrfachcodierung ist zulässig, da für ein abstraktes Medikament auch mehrere PZN-Codes existieren können, z.B. existieren für Aspirin 3 verschiedene Packungsgrößen.
Mehrfachcodierung ist zulässig, da für ein abstraktes Medikament auch mehrere ATC-Codes existieren können, z.B. existieren für Aspirin 4 verschiedene Codes, je nachdem wofür das Medikament angewendet wird.
Plain text representation of the concept
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.
Very often the text is the same as a displayName of one of the codings.
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.
C*E.9. But note many systems use C*E.2 for this
fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
Referenz auf das Medikament (Medication-Ressource)
Begründung des Must-Support: Basisinformation Hinweis: wird verwendet, wenn detaillierte Informationen zum Medikament vorliegen
The person, animal or group who is/was taking the medication.
Begründung des Must-Support: Basisinformation
**Begründung MS:** Die Verlinkung auf eine Patienten-Ressource dient der technischen Zuordnung der Dokumentation zu einem Patienten und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc. Im ISik Kontext MUSS die referenzierte Ressource konform zu [ISiKPatient](https://gematik.de/fhir/isik/StructureDefinition/ISiKPatient) sein. Jenseits von ISiK KÖNNEN weitere Instanzen mit anderen Profilen referenziert werden.
The encounter or episode of care that establishes the context for this MedicationStatement.
Begründung des Must-Support: Basisinformation im Krankenhaus-Kontext
.inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]
**Begründung MS:** Die Verlinkung auf eine Encounter-Ressource dient der technischen Zuordnung der Dokumentation zu einem Aufenthalt und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc. Im ISik Kontext MUSS die referenzierte Ressource konform zu [ISiKKontaktGesundheitseinrichtung](https://gematik.de/fhir/isik/StructureDefinition/ISiKKontaktGesundheitseinrichtung) sein. Jenseits von ISiK KÖNNEN weitere Instanzen mit anderen Profilen referenziert werden.
Zeitpunkt oder Zeitraum, für den die MedikationsInformation gilt
The interval of time during which it is being asserted that the patient is/was/will be taking the medication (or was not taking, when the MedicationStatement.taken element is No).
Begründung des Must-Support: Basisinformation Festlegung zur Nutzung: An dieser Stelle KANN eine lediglich Datums-genaue Angabe (einschließlich Granularität Jahr, Monat oder Tag für .effectiveDateTime oder .effectivePeriod auf Datums-Ebene gemäß der [FHIR-Core Vorgabe](https://hl7.org/fhir/R4/datatypes.html#dateTime) seitens eines bestätigungsrelevanten Systems unterstützt werden. Es KANN auch eine Uhrzeit angegeben werden. Für sekunden-genaue Angaben zur Verabreichung eines Medikaments an einen Patienten SOLL das Profil ISiKMedikationsVerabreichung (MedicationAdministration) verwendet werden.
The start of the period. The boundary is inclusive.
If the low element is missing, the meaning is that the low boundary is not known.
End time with inclusive boundary, if not ongoing
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
If the end of the period is missing, it means that the period is ongoing
Datum der Feststellung/des Bekanntwerdens der MedikationsInformation
The date when the medication statement was asserted by the information source.
Begründung des Must-Support: Nachvollziehbarkeit
Person or organization that provided the information about the taking of this medication
The person or organization that provided the information about the taking of this medication. Note: Use derivedFrom when a MedicationStatement is derived from other resources, e.g. Claim or MedicationRequest.
.participation[typeCode=INF].role[classCode=PAT, or codes for Practioner or Related Person (if PAT is the informer, then syntax for self-reported =true)
Allows linking the MedicationStatement to the underlying MedicationRequest, or to other information that supports or is used to derive the MedicationStatement.
Likely references would be to MedicationRequest, MedicationDispense, Claim, Observation or QuestionnaireAnswers. The most common use cases for deriving a MedicationStatement comes from creating a MedicationStatement from a MedicationRequest or from a lab observation or a claim. it should be noted that the amount of information that is available varies from the type resource that you derive the MedicationStatement from.
A reason for why the medication is being/was taken.
Festlegung zum MS: Die Elemente .reasonCode und .reasonReference MÜSSEN nach OR-Logik in der Ausgabe verwendet werden, d.h. nur eines MUSS geliefert werden können. Weiterhin MÜSSEN beide Elemente interpretiert werden können. Begründung zu Must-Support: Konsolidierung mit MII.
A coded concept identifying why the medication is being taken.
Condition or observation that supports why the medication is being/was taken.
.outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="reason for use"].value
Provides extra information about the medication statement that is not conveyed by the other attributes.
Begründung des Must-Support: Fachlich relevante Zusatzinformationen
Individual responsible for the annotation
The individual responsible for making the annotation.
Organization is used when there's no need for specific attribution as to who made the comment.
Indicates when this particular annotation was made.
The text of the annotation in markdown format.
Begründung des Must-Support: Angabe zusätzlicher Informationen kann fachlich relevant sein
Indicates how the medication is/was or should be taken by the patient.
Begründung des Must-Support: Basisinformation. Zur vollständig strukturierten Abbildung der zahlreichen Möglichkeiten sind die hier mit Must-Support gekennzeichneten Unterelemente erforderlich gemäß Konsens der ISiK AG Medikation. **Hinweis:** Zahlreiche [Beispiele zur Dosierungsanweisung sind im Implementierungsleitfaden Medikament von HL7 Deutschland](https://ig.fhir.de/igs/medication/dosierung-beispiele.html) dokumentiert.
Extensions that cannot be ignored even if unrecognized
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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Indicates the order in which the dosage instructions should be applied or interpreted.
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.
Festlegung zum Must-Support: Die Verarbeitung MUSS unterstützt werden, indem empfangende Systeme die Freitext-Dosierungsinformation entweder direkt in der Textform persistieren, ODER die Informationen in eine alternative (strukturierte) Form umwandeln (ggf. unter Einwirkung geeigneter Nutzer). Im letzteren Fall KANN auf eine Persistierung in Textform verzichtet werden, um Inkonsistenzen zu vermeiden. Ein System KANN jedoch strukturierte Dosierungsinformationen in Freitext-Dosierungsinformationen umwandeln, um sie in einem Dokument oder einer Benutzeroberfläche anzuzeigen - dabei ist auf Konsistenzwahrung zu allen strukturierten Elementen zu achten. Hinweis: Diese Festlegung folgt und spezifiziert folgende MS-Festlegung aus dem [ISiK Basismodul](https://gemspec.gematik.de/ig/fhir/isik/basis/6.0.0-rc/Index_Festlegungen.html/UebergreifendeFestlegungen_Must-Support-Flags): 'Systeme KÖNNEN es darüber hinaus ermöglichen, dass die jeweiligen Informationen vom Anwender ergänzt oder editiert werden.' Zum Beispiel könnte ein empfangendes System die Freitext-Dosierungsinformation in strukturierte Dosierungsinformation umwandeln, um sie in einer Medikationsverwaltung anzuzeigen oder später zu exponieren. Geht es zum Beispiel um eine Angabe zu Tageszeiten der Einnahme in der freitextlichen Dosierungsinformation als 'Morgens, Mittags, Abends', so könnte das empfangende System diese Angabe in strukturierte Dosierungsinformationen umwandeln, die die Einnahmezeiten in kodierter Form mit 'MORN', 'NOON', 'EVE' deklariert.
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. Additional information about administration or preparation of the medication should be included as text.
Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").
Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.
Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.
A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
Instructions in terms that are understood by the patient or consumer.
This attribute might 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.
The timing schedule for giving the medication to the patient. This 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.
Identifies specific times when the event occurs.
In a Medication Administration Record, for instance, you need to take a general specification, and turn it into a precise specification.
A set of rules that describe when the event is scheduled.
Many timing schedules are determined by regular repetitions.
if there's a duration, there needs to be duration units
duration.empty() or durationUnit.exists()
not(exists(f:duration)) or exists(f:durationUnit)
if there's a period, there needs to be period units
not(exists(f:period)) or exists(f:periodUnit)
f:duration/@value >= 0 or not(f:duration/@value)
f:period/@value >= 0 or not(f:period/@value)
If there's a periodMax, there must be a period
not(exists(f:periodMax)) or exists(f:period)
If there's a durationMax, there must be a duration
durationMax.empty() or duration.exists()
not(exists(f:durationMax)) or exists(f:duration)
If there's a countMax, there must be a count
not(exists(f:countMax)) or exists(f:count)
If there's an offset, there must be a when (and not C, CM, CD, CV)
offset.empty() or (when.exists() and ((when in ('C' | 'CM' | 'CD' | 'CV')).not()))
If there's a timeOfDay, there cannot be a when, or vice versa
not(exists(f:timeOfDay)) or not(exists(f:when))
Length/Range of lengths, or (Start and/or end) limits
Either a duration for the length of the timing schedule, a range of possible length, or outer bounds for start and/or end limits of the timing schedule.
Numerical value (with implicit precision)
The value of the measured amount. The value includes an implicit precision in the presentation of the value.
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).
Precision is handled implicitly in almost all cases of measurement.
PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value
< | <= | >= | > - how to understand the value
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.
Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.
If there is no comparator, then there is no modification of the value
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
How the Quantity should be understood and represented.
There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.
The identification of the system that provides the coded form of the unit.
Need to know the system that defines the coded form of the unit.
CO.codeSystem, PQ.translation.codeSystem
A computer processable form of the unit in some unit representation system.
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.
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.
PQ.code, MO.currency, PQ.translation.code
The low limit. The boundary is inclusive.
If the low element is missing, the low boundary is not known.
The high limit. The boundary is inclusive.
If the high element is missing, the high boundary is not known.
A total count of the desired number of repetitions across the duration of the entire timing specification. If countMax is present, this element indicates the lower bound of the allowed range of count values.
If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.
Repetitions may be limited by end time or total occurrences.
If present, indicates that the count is a range - so to perform the action between [count] and [countMax] times.
How long this thing happens for when it happens. If durationMax is present, this element indicates the lower bound of the allowed range of the duration.
For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).
Some activities are not instantaneous and need to be maintained for a period of time.
If present, indicates that the duration is a range - so to perform the action between [duration] and [durationMax] time length.
The units of time for the duration, in UCUM units.
The number of times to repeat the action within the specified period. If frequencyMax is present, this element indicates the lower bound of the allowed range of the frequency.
If no frequency is stated, the assumption is that the event occurs once per period, but systems SHOULD always be specific about this
If present, indicates that the frequency is a range - so to repeat between [frequency] and [frequencyMax] times within the period or period range.
Indicates the duration of time over which repetitions are to occur; e.g. to express "3 times per day", 3 would be the frequency and "1 day" would be the period. If periodMax is present, this element indicates the lower bound of the allowed range of the period length.
If present, indicates that the period is a range from [period] to [periodMax], allowing expressing concepts such as "do this once every 3-5 days.
The units of time for the period in UCUM units.
If one or more days of week is provided, then the action happens only on the specified day(s).
If no days are specified, the action is assumed to happen every day as otherwise specified. The elements frequency and period cannot be used as well as dayOfWeek.
Specified time of day for action to take place.
When time of day is specified, it is inferred that the action happens every day (as filtered by dayofWeek) on the specified times. The elements when, frequency and period cannot be used as well as timeOfDay.
An approximate time period during the day, potentially linked to an event of daily living that indicates when the action should occur.
When more than one event is listed, the event is tied to the union of the specified events.
Timings are frequently determined by occurrences such as waking, eating and sleep.
Real world event relating to the schedule.
zeitlicher Abstand der Gabe zum beschriebenen Zeitpunkt
The number of minutes from the event. If the event code does not indicate whether the minutes is before or after the event, then the offset is assumed to be after the event.
BID | TID | QID | AM | PM | QD | QOD | +
A code for the timing schedule (or just text in code.text). Some codes such as BID are ubiquitous, but many institutions define their own additional codes. If a code is provided, the code is understood to be a complete statement of whatever is specified in the structured timing data, and either the code or the data may be used to interpret the Timing, with the exception that .repeat.bounds still applies over the code (and is not contained in the code).
BID etc. are defined as 'at institutionally specified times'. For example, an institution may choose that BID is "always at 7am and 6pm". If it is inappropriate for this choice to be made, the code BID should not be used. Instead, a distinct organization-specific code should be used in place of the HL7-defined BID code and/or a structured representation should be used (in this case, specifying the two event times).
Code for a known / defined timing pattern.
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).
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".
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.
.outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept
If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [bodySite](http://hl7.org/fhir/R4/extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both.
A coded specification of the anatomic site where the medication first enters the body.
A coded concept describing the site location the medicine enters into or onto the body.
A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.
A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
Terminologies used often pre-coordinate this term with the route and or form of administration.
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.
A coded concept describing the technique by which the medicine is administered.
The kind of dose or rate specified, for example, ordered or calculated.
If the type is not populated, assume to be "ordered".
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.
The amount of therapeutic or other substance given at one administration event.
Das Must-Support-Flag auf doseQuantity bedeutet, dass produzierende Systeme zur Kodierung der Dosisangaben nach eigenem Ermessen entweder den Datentyp Quantity oder Ratio verwenden können. Beim Empfang und Verarbeitung der eingehenden Daten müssen dagegen beide Datentypen interpretiert werden können.
**Begründung MS:** Der Dosiswert ist notwendig, um die Dosisangabe korrekt interpretieren zu können.
**Begründung MS:** Die menschenlesbare Dosis-Einheit ist notwendig, um die Dosisangabe korrekt interpretieren zu können.
**Begründung MS:** Das CodeSystem der Dosisangabe ist notwendig, um die Dosisangabe korrekt interpretieren zu können.
**Begründung MS:** Der Code der Dosisangabe ist notwendig, um die Dosisangabe korrekt interpretieren zu können.
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. It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammer where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.
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.
Das Must-Support-Flag auf rateRatio bzw. rateQuantity bedeutet, dass produzierende Systeme zur Kodierung der Ratenangaben nach eigenem Ermessen entweder den Datentyp Ratio oder Quantity verwenden können. Beim Empfang und Verarbeitung der eingehenden Daten müssen dagegen beide Datentypen interpretiert werden können.
Maximaldosis (Zähler) pro Zeitraum (Nenner)
Upper limit on medication per unit of time.
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".
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.
Upper limit on medication per administration.
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.
The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.
Upper limit on medication per lifetime of the patient
Upper limit on medication per lifetime of the patient.
The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.