Generated Narrative: StructureDefinition ISiKMedikationsVerordnung Name Flags Card. Type Description & Constraints MedicationRequest 0..* MedicationRequest Ordering of medication for patient or group #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: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; status S 1..1 code Status der Verordnungsinformation #xD; intent S 1..1 code Ziel der Verordnungsinformation #xD; doNotPerform S 0..1 boolean Nicht durchführen #xD; Slices for medication[x] 1..1 CodeableConcept, Reference(Medication) Medication to be taken 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; Slices for coding Content/Rules for all slices #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; encounter S 0..1 Reference(Encounter) Referenz auf den Abteilungskontakt #xD; reference S 1..1 string Literal reference, Relative, internal or absolute URL #xD; authoredOn S 0..1 dateTime Erstellungsdatum der Verordnung #xD; requester S 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device) Referenz auf die verordnende Person #xD; reference S 1..1 string Literal reference, Relative, internal or absolute URL #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) 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; dosageInstruction S<a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R4/conformance-rules.html#constraints" title="This element has or is affected by constraints ( isik-dosage-as-needed-for )">C 0..* DosageDE Dosierungsangaben Constraints: isik-dosage-as-needed-for #xD; extension 0..* Extension Indikation für die Bedarfsmedikation #xD; extension 0..0 Extension #xD; Slices for value[x] 0..1 base64Binary, boolean, canonical(), code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference(), SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta Value of extension Slice: Unordered, Open by type:$this #xD; value[x]:valueCodeableConcept 0..1 CodeableConcept Value of extension #xD; text S 0..1 string Indikation für die Bedarfsmedikation (Freitext) #xD; Slices for extension Content/Rules for all slices #xD; extension:asNeededFor S 0..* CodeableConcept Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Dosage.asNeededFor Binding: SNOMEDCTMedicationAsNeededReasonCodes (example) #xD; text 0..1 string Freitext-Dosierungsanweisungen, z. B. 'Maximal 3x täglich 1 Stück bei Bedarf' #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 UCUM-Einheit für die Dauer 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; asNeeded[x] S 0..1 boolean Bedarfsmedikation (ja/nein) #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 1..1 MedicationQuantityDoseForm Numerator value #xD; denominator S 1..1 MedicationQuantity Denominator value #xD; maxDosePerAdministration S 0..1 MedicationQuantityDoseForm Maximaldosis pro Verabreichung #xD; dispenseRequest S 0..1 BackboneElement angeforderte Abgabemenge #xD; quantity S 0..1 MedicationQuantityDoseForm angeforderte Abgabemenge #xD; substitution S 0..1 BackboneElement Ersatz zulässig #xD; Slices for allowed[x] 1..1 boolean, CodeableConcept Whether substitution is allowed or not Slice: Unordered, Open by type:$this #xD; allowed[x]:allowedBoolean S 0..1 boolean Whether substitution is allowed or not #xD; priorPrescription S 0..1 Reference(MedicationRequest) Vorherige Verordnung mit Bezug zur aktuellen Verordnung #xD; Documentation for this format
Dieses Profil ermöglicht die Abbildung von Medikationsverordnungen eines Patienten in ISiK Szenarien.
Ordering of medication for patient or group
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.
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: Freitext-Beschreibung des Behandlungsziels.
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 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. 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.
ORC-2-Placer Order Number / ORC-3-Filler Order Number
A code specifying the current state of the order. Generally, this will be active or completed state.
Begründung des Must-Support: Erforderliche Angabe im FHIR-Standard. Hinweis für Implementierende: Im Falle einer create-Operation kann der Server den .code in .status zunächst auf 'on-hold' setzen, z. B. im Falle einer asynchronen Prüfung, die im Rahmen einer textuellen Übergabe möglich ist. Ggf. kann hier zusätzlich ein Mechanismus etabliert werden, der eine anschließende Änderung des Status an den Client kommuniziert. Der Server kann zusätzlich den .code in .statusReason auf 'clarif' setzen ('Clarification is required before the order can be acted upon.'), um anzuzeigen, dass eine Klärung erforderlich ist, bevor die Verordnung ausgeführt werden kann.
This element is labeled 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 specifying the state of the prescribing event. Describes the lifecycle of the prescription.
Captures the reason for the current state of the MedicationRequest.
This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the MedicationRequest was created at all is captured in reasonCode, not here.
Identifies the reasons for a given status.
.inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde
Whether the request is a proposal, plan, or an original order.
Begründung des Must-Support: Erforderliche Angabe im FHIR-Standard Hinweis: i.d.R. 'order'
This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request
.moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)
Indicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).
The category can be used to include where the medication is expected to be consumed or other types of requests.
A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.
Message/Body/NewRx/MedicationPrescribed/Directions or Message/Body/NewRx/MedicationPrescribed/StructuredSIG
.inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication usage"].value
Indicates how quickly the Medication Request should be addressed with respect to other requests.
Identifies the level of importance to be assigned to actioning the request.
If true indicates that the provider is asking for the medication request not to occur.
**Begründung MS:** Die Kennzeichnung als Must-Support erfolgt, da es sich um ein als Modifier-Element markiertes Feld in der Kernspezifikation handelt. Und wegen der Kompatibilität mit eRezept und ePA Profilen, welche die Angabe von 'doNotPerform' nicht verbieten.
This element is labeled as a modifier because this element negates the request to occur (ie, this is a request for the medication not to be ordered or prescribed, etc)
Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the report.
Identifies the medication being requested. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medications.
If only a code is specified, then it needs to be a code for a specific product. 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.
A coded concept identifying substance or product that can be ordered.
Message/Body/NewRx/MedicationPrescribed Medication.code.coding.code = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCode Medication.code.coding.system = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCodeQualifier Medication.code.coding.display = Message/Body/NewRx/MedicationPrescribed/DrugDescription
RXE-2-Give Code / RXO-1-Requested Give Code / RXC-2-Component Code
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
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.
A link to a resource representing the person or set of individuals to whom the medication will be given.
Begründung des Must-Support: Basisinformation
Message/Body/NewRx/Patient (need detail to link to specific patient … Patient.Identification in SCRIPT)
**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 during which this [x] was created or to which the creation of this record is tightly associated.
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.
Information to support ordering of the medication
Include additional information (for example, patient height and weight) that supports the ordering of the medication.
.outboundRelationship[typeCode=PERT].target[A_SupportingClinicalStatement CMET minimal with many different choices of classCodes(ORG, ENC, PROC, SPLY, SBADM, OBS) and each of the act class codes draws from one or more of the following moodCodes (EVN, DEF, INT PRMS, RQO, PRP, APT, ARQ, GOL)]
The date (and perhaps time) when the prescription was initially written or authored on.
RXE-32-Original Order Date/Time / ORC-9-Date/Time of Transaction
The individual, organization, or device that initiated the request and has responsibility for its activation.
Begründung des Must-Support: Nachvollziehbarkeit
The specified desired performer of the medication treatment (e.g. the performer of the medication administration).
Desired kind of performer of the medication administration
Indicates the type of performer of the administration of the medication.
If specified without indicating a performer, this indicates that the performer must be of the specified type. If specified with a performer then it indicates the requirements of the performer if the designated performer is not available.
Identifies the type of individual that is desired to administer the medication.
The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order.
.participation[typeCode=TRANS].role[classCode=ASSIGNED].code (HealthcareProviderType)
The reason or the indication for ordering or not ordering the medication.
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 Profil: https://www.medizininformatik-initiative.de/fhir/core/modul-medikation/StructureDefinition/MedicationRequest
A coded concept indicating why the medication was ordered.
ORC-16-Order Control Code Reason /RXE-27-Give Indication/RXO-20-Indication / RXD-21-Indication / RXG-22-Indication / RXA-19-Indication
Begründung des Must-Support: Falls der Grund kodierbar ist, sollte er auch kodiert werden.
Begründung des Must-Support und Kardinalität: Ein Coding Element benötigt immer ein System um die Bedeutung des Codes zu definieren.
Begründung des Must-Support und Kardinalität: Ein Coding Element benötigt immer einen Code um die Bedeutung des Codes zu definieren.
Begründung des Must-Support: Ein Display Element ist für die Lesbarkeit der Information notwendig.
Condition or observation that supports why the medication was ordered.
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.
Begründung des Must-Support: Referenz auf die Diagnose oder Untersuchung, die die Medikation begründet.
Instantiates FHIR protocol or definition
The URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest.
Instantiates external protocol or definition
The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this MedicationRequest.
A plan or request that is fulfilled in whole or in part by this medication request.
.outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]
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.
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.
.outboundRelationship(typeCode=COMP].target[classCode=SBADM, moodCode=INT].id
Overall pattern of medication administration
The description of the overall patte3rn of the administration of the medication to the patient.
This attribute should not be confused with the protocol of the medication.
Identifies the overall pattern of medication administratio.
Act.code where classCode = LIST and moodCode = EVN
Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service.
Extra information about the prescription that could not be 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 to be used 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.
Wenn Indikationen für eine Bedarfsmedikation angegeben sind, MUSS asNeededBoolean vorhanden und true sein.
extension('http://hl7.org/fhir/5.0/StructureDefinition/extension-Dosage.asNeededFor').empty() or asNeededBoolean = true
Begründung des Must-Support: Ermöglicht die Angabe mehrerer Indikationen für die Bedarfsmedikation, z.B. 'Schmerzen', 'Fieber', 'Hustenreiz' etc. Diese Bedingungen sind ODER verknüpft, d.h. die Bedarfsmedikation soll bei Vorliegen einer ODER mehrerer dieser Bedingungen angewendet werden.
Indikation für die Bedarfsmedikation (Freitext)
Begründung des Must-Support: Ermöglicht die Angabe einer Indikation für die Bedarfsmedikation in Freitextform, eine Kodierung ist nicht verpflichtend. Es wird jedoch empfohlen, die Indikation zusätzlich in kodierter Form anzugeben, um die Interoperabilität zu erhöhen.
Optional Extension Element - found in all resources.
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.
Freitext-Dosierungsanweisungen, z. B. 'Maximal 3x täglich 1 Stück bei Bedarf'
Freitext-Dosierungsanweisungen, z. B. 'Maximal 3x täglich 1 Stück bei Bedarf'. Als Quelle dient hier ausschließlich der Arzt oder Apotheker
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-rc1/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.
Wann das Medikament verabreicht werden soll
Um widersprüchliche Anweisungen zu vermeiden, ist entweder Dosage.timing oder Dosage.text zu befüllen. Falls eine strukturierte Dosierung als Text abgebildet werden soll ist dafür die GeneratedDosageInstructionsMeta Extension zu verwenden.
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.
Eine Menge von Regeln, die beschreiben, wann das Ereignis geplant ist.
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))
Wenn nur timeOfDay verwendet wird und täglich dosiert wird, ist die Angabe in einem einzigen Dosage-Element zu modellieren. Mehrere Dosage-Elemente sind nur zulässig, wenn sich die Dosis (Wert) unterscheidet.
( %resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage ).all( ( timing.repeat.dayOfWeek.empty() and timing.repeat.timeOfDay.exists() and timing.repeat.when.empty() and (timing.repeat.period.exists() and timing.repeat.period = 1) and (timing.repeat.periodUnit.exists() and timing.repeat.periodUnit = 'd') ) implies ( ( ( %resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage ).where( timing.repeat.dayOfWeek.empty() and timing.repeat.timeOfDay.exists() and timing.repeat.when.empty() and (timing.repeat.period.exists() and timing.repeat.period = 1) and (timing.repeat.periodUnit.exists() and timing.repeat.periodUnit = 'd') ).count() = 1 ) or ( ( %resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage ).where( timing.repeat.dayOfWeek.empty() and timing.repeat.timeOfDay.exists() and timing.repeat.when.empty() and (timing.repeat.period.exists() and timing.repeat.period = 1) and (timing.repeat.periodUnit.exists() and timing.repeat.periodUnit = 'd') ).doseAndRate.dose.ofType(Quantity).value.distinct().count() > 1 ) ) )
Wenn nur when verwendet wird und täglich dosiert wird, ist die Angabe in einem einzigen Dosage-Element zu modellieren. Mehrere Dosage-Elemente sind nur zulässig, wenn sich die Dosis (Wert) unterscheidet.
( %resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage ).all( ( timing.repeat.dayOfWeek.empty() and timing.repeat.when.exists() and timing.repeat.timeOfDay.empty() and (timing.repeat.period.exists() and timing.repeat.period = 1) and (timing.repeat.periodUnit.exists() and timing.repeat.periodUnit = 'd') ) implies ( ( ( %resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage ).where( timing.repeat.dayOfWeek.empty() and timing.repeat.when.exists() and timing.repeat.timeOfDay.empty() and (timing.repeat.period.exists() and timing.repeat.period = 1) and (timing.repeat.periodUnit.exists() and timing.repeat.periodUnit = 'd') ).count() = 1 ) or ( ( %resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage ).where( timing.repeat.dayOfWeek.empty() and timing.repeat.when.exists() and timing.repeat.timeOfDay.empty() and (timing.repeat.period.exists() and timing.repeat.period = 1) and (timing.repeat.periodUnit.exists() and timing.repeat.periodUnit = 'd') ).doseAndRate.dose.ofType(Quantity).value.distinct().count() > 1 ) ) )
boundsDuration.unit muss zur UCUM boundsDuration.code passen (z. B. 'Woche(n)' nur mit code='wk').
bounds.ofType(Duration).exists().not() or ( ( bounds.ofType(Duration).code = 'd' implies ( bounds.ofType(Duration).unit = 'Tag(e)' or bounds.ofType(Duration).unit = 'Tag' or bounds.ofType(Duration).unit = 'Tage' ) ) and ( bounds.ofType(Duration).code = 'wk' implies ( bounds.ofType(Duration).unit = 'Woche(n)' or bounds.ofType(Duration).unit = 'Woche' or bounds.ofType(Duration).unit = 'Wochen' ) ) and ( bounds.ofType(Duration).code = 'mo' implies ( bounds.ofType(Duration).unit = 'Monat(e)' or bounds.ofType(Duration).unit = 'Monat' or bounds.ofType(Duration).unit = 'Monate' ) ) and ( bounds.ofType(Duration).code = 'a' implies ( bounds.ofType(Duration).unit = 'Jahr(e)' or bounds.ofType(Duration).unit = 'Jahr' or bounds.ofType(Duration).unit = 'Jahre' ) ) )
Länge/Bereich der Längen oder (Start- und/oder End-)Grenzen
Entweder eine Dauer für die Länge des Zeitplans, ein Bereich möglicher Längen oder äußere Begrenzungen für Start- und/oder Endgrenzen des Zeitplans.
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.
Die UCUM-Einheit für die Dauer, z. B. d für Tag, h für Stunde, min für Minute.
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.
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
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.
Die Anzahl der Wiederholungen innerhalb des angegebenen Zeitraums. Falls frequencyMax vorhanden ist, gibt dieses Element die Untergrenze des zulässigen Bereichs der Häufigkeit an.
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.
Gibt die Zeitspanne an, über die die Wiederholungen stattfinden sollen; z. B. um „3-mal täglich“ auszudrücken, wäre 3 die Häufigkeit und „1 Tag“ der Zeitraum. Falls periodMax vorhanden ist, gibt dieses Element die Untergrenze des zulässigen Bereichs der Zeitspanne an.
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.
Die Zeiteinheit für den Zeitraum, in UCUM-Einheiten.
Wenn ein oder mehrere Wochentage angegeben sind, findet die Aktion nur an den angegebenen Tagen statt.
Wenn keine Tage angegeben sind, wird angenommen, dass die Aktion an jedem Tag wie sonst angegeben stattfindet.
Angegebene Tageszeit, zu der die Aktion stattfinden soll.
Wenn eine Tageszeit angegeben ist, wird angenommen, dass die Aktion jeden Tag (ggf. gefiltert durch dayOfWeek) zu den angegebenen Zeiten stattfindet.
Ein ungefährer Zeitraum während des Tages, der möglicherweise mit einem Ereignis des täglichen Lebens verknüpft ist und angibt, wann die Aktion stattfinden soll.
Wenn mehr als ein Ereignis angegeben ist, bezieht sich das Ereignis auf die Vereinigung der angegebenen Ereignisse.
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).
Begründung des Must-Support: Abbildung einer Bedarfsmedikation.
.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
The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.
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.
Indicates the quantity or duration for the first dispense of the medication.
If populating this element, either the quantity or the duration must be included.
SubstanceAdministration -> ActRelationship[sequenceNumber = '1'] -> Supply
The amount or quantity to provide as part of the first dispense.
The length of time that the first dispense is expected to last.
Minimum period of time between dispenses
The minimum period of time that must occur between dispenses of the medication.
This indicates the validity period of a prescription (stale dating the Prescription).
It reflects the prescribers' perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The 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.
Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.
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. A prescriber may explicitly say that zero refills are permitted after the initial dispense.
If displaying "number of authorized fills", add 1 to this number.
The amount that is to be dispensed for one fill.
RXD-4-Actual Dispense Amount / RXD-5.1-Actual Dispense Units.code / RXD-5.3-Actual Dispense Units.name of coding system
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.
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.
Indicates the intended dispensing Organization specified by the prescriber.
.outboundRelationship[typeCode=COMP].target[classCode=SPLY, moodCode=RQO] .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]
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.
Begründung des Must-Support: Alignment mit dem (E-)Rezept
specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions
True if the prescriber allows a different drug to be dispensed from what was prescribed.
This element is labeled as a modifier because whether substitution is allow or not, it cannot be ignored.
Identifies the type of substitution allowed.
RXO-9-Allow Substitutions / RXE-9-Substitution Status
Indicates the reason for the substitution, or why substitution must or must not be performed.
A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
Vorherige Verordnung mit Bezug zur aktuellen Verordnung
A link to a resource representing an earlier order related order or prescription.
Begründung des Must-Support: Erforderlich zur Abbildung des fachlichen Zusammenhangs zwischen Verordnungen (z. B. Fortführung, Änderung oder Ersetzung) und zur Nachvollziehbarkeit der Medikationshistorie.
.outboundRelationship[typeCode=?RPLC or ?SUCC]/target[classCode=SBADM,moodCode=RQO]
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.
This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.
A list of events of interest in the lifecycle
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.
This might 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.).
.inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]