Generated Narrative: StructureDefinition ISiKMedikationsVerabreichung Name Flags Card. Type Description & Constraints MedicationAdministration 0..* MedicationAdministration Administration of medication to 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; status S 1..1 code Status der Verabreichungsinformation #xD; Slices for medication[x] 1..1 CodeableConcept, Reference(Medication) What was administered 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; 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] 1..1 dateTime, Period Start and end time of administration Slice: Unordered, Open by type:$this #xD; effective[x]:effectiveDateTime S 0..1 dateTime Zeitpunkt der Verabreichung #xD; effective[x]:effectivePeriod S 0..1 Period Zeitraum der Verabreichung #xD; start S 0..1 dateTime Starting time with inclusive boundary #xD; end S 0..1 dateTime End time with inclusive boundary, if not ongoing #xD; performer S 0..* BackboneElement Durchführende Person(en) der Verabreichung #xD; actor S 1..1 Reference(Practitioner | PractitionerRole | Patient | RelatedPerson | Device) Referenz auf die verabreichende Person #xD; reference S 1..1 string Literal reference, Relative, internal or absolute URL #xD; reasonCode S 0..* CodeableConcept Grund der Medikation (Referenz) #xD; reasonReference S 0..* Reference(Condition | Observation | DiagnosticReport) Grund der Medikation (Referenz) #xD; reference S 1..1 string Literal reference, Relative, internal or absolute URL #xD; request S 0..1 Reference(MedicationRequest) Referenz auf die Verordnung #xD; note S 0..* Annotation Zusätzliche Anmerkungen zur Medikation #xD; text S 1..1 markdown Freitext-Notiz #xD; dosage S 0..1 BackboneElement Dosierungsangaben #xD; text S 0..1 string Freitext-Dosierungsangabe #xD; site S 0..1 CodeableConcept Körperstelle der Verabreichung #xD; Slices for coding S 0..* Coding Code defined by a terminology system Slice: Unordered, Open by pattern:$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:$this #xD; coding:EDQM S 0..1 ISiKCoding Code defined by a terminology system Binding: Medicine Route of Administration - IPS (required) Required Pattern: At least the following #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://standardterms.edqm.eu #xD; coding:SNOMED-CT S 0..1 ISiKSnomedCTCoding Code defined by a terminology system Binding: SctRouteOfAdministration (required) Required Pattern: At least the following #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://snomed.info/sct #xD; text S 0..1 string Plain text representation of the concept #xD; dose S 0..1 MedicationQuantityDoseForm verabreichte Dosis #xD; Slices for rate[x] 0..1 Ratio, SimpleQuantity(4.0.1) Dose quantity per unit of time Slice: Unordered, Open by type:$this #xD; rate[x]:rateRatio S 0..1 Ratio Verabreichungs-Rate (Verhältnis) #xD; numerator S 1..1 MedicationQuantityDoseForm Numerator value #xD; denominator S 1..1 MedicationQuantity Denominator value #xD; rate[x]:rateQuantity S 0..1 MedicationQuantity Verabreichungs-Rate #xD; Documentation for this format
Dieses Profil ermöglicht die Abbildung der Verabreichung von Medikamenten für einen Patienten in ISiK Szenarien. Hinweis zur Auswahl des Profils: In Abgrenzung zu ISiKMedikationsInformation (MedicationStatement) wird mittels des vorliegenden Profils die Verabreichung eines Medikaments an einen Patienten mit einer Zeitpunkt-genauen Angabe abgebildet (.effectiveDateTime oder .effectivePeriod auf Sekundenebene gemäß der [FHIR-Core Vorgabe](https://hl7.org/fhir/R4/datatypes.html#dateTime)). D.h. die lediglich Datums-genaue Angabe ist im vorliegenden Profil nicht erlaubt. Das Profil ISiKMedikationsInformation (MedicationStatement) kann ebenfalls für die Abbildung der Verabreichung von Medikamenten für einen Patienten verwendet werden, wenn keine Zeitpunkt-genauen Angaben zur Verabreichung vorliegen, sondern lediglich Datums-genaue Angaben (einschließlich Granularität Jahr, Monat oder Tag). Begründung zur Profil- und Nutzungsdifferenzierung: Handelt es sich bei Erfassung um eine medizinische Verabreichungsdokumentation, dann ist ein genauer Zeitstempel zwingend. Die medizinische Verabreichungsdokumentation muss durch medizinisches Personal erfolgen. Angaben von Patienten und Angehörigen sind grundsätzlich keine medizinische Verabreichungsdokumentation und daher als MedicationStament zu erfassen(['report that such a sequence (or at least a part of it) did take place'](https://hl7.org/fhir/R4/medicationstatement.html)). **Hinweis zur Pausierung einer Medikation (Best-Practice):** Für die Abbildung der Pausierung einer Medikation wird empfohlen, **mehrere `MedicationAdministration`-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 `MedicationAdministrations` 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 `MedicationAdministration`-Einträge bleibt die Verlaufshistorie erhalten. *(Dieser Anwendungsfall ist aktuell nicht gefordert, aber zukünftig denkbar.)*
Administration of medication to a patient
Describes the event of a patient consuming or otherwise being administered a medication. This may be as simple as swallowing a tablet or it may be a long running infusion. Related resources tie this event to the authorizing prescription, and the specific encounter between patient and health care practitioner.
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.
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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 Administration 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 protocol, guideline, orderset, or other definition that was adhered to in whole or in part by this event.
A larger event of which this particular event is a component or step.
.outboundRelationship[typeCode=COMP]/target[classCode=SBADM or PROC,moodCode=EVN]
Will generally be set to show that the administration has been completed. For some long running administrations such as infusions, it is possible for an administration to be started but not completed or it may be paused while some other process is under way.
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 set of codes indicating the current status of a MedicationAdministration.
A code indicating why the administration was not performed.
A set of codes indicating the reason why the MedicationAdministration is negated.
RXA-9-Administration Notes / RXA-18 Substance/Treatment Refusal Reason
.outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="reason not given"].value
Indicates where the medication is expected to be consumed or administered.
A coded concept describing where the medication administered is expected to occur.
.inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication usage"].value
Identifies the medication that was administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.
If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example, if you require form or lot number, then you must reference the Medication resource.
Codes identifying substance or product that can be administered.
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.
The person or animal or group receiving 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 visit, admission, or other contact between patient and health care provider during which the medication administration was performed.
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.
Additional information to support administration
Additional information (for example, patient height and weight) that supports the administration 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)]
A specific date/time or interval of time during which the administration took place (or did not take place, when the 'notGiven' attribute is true). For many administrations, such as swallowing a tablet the use of dateTime is more appropriate.
RXA-3-Date/Time Start of Administration / RXA-4-Date/Time End of Administration
Begründung des Must-Support: Basisinformation Festlegung zur Nutzung: eine Zeitpunkt-genaue Angabe (.effectiveDateTime oder .effectivePeriod auf Sekundenebene gemäß der [FHIR-Core Vorgabe](https://hl7.org/fhir/R4/datatypes.html#dateTime)) MUSS hier seitens eines bestätigungsrelevanten Systems unterstützt werden. Für grobgranularere Angaben (z.B. nur Jahr, Monat oder Tag) SOLL das Profil ISiKMedikationsInformation (MedicationStatement) 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
Durchführende Person(en) der Verabreichung
Indicates who or what performed the medication administration and how they were involved.
Begründung des Must-Support: Nachvollziehbarkeit
RXA-10-Administering Provider / PRT-5-Participation Person: PRT-4-Participation='AP' (RXA-10 is deprecated)
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
Distinguishes the type of involvement of the performer in the medication administration.
A code describing the role an individual played in administering the medication.
Indicates who or what performed the medication administration.
A code indicating why the medication was given.
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.
A set of codes indicating the reason why the MedicationAdministration was made.
Condition or observation that supports why the medication was administered.
.outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="reason for use ASSERTION"].value
The original request, instruction or authority to perform the administration.
**Einschränkung der übergreifenden MS-Definition:** Verfügt ein bestätigungsrelevantes System nicht über die Möglichkeit zur Abbildung der zugrunde liegenden Verordnung einer Verabreichung, so MUSS dieses System die Information NICHT abbilden. Motivation zum eingeschränkten MS: Die referenzierte Verordnung (`MedicationRequest`) bildet in der Regel die Grundlage einer Verabreichung (`MedicationAdministration`). Aus fachlicher Sicht ist die Verknüpfung beider Ressourcen wesentlich, da sie die Nachvollziehbarkeit der therapeutischen Maßnahme unterstützt. Allerdings existieren in der Versorgungspraxis auch Systeme, die keine strukturierte Erfassung oder Referenzierung einer zugrundeliegenden Verordnung vorsehen. Daher wird `MedicationAdministration.request` in ISiK als eingeschränktes Must Support definiert, um eine einheitliche Implementierung zu fördern.
ORC-2-Placer Order Number / ORC-3-Filler Order Number
The device used in administering the medication to the patient. For example, a particular infusion pump.
PRT-10 Participation Device / RXR-3 Administrative Device
device->Access OR device->AssignedDevice
Extra information about the medication administration 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
Describes the medication dosage information details e.g. dose, rate, site, route, etc.
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
SHALL have at least one of dosage.dose or dosage.rate[x]
exists(f:dose) or exists(f:*[starts-with(local-name(.), 'rate')])
Free text dosage can be used for cases where the dosage administered is too complex to code. When coded dosage is present, the free text dosage may still be present for display to humans. The dosage instructions should reflect the dosage of the medication that was administered.
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 kann die textuelle Information '1L Infusion mit Rate 50ml/h' in eine entsprechende, strukturierte Form überführt werden - d.h. in die Angabe von 'dose' und 'rateQuantity'.
A coded specification of the anatomic site where the medication first entered the body. For example, "left arm".
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 concept describing the site location the medicine enters into or onto the body.
RXR-2 Administration Site / RXR-6 Administration Site Modifier
A code specifying the route or physiological path of administration of a therapeutic agent into or onto the patient. For example, topical, intravenous, etc.
A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
A coded value indicating the method by which the medication is intended to be or was introduced into or on the body. This attribute will most often NOT be populated. It is most commonly used for injections. For example, Slow Push, Deep IV.
One of the reasons this attribute is not used often, is that the method is often pre-coordinated with the route and/or form of administration. This means the codes used in route or form may pre-coordinate the method in the route code or the form code. The implementation decision about what coding system to use for route or form code will determine how frequently the method code will be populated e.g. if route or form code pre-coordinate method code, then this attribute will not be populated often; if there is no pre-coordination then method code may be used frequently.
A coded concept describing the technique by which the medicine is administered.
The amount of the medication given at one administration event. Use this value when the administration is essentially an instantaneous event such as a swallowing a tablet or giving an injection.
If the administration is not instantaneous (rate is present), this can be specified to convey the total amount administered over period of time of a single administration.
RXA-6 Administered Amount / RXA-7 Administered Units
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.
If the rate changes over time, and you want to capture this in MedicationAdministration, then each change should be captured as a distinct MedicationAdministration, with a specific MedicationAdministration.dosage.rate, and the date time when the rate change occurred. Typically, the MedicationAdministration.dosage.rate element is not used to convey an average rate.
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.
A list of events of interest in the lifecycle
A summary of the events of interest that have occurred, such as when the administration was verified.
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]